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Anxiety Attacks
Anxiety Attacks: Understand Why They Happen & How to Deal With Them | Four Seasons Counselling

Anxiety Attacks: Understand Why They Happen & How to Deal With Them | Four Seasons Counselling

Anxiety is a future-based stressor. It comes from our fear of the unknown based on the numerous possibilities that we have already been exposed to in the past. Anxiety and panic attacks can be frightening experiences. Even if you are a routine sufferer, those feelings continue to be overwhelming and disruptive. Over time, this can cause persistent distress, shame, or paranoia about when the next episode may happen. Let’s take a look at anxiety attacks, panic attacks, their origins, symptoms, and what steps you should take if they affect your daily functioning.

What is an Anxiety Attack?

An anxiety attack, often used interchangeably with “panic attack” is a period of heightened, intense worry that is accompanied by a number of other physical and mental symptoms, including sweating, chest pain, rapid heartbeat, dizziness, and thoughts of dying. These episodes can last anywhere from a few minutes to a few hours. For those who have never experienced an anxiety or panic attack, it can be overwhelming and is often mistaken for a heart attack.


It is important to note that not everyone with anxiety or panic attacks will experience all of the symptoms listed below. Some people may experience symptoms that are not listed here. Additionally, these symptoms can also be associated with other medical or psychiatric conditions, so it is important to speak with a healthcare professional for a proper diagnosis and treatment plan.

Symptoms of Anxiety:

  • Excessive worry or fear about everyday situations
  • Restlessness or feeling on edge
  • Fatigue or feeling tired easily
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbances (difficulty falling asleep or staying asleep, or restless sleep)
  • Physical symptoms such as sweating, trembling, shortness of breath, heart palpitations, or stomach discomfort.

Symptoms of Panic Attacks:

  • Sudden and intense fear or discomfort, often with no apparent cause
  • Rapid heartbeat or palpitations
  • Sweating
  • Trembling or shaking
  • Paralysis
  • Shortness of breath or feeling like you’re choking
  • Chest pain or discomfort, often confused for a heart attack
  • Nausea or abdominal distress
  • Feeling dizzy, light-headed, or faint
  • Numbness or tingling sensations
  • Feeling hot or cold flashes
  • Fear of losing control or going crazy
  • Fear of dying

Difference Between Normal & Abnormal Anxiety

Anxiety is a normal and natural human response to stress, danger, or uncertainty. It’s common to experience anxiety before a big test, job interview, or first date. However, when anxiety becomes excessive, chronic, or begins to interfere with daily life, it may be considered clinical anxiety. Clinical anxiety is a general term used by mental health professionals to describe any number of anxiety disorders that consistently interfere with day-to-day functioning.

Normal anxiety can be beneficial in certain situations. Humans evolved to be in tune with danger cues, which helps prepare the body for survival mode. In small doses, anxiety can even improve performance and motivation as it clears the mind to focus on just one thing. Normal anxiety tends to be temporary and situational, meaning that once the perceived threat or stressor has passed, the anxiety subsides. There is an associated feeling of relief once the big event or scary situation is over.

Clinical anxiety, on the other hand, is a persistent and excessive worry or fear that does not go away, even when the threat is gone or the event is over. The body and brain remain in survival mode. Clinical anxiety may escalate into intense anxiety or panic attacks, and their symptoms often interfere with their ability to work, study, or socialize.

Noticing the difference between clinical anxiety and regular anxiety is very simple. Normal anxiety tends to be milder and short-lived, even fleeting. Clinical anxiety can cause more severe and prolonged symptoms, including physical symptoms such as muscle tension, headaches, and digestive issues. For those with certain types of clinical anxiety, a person may go to bed anxious and wake up the next day with the same amount of anxiety.

Clinical anxiety can take different forms, including generalized anxiety disorder (GAD), panic disorder, social anxiety disorder, and specific phobias. Each of these disorders has its own set of symptoms and diagnostic criteria, but they all share the common characteristic of excessive and persistent anxiety.

Normal, fleeting anxiety can be managed with coping strategies like relaxation or stress management techniques. This can include deep breathing or visualization exercises. More often than not, clinical anxiety may require professional treatment. Treatment for clinical anxiety can involve medication, psychotherapy, or a combination of both. Cognitive-behavioral therapy (CBT) is one of the most effective therapies for clinical anxiety, as it helps people identify and change negative thought patterns and behaviors that contribute to their anxiety, but other therapies may be just as effective. It is important to seek professional help if you suspect that you or someone you know may have clinical anxiety or panic attacks, as they may need more help than you are able to provide.

What Causes Anxiety Attacks?

Anxiety attacks, also known as panic attacks, can be caused by a variety of factors, including psychological, biological, and environmental factors. Understanding the underlying causes of anxiety attacks can be helpful in managing and preventing them.

