When I Have a Panic Attack
And I’m Afraid I’m Going Crazy!
A Psychiatric Guide
A Psychiatric Guide for When You Have a Panic Attack and Fear “I’m Going Crazy”
The fear of “going crazy” during a panic attack is very common and usually does not mean that you are experiencing psychosis or losing your mind.
During a panic attack, the body’s alarm system (Fight-or-Flight response) suddenly becomes overactive. In an attempt to explain the intense physical symptoms, the brain may begin catastrophizing:
“I’m losing control.”
“I’m going to die.”
“I’m going crazy.”
These thoughts can further intensify the panic itself.
Key point: A panic attack is not dangerous, but it can be extremely frightening. It usually peaks within 10–30 minutes and then gradually subsides.
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1. Safety First: When Should I Seek Immediate Medical Attention?
If any of the following are present, immediate medical evaluation is necessary (emergency department/doctor):
• New or pressure-like chest pain, severe shortness of breath, or fainting
• New neurological symptoms such as weakness on one side of the body, difficulty speaking, or seizures
• High fever, severe confusion, stimulant or alcohol use, or sudden withdrawal from them
• Thoughts of harming yourself or others
• A new onset of panic symptoms at an older age, or panic symptoms occurring alongside significant heart or lung disease
If none of these apply and the pattern resembles a panic attack, we can move on to managing the attack and establishing effective long-term treatment.
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2. When the Panic Attack Starts: A 10-Minute Protocol
Step A) Label It Accurately — 30 Seconds
Say quietly to yourself:
• “This is a panic attack. It is a wave of anxiety. There is no real danger.”
Labeling the experience can help activate the more rational parts of the brain.
Step B) Anti-Hyperventilation Breathing — 2–3 Minutes
The goal is to reduce rapid breathing, which can worsen dizziness, tingling sensations, and feelings of unreality.
• Inhale through your nose for 2–3 seconds.
• Exhale slowly through your mouth for 6 seconds.
• Repeat for 8–10 cycles.
Do not focus on taking “deep breaths.” Instead, focus on slow and gentle breathing.
Step C) Ground Your Body — 2 Minutes
Grounding means directing your attention toward physical sensations.
Choose one of the following:
• 5-4-3-2-1 technique: Five things I can see… four things I can touch…
• Isometric pressure: Press your feet firmly into the floor, clasp your hands together and squeeze for 10 seconds. Repeat five times.
• Hold a cold object, such as a glass of cold water, in your hand.
Step D) Manage the Thought “I’m Going Crazy” — 1 Minute
Instead of engaging in a long internal argument, use one short sentence:
• “This thought is a symptom of anxiety, not reality.”
• “Panic = intense fear + a body on high alert. It is not insanity.”
Clinical reality: During panic attacks, people are usually aware that “something feels strange” and actively seek help. This level of self-awareness differs from what is typically seen in true psychosis.
Step E) Small Movement, Not Major Escape — 2 Minutes
If you can:
• Walk around a little, relax your shoulders, and drink some water.
Completely escaping from the situation can sometimes teach the brain, “That place was dangerous,” which may reinforce the panic cycle.
If the situation is not genuinely unsafe, remaining there in a controlled way can be helpful.
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3. Why Do I Feel Like I’m “Going Crazy”?
During a panic attack, you may experience:
• Depersonalization/derealization: A feeling that you or your surroundings are unreal
• Rapid heartbeat, trembling, sweating, or shortness of breath
• Fear of losing control: “What if I scream/run away/do something?”
These experiences result from adrenaline, changes in breathing patterns, and excessive attention to bodily sensations. They are not signs of “insanity.”
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4. After the Attack: What Can Break the Cycle?
A) Make a Short Record — 2 Minutes
Write down three things:
- Where was I?
- What thought occurred? (“I’m going crazy.”)
- What actually happened? (The panic subsided, I survived, and I regained control.)
This gives the brain evidence against the catastrophic prediction.
B) Reduce Unhelpful Behaviors
The following behaviors can contribute to chronic panic:
• Constantly checking your heart rate or oxygen level
• Repeatedly searching your symptoms on the internet
• Extensively avoiding certain places, which can contribute to the development of agoraphobia
Instead, use gradual and controlled exposure.
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5. Effective Treatments — The Gold Standard
CBT Specifically for Panic Disorder
The most effective non-medication treatment includes:
• Correcting catastrophic interpretations such as “I’m going crazy” or “I’m going to die.”
• Interoceptive exposure: Controlled practice of physical sensations associated with panic—such as briefly breathing rapidly or spinning around—so the brain can learn that these sensations are not dangerous.
• Situational exposure: Particularly when avoidance behaviors have developed.
Medications — Under the Supervision of a Psychiatrist
• SSRIs/SNRIs are considered first-line medications for recurrent panic attacks. Their effects usually develop over several weeks.
• Benzodiazepines may provide short-term relief, but they carry risks of dependence and tolerance and are generally not considered a long-term solution.
• If heart palpitations are the predominant symptom, additional treatment targeting physical symptoms may sometimes be considered, depending on your individual circumstances.
If your panic attacks are new, severe, or becoming more frequent, the best approach is to undergo an evaluation for possible medical causes—such as thyroid disorders, anemia, arrhythmias, asthma, or caffeine/stimulant use—and begin appropriate targeted treatment.
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6. A Daily “Prevention” Package
• Reduce caffeine and energy drinks, as they can trigger panic attacks in many people.
• Maintain a regular sleep schedule.
• Do 15–30 minutes of mild aerobic exercise.
• Practice slow, calm breathing twice a day—not only during panic attacks.
• Reduce alcohol and substance use, particularly stimulants.
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7. A Few Ready-to-Use Phrases for Moments of Crisis
• “This is a wave. It comes, and it goes.”
• “My body has triggered a false alarm. I am safe right now.”
• “This feeling that I’m going crazy is a symptom of anxiety, not reality.”
• “Another five minutes will pass. I’ve gotten through this before.”
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