Identifying Panic Attacks

Panic attacks are defined as bursts of extreme anxiety and fear that come on suddenly out of nowhere.

Feelings may include: fear of death, fear of losing control, fear of insanity, foreboding, despair, and even derealization/depersonalization or dissociation. Symptoms of dissociation in panic include: feeling zoned out, brain fog, feeling detached and distant from your own body or distant from your environment.

Physical signs that you are experiencing panic attacks include:

  • Feeling of an elephant on your chest
  • Numbness and tingling
  • Trembling and shaking
  • Feeling faint and dizzy
  • Difficulties breathing
  • Racing heartbeat
  • Digestive upset
  • Nausea
  • Vomiting

A Panic Attack is Different from an Anxiety Attack

Anxiety attacks are a flair in an underlying anxious state and typically come from another diagnosable mental or physical health condition like: generalized anxiety disorder, obsessive-compulsive disorder, as a result of going through a huge stressor, enduring loss, grief, disappointment, or even if you or someone you know is experiencing a trauma or going through a stressor.

Symptoms of an anxiety attack include:

  • Extreme worry
  • Anticipation
  • Distress
  • Fear

Learn more about anxiety attacks here.

What are Examples of Root Causes of Panic Attacks?

Before 1977, the dominant model for understanding both biological and psychological disease was biomedical. While the biomedical model offers a foundation for therapeutic understanding of the cause of illnesses, the major limitation is that it neglects to consider variables beyond biological abnormalities. In response to this, in 1977 George L. Engel developed what he called the biopsychosocial model.

The Cast of Characters (a major section in the Anxiety Breakthrough Program) is a tool that I created to help us expand on the biopsychosocial model so that we can further explore the different root causes of panic attacks.

The Cast of Characters is comprised of:

  • Psychological Characters
  • Social Characters
  • Physical Characters


Psychological Characters

Psychological Characters goes beyond the basic psychological tenet of the biopsychosocial model by acknowledging that there are many aspects to a person’s mental and emotional self.

Have you ever felt conflicted about something? Whether it’s something small, like if you’d prefer a salad or a sandwich for lunch. Or something much more important, like: Do I get on this airplane or is my anxiety right and it’s too dangerous? This lack of certainty can be an incredibly stressful experience for anyone, especially a child.

For purposes of this article, we will focus on a therapeutic framework that I created, called the 4-Part P.A.R.T. Process; it is based on an evidence-based process called Parts Work.

Parts Work is used in Ego State therapy (Shapiro, R, 2016) Internal Family Systems (IFS) (IFS Institute, 2021), and Eye Movement Desensitization and Reprocessing (EMDR) (EMDRIA, 2020) and asserts that the mind is made up of multiple parts, each with its own viewpoints and qualities.

The 4-Part PART Process

  • P: Problem Identification
  • A: Access the Deeper Message
  • R: Retrieve Memories
  • T: Tend to the Triggered Part

Let me walk you through a typical process: 

To identify the problem, think of something that is very stressful in your life right now where you feel there is no solution.

Close your eyes and breathe.

Bring up this unpleasant thought or feeling.

Attempt to locate or observe how your body feels when you bring up this unpleasant feeling or thought. (This is discussed in more detail in the SI exercise)

To access the deeper message, focus on the feeling or thought and attempt to understand this part in more detail. Ask yourself outloud, “Are there any earlier parts of myself or ages that feel disturbed or upset with what is happening to me right now?”

See if you can get a visualization of that in your mind. Often you will find either an earlier part of you will feel affected by this circumstance or that this circumstance is triggering the emotions of an earlier age of yourself.

Pause here.

Honor and validate the emotion that the younger part of you or age is experiencing at this moment.

Notice that we are a collection of emotions and feelings related to things that have happened to us in the past. These are based on our experiences and interpretations of those experiences.

In this exercise we are simply radically acknowledging that our current adult self is not feeling the exact same way as our earlier part. Often our earlier parts feel powerless and without a voice.

  • Once you identify what part or age of yourself is upset, begin to slowly tap left and right alternating on each leg. 
  • While tapping, ask that part out loud: 

“Would you allow me (your current age) to handle this situation? And to use my resources and my support systems to deal with this in the now, and in this year ___(say the year aloud)____? 

I will allow you to feel safe, protected, and harbored by me. 