One of the most common causes of anxiety attacks is stress. Stressful life events such as financial difficulties, relationship problems, or work-related stress can trigger anxiety attacks. Chronic stress can also cause changes in brain chemistry, leading to increased anxiety.

Anxiety attacks can also be caused by a history of trauma or abuse. People who have experienced trauma, such as physical or emotional abuse, may be more prone to developing anxiety attacks. Similarly, people with a history of anxiety disorders, such as generalized anxiety disorder or social anxiety disorder, may be more susceptible to anxiety attacks.

Biological factors also contribute to anxiety attacks. Imbalances in brain chemistry, particularly in the neurotransmitters, serotonin and dopamine, can lead to increased anxiety. Hormonal imbalances, such as those that occur during menstruation, menopause, or thyroid disorders, can also contribute to anxiety attacks. Neurodivergence, which is an umbrella term used for ways of thinking that exist outside of the neurotypical realm and includes autism and ADHD, is often comorbid with anxiety.

Environmental factors can also play a role in causing anxiety attacks. For example, living in a high-crime or unsafe neighborhood can cause feelings of anxiety and fear. Substance abuse, including the use of alcohol or drugs, can also contribute to anxiety attacks. A surprise agitator for anxiety and panic is caffeine. Caffeine usage above 400mg a day is related to increased likelihood for panic attacks and persistent anxiety. This can be as little as two energy drinks or four cups of coffee per day.

In some cases, anxiety attacks occur without an obvious trigger. These unprovoked anxiety attacks may be caused by underlying mental health conditions, such as panic disorder or post-traumatic stress disorder (PTSD).

Understanding the underlying causes of anxiety attacks can be helpful in managing and preventing them. Seeking professional help, practicing stress management techniques, and making lifestyle changes can all be effective in reducing the frequency and severity of anxiety attacks.

Panic Attack vs. Anxiety Attack

The phrases “panic attack” and “anxiety attack” are often used interchangeably. While they have similar symptoms and can even occur at the same time, some therapists prefer to use different terms for different circumstances. Some differences include:

  • Panic attacks occur out of the blue while Anxiety attacks tend to grow over time
  • Panic attacks do not have a specific trigger while Anxiety attacks are specifically connected to a particular stressor
  • Panic attacks are severe while Anxiety attacks have a range from mild, mild to moderate, moderate, moderate to severe, or severe
  • Panic attacks activate the fight-flight-freeze response
  • Panic attacks typically last around ten minutes, lasting no longer than 30 minutes while Anxiety attacks can build and last up to hours
  • Panic attack medication belongs to a drug class called Benzodiazepines while anxiety attack medication typically belongs to a class of drugs called Selective Serotonin Reuptake Inhibitors (SSRIs)

Doctors and therapists may take similar approaches in addressing both panic and anxiety attacks regarding lifestyle changes and therapeutic approaches. However, medication for panic attacks affects a different function of the brain than medication for anxiety attacks. Because patients often have anxiety and panic, doctors will prescribe anxiety medication for daily use and panic attack medication for use on an as-needed basis. Complicating this definition is the fact that there are no diagnostic criteria for what defines an anxiety attack versus a panic attack.

Diagnoses Related to Anxiety Attacks

The onset of panic and anxiety attacks can be attributed to a number of factors, including specific diagnoses. Here are just a few of the associated diagnoses seen in adults and how they influence the likelihood of panic attacks:

Panic Disorder

Panic attacks are the trademark symptom of Panic Disorder. Panic Disorder is a type of anxiety disorder marked by recurrent and unexpected panic attacks. People with panic disorder often live in fear of experiencing another panic attack and may avoid certain situations or places for fear of triggering an attack. The fear of future panic attacks can also lead to heightened anxiety and an increased sense of vulnerability, making it difficult for individuals to carry out daily activities. This creates a vicious cycle where a person has a panic attack, the panic attack symptoms subside and the panic attack ends, then the person remains in a state of anxiety until another panic attack begins.

Panic Disorder can be diagnosed when panic attacks are recurrent and unexpected and accompanied by at least one month of persistent worry or behavioral changes related to the attacks. Panic Disorder has a number of causes, including trauma, biological, environmental, and genetic factors.

Effective treatments for panic disorder include talk therapy, medication, or a combination of both. Talk therapy with a licensed professional can help individuals identify and challenge the negative thought patterns and behaviors associated with panic disorder, while medications like antidepressants or benzodiazepines can help to manage symptoms in the short-term. Seeking professional help is important for those who are experiencing panic attacks or think they may have panic disorder to get an accurate diagnosis and receive appropriate treatment.

Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) is a type of anxiety disorder characterized by persistent and excessive worry about various aspects of life, such as work, health, and relationships. It is the diagnosis most associated with the phrase “clinical anxiety.”  Individuals with Generalized Anxiety Disorder often find it difficult to control their worry and may experience physical symptoms such as muscle tension, restlessness, and fatigue.

While panic attacks are not a defining characteristic of GAD, they can occur in individuals with this disorder. Panic attacks in individuals with GAD may be triggered by the anticipation of a stressful situation or a specific fear, such as fear of flying or fear of public speaking. These panic attacks can be just as intense and distressing as those experienced by individuals with panic disorder, but they are not always accompanied by the same persistent fear of future attacks and are associated with a specific stressor.

GAD and Panic Disorder share many similarities and may be difficult to distinguish from one another. However, the key difference is that GAD involves chronic, excessive worry about a variety of topics, whereas panic disorder is characterized by recurrent, unexpected panic attacks. It is important to seek professional help if you are experiencing symptoms of GAD or panic attacks, as effective treatments are available, including therapy and medication.

It may be helpful to think of Generalized Anxiety Disorder as the person constantly being on high alert, while Panic Disorder is a momentary bomb of distress.


Agoraphobia is a type of anxiety disorder specific to an intense fear or anxiety about being in situations or places where escape might be difficult or help might not be available. This fear often leads to avoidance of certain situations or places, such as crowded areas, public transportation, or being alone outside the home. The fear of being in these situations or places can trigger panic attacks. The experience of a panic attack in these situations can further reinforce the fear of being in those situations, which perpetuates the cycle of avoidance and panic attacks. The most common treatment for agoraphobia is a combination of daily medication for anxiety, as-needed medication for panic attacks, and talk therapy, usually Cognitive Behavioral Therapy.

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic Stress Disorder (PTSD) is a mental health disorder that can develop after a person experiences or witnesses a traumatic event. It exists in its own category, outside the other anxiety disorders. Symptoms of PTSD can include flashbacks, nightmares, intrusive thoughts, and avoidance of reminders of the traumatic event. Those with Complex PTSD (C-PTSD) may also have chronically low self-esteem, interpersonal disturbances, and difficulty managing mood or affect. Individuals with Post-traumatic Stress Disorder may also experience panic attacks and clinical anxiety.

Panic attacks in individuals with PTSD can be triggered by reminders of the traumatic event, such as a loud noise or a particular smell, although they can also happen spontaneously, without a trigger. The symptoms of panic attacks and anxiety in individuals with PTSD are similar to those who suffer from Panic Disorder or Generalized Anxiety Disorder. These diagnoses are often confused for one another, although it is possible for all three diagnoses to exist at once, or for an individual to just have one or two diagnoses without the others.

The occurrence of panic attacks in individuals with PTSD can be distressing and can interfere with daily functioning. Panic attacks may lead to increased avoidance of certain situations or activities, which can further exacerbate symptoms of PTSD by increasing isolation. For those who have C-PTSD and a negative self-concept, this may only perpetuate inherent feelings of shame. Additionally, individuals with PTSD and co-occurring panic attacks may be at increased risk of developing other mental health disorders, such as depression or substance abuse.

Effective treatments for PTSD and panic attacks include therapy, medication, or a combination of both. Trauma-focused therapy can help individuals with PTSD to process and cope with their specific traumas and reduce the frequency and intensity of panic attacks. Medications, such as selective serotonin reuptake inhibitors (SSRIs), can also be effective in reducing symptoms of PTSD and panic attacks.

Substance-induced Anxiety Disorder

Substance-induced Anxiety Disorder is a type of anxiety disorder that specifically occurs from drug or alcohol use, withdrawal, or exposure to toxins. The use of certain drugs, such as cocaine or amphetamines, also known as stimulants or uppers, can cause intense anxiety and panic attacks. Methamphetamine highs often cause hallucinations and violent paranoia, which increases aggression, stimulation, and panic. Substance-induced Anxiety Disorder also includes Caffeine-induced Anxiety Disorder, where caffeine is responsible for heightening feelings of anxiousness or panic. As little as two energy drinks per day can drastically increase the likelihood of panic attacks and anxiety. Additionally, withdrawal from drugs, alcohol, or caffeine can also trigger panic attacks and other symptoms of anxiety as the body works hard to remove toxins from its organs.

The symptoms of Substance-induced Anxiety Disorder often look similar to Panic Disorder, including feelings of fear, sweating, trembling, and shortness of breath. However, Substance-induced Anxiety Disorder is directly linked to the use of drugs or alcohol, while Panic Disorder is not.

It is important to seek professional help if you are experiencing symptoms of substance-induced anxiety disorder or panic attacks. Treatment may involve detoxification, therapy, or medication to manage symptoms and prevent future episodes. Identifying and addressing the underlying cause of substance-induced anxiety disorder is crucial to achieving long-term recovery and managing symptoms effectively.

