Silent Panic Attacks vs. Silent Anxiety Attacks (And What Helps)
Not all instances of anxiety look dramatic from the outside. Some are silent panic attacks or anxiety attacks. They’ll happen with fewer visible symptoms but just as much internal distress. You might look fine, and it may go undetected by others, but these quieter experiences are very real and worthy of care.
Additionally, there might be a lot of confusion about what exactly is going on inside. Anxiety attack and panic attack are often used interchangeably. While they have some overlapping symptoms, they are actually distinct experiences. When you search the internet for advice on what to do, you often find the same prescription for both. But it’s important to know the difference because they require different approaches.
TL;DR: An anxiety attack builds gradually. A panic attack comes on very suddenly. Slowing down and using grounding skills can be effective for anxiety attacks, but not for panic. As paradoxical as it sounds, the best thing you can do during a panic attack is to allow it. Shifting your response to it in this way will reduce the occurrence of future panic attacks.
But let’s look at this together, get clear on what these terms mean, and talk about what actually helps in the moment.
What’s the Difference?
Both experiences can involve fear, fast heartbeat, shortness of breath, throat tightness, dizziness, nausea, shaking, sweating, or hand tingling. But the criteria below explains how they differ:
Anxiety Attacks:
Builds over hours or days to a breaking point
Typically brought on by anticipation of some event
Usually last less than 30 minutes
Panic Attacks:
Overwhelming fear comes on suddenly
Can be expected or unexpected
Fear of dying or passing out
Usually peak within 10 min and end within 30 (some symptoms may linger over an hour)
In some cases, you can experience a combination of both. For example, anxiety is brewing and increasing in the leadup to an exam. It then culminates in a panic attack on the day of the test. Panic disorder involves 1 of 3 main symptoms: either derealization (feeling numb, detached, or floaty), fear of a heart attack, or fear of hyperventilation and passing out. With panic disorder, you’re having recurring panic attacks.
The good news is that, no matter the severity, all of this is treatable. For the rest of this post, I’m going to focus on panic attacks because this is the piece that’s most misunderstood.
A panic attack feels physically dangerous, but in reality, it is not.
You might ask: but how do you know you’re not gonna pass out from a panic attack or if you’re having a heart attack?
When you’re having a panic attack, it shoots your blood pressure up. You have low blood pressure when you’re about to pass out. A heart attack develops from physical exertion and will continually worsen beyond the time frame of a panic attack (20-30 minutes). When you’re having a heart attack, you feel worse when you walk around. But movement can make you feel a little better during a panic attack. Check out Dr. Nick Wignall for more debunking of panic attack-related fears.
Understanding Silent Panic Attacks
Silent panic attacks can often get triggered by something small: a sensation in your body (like your heart pounding), an intense emotion, or a stressful thought. It might even be something as simple as standing up too quickly.
But the panic isn't caused by the trigger itself—it’s how we unconsciously interpret that sensation or emotion.
And how we interpret our inner experience has a lot to do with what we’ve learned. In American culture at large, we get the message that anxiety should be avoided, and we judge it as a problem. It’s stressful. And, as human beings, we instinctually prefer pleasure and are averse to pain. Growing up, you may have been taught (explicitly or implicitly) that feeling fear made you weak and should be dealt with on your own. Maybe you were shamed for it. Regardless of history, many of us walk around with the assumption that, if you feel anxiety, the next obvious step is to find a way to get rid of it.
So when your heart pounds or your chest feels tight, you might think something like: “Oh no. This feels horrible. Something’s wrong. How do I make it stop?!” or “S**t! Not again. Go away!!” Your nervous system reads these reactions as: Danger!
Your body’s fight-or-flight response becomes activated. Adrenaline and cortisol start coursing through your system, intensifying the sensations. Those stronger sensations seem even more dangerous, and round and round it goes. The central point is: when we try to force, avoid, or control the sensations, we confirm the belief that anxiety is a threat. And that’s what keeps the cycle going.