I know you didn’t get to feel that when you were younger, but I want you to know that I see you, I am an adult now, I am in charge, I have a lot of experiences, resources to draw upon to help me draw upon this situation and stressful experience that you did not have. 

I want you to loosen your grip trying to help me or control the situation. 

I want you to put down your sense of control and strong emotion that is attempting to dominate my current feelings. 

Allow me who is here right now to protect you and relax while I slowly but surely move ahead and deal with this stressful and difficult experience.”

  • Address your younger part and ask them: “What would you rather do than stress or worry about this?”
  • Give that part permission. Put your hands on your heart and encourage them to do that thing that they would rather be doing, and say: “I’ve got this.”


We can empower our current adult self with rational mind, resources and experiences with knowledge to be able to boldly move ahead and let our younger ages and parts of ourselves put down their burdens.


Social Characters

We are intimately impacted by those who surround us. This includes family, friends, and our communities. Six key social factors should be considered:

  • Peer relationships
  • Adult relationships
  • Household dynamic
  • Political climate
  • Socioeconomic status
  • Culture (home and community)

Have you ever experienced feeling great mentally, and then having a negative interaction with someone threw you off, crushed the mental state you were in? This is the variable of the social character. 

Social Psychology believes that if you are surrounded by people who are anxious you are more likely to be anxious. If the people in your life constantly tear you down, your psyche will likely do the same to you. Contrastingly, if the people you surround yourself with are confident and build each other up, you will likely feel more confident and build yourself up more. 

The House of Boundaries exercise in the Anxiety Breakthrough Program gives us an idea on how to relate with others intimately, but to also create structure for self-protection. Some people are trustworthy to be in our houses, and others, let’s face it: they belong on the front porch. 

Physical Characters

Physical Characters, which may also be referred to as our biological characters, refers to the interrelationship between our mental and emotional health and physical factors, such as: genetics, hormones, neurotransmitters, gut and endocrine health. This is where the importance of labs and testing comes into play. What’s happening biologically to make us anxious and panic? The physical character is discovering the imbalances that are underneath, that are asking for attention. 


What are the 3 Panic-Producing Parts of the Brain and How Do They Work to Create Panic?

There are three primary areas of the brain that impact your mind and mood. They are the Frontal Lobe, the Midbrain, and the Brain Stem.

The Frontal Lobe contains an area called the Prefrontal Cortex (PFC). The PFC is where we engage in logical, or rational thinking.

The Amygdala is located in the midbrain area called the Limbic System. The Amygdala is called “the emotional seat of the brain.” It is responsible for the feelings we experience.

Finally, the Brain Stem, which some also call the “reptilian brain,” is the area of the brain that controls automatic physical responses to stress, for example: Blood pressure, breathing, and heart rate changes, and sweating, numbness, tingling, and more.

So let’s talk about how these areas all work together:

Your brain communicates to other parts of the brain and to your body via chemical signals, called neurotransmitters (NT), that travel through highways of nerves and cells called the nervous system.

For purposes of today’s conversation on panic attacks, let’s focus on the autonomic nervous system (ANS).

The ANS is the part of the nervous system that regulates your body’s involuntary functions like heart rate, blood flow, breathing, and digestion. Think of the ANS in terms of a dial.

When the dial is turned up, the ANS shifts your body into a state that is called autonomic arousal. In this state, your body produces chemicals like cortisol, adrenaline (epinephrine and norepinephrine), and glutamate. In autonomic arousal you will feel typical symptoms we see in panic or when we’re running from danger.

When the dial is turned down, your body shifts into what is called a parasympathetic state. You might know this as the rest and digest system. Examples of chemicals that drive this parasympathetic state are acetylcholine and GABA. This causes your heart rate to slow, your muscles relax, and your body goes back to a normal resting state.

Let me share with you an example of how this pattern may play out:

Suzie is gathering berries in a field to take home to her family. Well aware that tigers live nearby, Suzie’s senses are attuned to any signs of danger in the brush. A hungry tiger growls in the distance, and before Suzie logically realizes it, a fear signal starts in her limbic system that causes a cascade of changes in both her brain and body that results in autonomic arousal.