How to Cope

Coping with panic attacks and anxiety can be challenging, but there are several strategies and techniques that can be effective in managing and reducing symptoms. Anxiety and Panic attacks also respond well to therapeutic intervention. Here are some tips on how to best cope with panic attacks and clinical anxiety:

  • Practice relaxation techniques: Relaxation techniques such as deep breathing, progressive muscle relaxation, and mindfulness meditation can help to reduce feelings of anxiety and panic. These techniques can help you to slow down your breathing, relax your muscles, and focus your mind on the present moment.
  • Exercise regularly: Exercise is a great way to reduce anxiety and stress. It helps to release endorphins, which are natural mood-boosting chemicals in the brain. Aim for at least 30 minutes of physical activity each day, such as walking, jogging, or yoga.
  • Get enough sleep: Lack of sleep can make symptoms of anxiety and panic attacks much worse. Make sure to get enough sleep each night and establish a consistent sleep schedule. Most professionals suggest 8-10 hours of quality sleep in a comfortable environment.
  • Avoid triggers: Identify situations or activities that trigger your anxiety or panic attacks and try to avoid them if possible. This may involve avoiding certain people or social situations or making lifestyle changes such as reducing caffeine intake or quitting smoking.
  • Seek professional help: If your anxiety or panic attacks are interfering with your daily life, you might benefit from seeing a licensed professional. A therapist or psychiatrist can help you to identify triggers, develop coping strategies, and provide treatment options such as medication or traditional talk therapy.
  • Practice self-care: Taking care of yourself is essential for managing anxiety and panic attacks. Make time for activities that you enjoy, such as reading, listening to music, or crafting. Eat a healthy diet, stay hydrated, and prioritize self-care activities such as taking a bath or practicing yoga.
  • Maintain social connections: The people around you can provide a sense of support, belonging, and help to reduce feelings of isolation and loneliness. Regular social interactions can also serve as a distraction from anxious thoughts and provide opportunities for positive experiences and new perspectives, improving overall mental wellbeing.

What to Ask Your Doctor

If you suspect you are having anxiety or panic attacks, get in touch with your doctor. They may be able to help ease some concerns for you. Here is a list of questions you may use to guide your conversation:

  • Is this normal anxiety or something more serious? How can you tell?
  • What tests, if any, are needed for a diagnosis?
  • Do I need ongoing treatment?
  • How long will treatment last?
  • Is medication the best route for treatment or are there other alternatives?
  • What are the potential side effects of medications used to treat panic attacks and anxiety?
  • Is it possible to get addicted to these medications?
  • Do I have to go to therapy as part of panic attack treatment?
  • Is there something physical triggering my panic attacks?
  • How can I manage my symptoms during a panic attack?
  • Can panic attacks be cured, or will I need to learn to manage them long-term?
  • Are there any lifestyle changes or self-help strategies that can help manage panic attacks?
  • What will make my panic attacks and anxiety worse?
  • Do you have any recommendations for psychotherapists or mental health centers?

How to Help Someone Having a Panic Attack

Witnessing someone you care about have a panic attack can be frightening or overwhelming. It’s important to remember that panic attacks are pretty common. Here are some Dos and Dont’s to help the situation, rather than make it worse.

Do: Keep calm and remain non-judgmental. The person having the panic attack might feel embarrassment or shame, so they might need some reassurance of your support.

Do: Encourage them to focus on breathing. Ask them to take slow, deep breaths and to exhale slowly. You can guide them in counting their breaths or using a grounding technique, like asking them if they see or smell the same things you do. Slow, deep breathing prevents hyperventilation, which makes panic attack symptoms worse.

Do: Make sure the person is in a quiet and safe space. If they’re in a crowded or noisy environment, suggest moving to a quieter area where they can feel less overwhelmed by sounds, lights, or movement.

Don’t: Try to reason with the person or tell them to “just relax.” This can make them feel worse, as it sounds dismissive and minimizes their anxiety or panic.

Do: Simply listen to them and validate their feelings.

Do: Check to see if the person has a prescribed medication for their anxiety or panic attacks.

Do: Offer to help the person take their meds.

Don’t: Force medication on the person or tell them they need to take it unless you are authorized to do so

Do: Check in with the person and see how they’re feeling after their panic attack symptoms subside.

Helping someone who is experiencing a panic attack involves remaining calm, encouraging deep breathing, finding a quiet and safe space, helping them focus on their senses, avoiding invalidating their feelings, and checking in with them afterwards. By following these suggestions, you can become a great pillar of support for those in need.

If you are in the Toronto area and would like to discuss panic attacks, anxiety, or general support, please reach out to us at or click here to visit our online portal to schedule a consultation.

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