By the way, this is not your fault. It’s a learned reaction. And your body is just trying to protect you. Take a minute and ask yourself: what do you automatically say or think inside when a panic attack is coming on?
Most Common Unhelpful Advice
“Just take some deep breaths.”
“Calm yourself down.”
“Distract yourself.”
Underlying these well-intentioned ideas is the message: “Don’t feel it. You need to stop it.” In other words, “this is dangerous.”
It’s not a perfect analogy, but have you ever noticed what happens when someone says “you need to calm down” in response to another person’s intense anger? It usually doesn’t go that well. In fact, it tends to backfire, and the person usually just feels more angry. A similar dynamic is at play when it comes to panic.
What Does Help?
Simply put, the most effective way to respond to a panic attack is to allow it. Meeting it with acceptance instead of resistance. This does not mean you have to like it or pretend to be the Buddha. Panic attacks suck! But it actually reduces the occurrence of panic attacks. I’ve seen it with my therapy clients. This strategy is drawn from Acceptance and Commitment Therapy (ACT), an offshoot of Cognitive Behavioral Therapy (CBT) created by psychologist Steven Hayes. This approach to therapy developed, in part, to help treat his own panic disorder. So, what does this look like in practice?
1. Installing a New Belief: Anxiety is uncomfortable, not dangerous
The story you tell directly affects your brain’s perception of danger. You can consciously try on a new belief in daily life and especially, during a panic attack. You can tell (and teach your system through experience) that the sensations of anxiety are safe to feel—even if they’re incredibly uncomfortable—and that you can tolerate them. It gradually wears down the fear of anxiety.
You might keep the following statements stored in your phone so you can access them easily. As the panic attack is happening, say to yourself out internally or out loud:
“My body can handle these sensations.”
“This is going to pass.”
“This feels intense, but it’s not dangerous.”
“My feelings are just feelings. They can’t hurt me.”
“I can let this move through me.”
“I may feel scared, but I am actually safe in this moment.”
“It’s ok to have a fast heartbeat.”
“It’s ok to breathe this way.”
These statements direct your system that it doesn’t have to defend against what’s happening.
2. Riding it Out
I know it’s easier said than done. But, when the panic attack is happening, let the sensations be there. Ride them out.
You can even exaggerate them a little: tightening the muscle that’s already tense or jiggling your legs faster.
The intensity typically peaks within 10 minutes, which can feel like an eternity. But it will pass. You might also picture it as an ocean wave. It’s gonna build, crest, crash on shore, and flow back out.
After it’s over? Be gentle with yourself. You just got yourself through something difficult.
At a later time, articulate your known triggers for panic attacks so that you’re better prepared to use these new skills in that situation. And eventually, the need to use them will fade.
Zooming Out
At times, silent panic attacks can function like a warning light that comes on in your car, alerting you to a potential issue. When you’re in a settled state and can look at the bigger picture of your life, ask yourself if any changes can be made to decrease your overall stress. What’s your current relationship to sleep, exercise, work, alcohol, or caffeine? Have you experienced a major loss or significant event that’s been hard to process? For long-term relief with anxiety and panic attacks, addressing these factors are just as essential. But you don’t have to tackle them all at once. And you can have support along the way.
You can strengthen your ability to feel challenging sensations and feelings, just like a muscle. You can begin to plant the belief that anxiety is safe to feel and survivable. And over time, you can tend to anything that may sit underneath the anxiety. That’s what I help people do in therapy. And if that’s something you’re ready for, I’d love to connect with you.
Reach out today to schedule a free consultation.
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Elizabeth Dausch is an integrative therapist in Oakland, CA offering skilled support with breakups, dating, anxiety, and relationship issues. Her approach incorporates Internal Family Systems, somatic, and mindfulness practices, and she tailors therapy to each client's unique needs. Learn more about Elizabeth.
She can also be reached at (510) 683-5858 or elizabeth.dausch@mindfulcenter.org.