Her heart is beating faster so that her cells and muscles can receive the energy they need in order for her to run, her breathing speeds up so that she can keep up with the increased demand for oxygen, her blood pressure rises with her faster heart rate, her body deprioritizes sending blood to the fingertips in preference for sending to the heart and large muscle groups thus causing numbness and tingling on her cheeks and in her finger tips, her body temperature rises with all of the metabolic activity, her muscles are clenched and are pumping as she zig zags around trees and jumps over fallen branches and stones. Her thoughts are racing at lightning speeds and she is able to calculate a strategy to get herself to safety, quickly.

Do any of these changes sound familiar?

What if Suzie were to experience these sensations while trying to go to sleep at night? Heart throbbing, muscles twitching, breathing rapid, numbness and tingling, body temperature rising, and thoughts racing? She might call this a panic attack, right?

The only difference between your body going into a state that will save you from being a tiger’s lunch, and a panic attack is CONTEXT. Your body is responding in the exact same way, causing very similar sensations.

Techniques that people can use to reduce or stop panic attacks

TIPPSSSS and the 4S Model

When to do this exercise: This can be used at any time you feel amplification of your symptoms. In particular consider these strategies for when you are in the top of the Yellow Zone, the Wonky Zone, and the Red Zone.

How to do this exercise
: Go to your workbook or circle at least one suggestion per bullet-list item that you are willing to try or that has worked for you in the past.

  • Tip the Temperature of your body: Take a hot shower, take a cold shower, take a hot and cold alternating shower, hold your breath and put your face in a bucket of ice cold water and hold for 15-30 seconds, place an ice pack to your face for 15-30 seconds, turn the air conditioner up or down, turn the heater up or down, go outside, open the windows of your car, close the windows of your car, turn the car’s air conditioner on, turn the car’s heaters on, use seat warmers in your car.

  • Intense exercise: Stand up and run in place for 30 seconds, walk to the bathroom, do a lap around your building, do sprint burst exercise (you can learn more about this in the exercise section of the Forcefield Strategies), do as many push ups as you can in 15 seconds, do as many burpees as you can in 15 seconds, hold a plank for 15-30 seconds, do as many sit-ups as you can in 15-30 seconds, do as many jumping-jacks as you can for 15-30 seconds.

  • Paced breathing: Do the 4 count square breath by inhaling for 4 seconds, then hold at the top for 4 seconds, then exhale for 4 seconds, then hold at the bottom for 4 seconds. Enhance this by doing this exercise for 3 minutes. Enhance this exercise by breathing in and out through your nose. You may also breathe in and out through a short straw.

  • Paired muscle relaxation: Clench and hold your muscle groups as hard as you can for 10 seconds each and then relax with a long slow exhale. Start with your feet, then your legs, then your glute muscles, then your abdominal muscles, then your chest, arms, shoulders, jaw, tongue, forehead.

  • Senses: The 4S Model (Scene, Scent, Sip, Stimuli)
    • Scene: Change the scene, go for a walk, get up and go to the bathroom, do a lap around the office, go upstairs in your house.
    • Scent: Smell an essential oil, candle, perfume, flowers, or something else that is novel and different.
    • Sip: this is when iced or hot teas can really show their magic. My favorite stress-stopping teas include: Lavender, chamomilla, kava kava, melissa, and scutellaria.
    • Stimuli: Open or close the window, splash water on your face, apply a cold pack to your face, take a shower and alternate cold and hot water, change your shoes, if your hair is down put your hair up or vice versa. Change the stimuli to your body.

You can get through this, you can feel better, panic attacks aren’t harmful. They’re just really miserable. But you can get better, you can get your life back and you can get to the bottom of the panic attacks. The Anxiety Breakthrough Program goes into detail on the root cause of anxiety and panic, testing that can be done, supplements and herbs for anxiety (based on what symptoms are being experienced), and so much more! Start this self-paced online program today!

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Dr. Nicole Cain, ND

Dr. Nicole Cain, ND MA is an Integrative Mental Health Doctor, Consultant, and Educator. She offers integrative solutions for anxiety, depression, bipolar disorder and other mental Health concerns as well as powerful courses to empower you on your health journey. Dr. Nicole Cain ND MA has helped countless people take back control of their lives, and she can help you. If you’ve ever dealt with anxiety, depression or disruptive mood issues, you know it can feel like your life is spiraling out of control. It can feel like a weight you carry everywhere, like you’re uncomfortable in your own skin, or like you’re living in a monochrome nightmare. Dr. Nicole Cain is here to help you wake up into a life you love.