What is a panic attack?

A panic attack (PA) is a sudden episode of intense anxiety accompanied by pronounced physiological reactions. Neurobiologically, it is an abrupt activation of the sympathetic nervous system triggering the "fight or flight" response - even when there is no objective threat.2

Important: A panic attack is never life-threatening - even though bodily signals may suggest otherwise. Symptoms typically last from a few minutes to half an hour.

Main symptoms

Feeling of breathlessness
Heart palpitations
Dizziness
Chest pressure
Feeling of anxiety
Body trembling
Increased sweating
Difficulty breathing deeply

Three Pathways of Panic Attack Genesis

In practical work it is useful to distinguish three main mechanisms. They usually occur in combination.

01

Emotional Genesis

Chronic stress, suppressed emotions, prolonged psycho-emotional tension. Clark's (1986) cognitive model shows how catastrophic interpretation of bodily sensations creates a panic spiral.3

02

Biochemical Genesis

Blood sugar drop, sleep deprivation, intoxication, dietary factors. Hypoglycaemia can directly trigger autonomic reactions resembling panic attack symptoms.10

03

Structural Genesis - Our Focus

Breathing mechanics dysfunction, restricted diaphragm mobility, trigger points in breathing muscles, restricted rib mobility, vagus nerve irritation. This is where massage and manual therapy can help the most.

Autonomic Nervous System

The autonomic nervous system regulates the function of internal organs and maintains the body's stable state. Chronic stress reduces its flexibility and increases the risk of panic attacks.4

⚡ Sympathetic - "fight or flight"

  • Heart rate increases
  • Breathing speeds up
  • Blood pressure rises
  • Muscle tone increases
  • Anxiety increases

✦ Parasympathetic - "rest and digest"

  • Heart rate slows down
  • Muscles relax
  • Breathing normalises
  • Digestion improves
  • Energy reserves are restored

According to Porges' polyvagal theory, the social engagement system is evolutionarily established and its disruption promotes panic states.5

Vagus Nerve - The Main Pathway of Parasympathetic Regulation

The vagus nerve (cranial nerve X) innervates the heart, lungs and digestive tract. Low vagal tone - measured as heart rate variability - is an important predictor of panic attacks.6

Possible Vagus Nerve Irritation Zones

1

At the Cranial Level

Suboccipital muscles, the occipital bone and mastoid bone. Increased tension in this area can be associated with increased activation of the nervous system.

2

At the Neck Level

Scalene muscles and thoracic outlet structures. Tension affects breathing biomechanics and the function of breathing muscles.

3

Anterior Diaphragmatic Level

The xiphoid process area. Tension here accompanies restriction of diaphragm mobility and a sense of pressure below the sternum.

Breathing Biomechanics and Panic Attacks

Restriction of rib movement amplitude reduces breathing efficiency. Spasm of intercostal muscles disrupts thoracic excursion, leading to shallow breathing.

Wilhelm and Roth (2001) documented that chronic hyperventilation and dysfunctional breathing patterns are closely associated with panic disorder.7 Ma et al. (2017) showed that diaphragmatic breathing activates the parasympathetic system via the vagus nerve and lowers anxiety levels.8

Trigger points in breathing muscles: Trigger points in the diaphragm, intercostal muscles and m. pectoralis minor can directly mimic panic attack symptoms - chest pressure, breathing difficulty and heart palpitations.9

How to Influence the Autonomic Nervous System

Activating the sympathetic

  • Cold shower
  • Fast short inhalations
  • Bright light
  • Intense fast massage
  • Caffeine
  • Loud music

Activating the parasympathetic

  • Warm bath
  • Slow long exhalation
  • Dimness, semi-darkness
  • Slow rhythmic massage
  • Meditation
  • Calm music
The role of the massage therapist: Tense muscles block rib mobility. The massage therapist restores rib mobility in all 360 degrees of movement and restores muscle tone so they perform their function in breathing. This normalises thoracic excursion, improves diaphragm function and reduces pressure on the autonomic nervous system.

Frequently Asked Questions

What is a panic attack and what does it look like?
A panic attack is a sudden episode of intense anxiety accompanied by strong physiological reactions - heart palpitations, breathlessness, dizziness and chest pressure. Symptoms last from a few minutes to half an hour. A panic attack is not life-threatening.
What are the physiological causes of a panic attack?
Panic attacks have three main causes: emotional (chronic stress), biochemical (blood sugar drop, sleep deprivation) and structural (breathing mechanics dysfunction, trigger points, restricted diaphragm mobility). They usually occur in combination.
How is breathing connected to panic attacks?
The diaphragm is the main breathing muscle. Dysfunction of its mobility and spasm of intercostal muscles reduce breathing efficiency and lead to shallow breathing - which can trigger a panic reaction. Diaphragmatic breathing activates the parasympathetic system via the vagus nerve and lowers anxiety levels (Ma et al., 2017).
Does massage help with panic attacks?
Yes. Slow rhythmic massage activates the parasympathetic nervous system, relieves tension in breathing muscles and addresses trigger points in the chest. Restoring thoracic mobility and normalising diaphragm function can significantly reduce the frequency of panic attacks.
What is the role of the vagus nerve in panic attacks?
The vagus nerve is the main pathway of parasympathetic regulation. Low vagal tone is an important predictor of anxiety disorders and panic attacks. Increasing vagal tone through breathing and massage helps prevent panic attacks.
What is the difference between the sympathetic and parasympathetic nervous systems?
The sympathetic activates in danger - speeds up heart activity and breathing ("fight or flight"). The parasympathetic is the recovery system - slows heart rate, relaxes muscles, normalises breathing. In panic attacks the sympathetic is overactive and parasympathetic tone is low.

Scientific References

  1. Kessler RC, et al. (2006). Epidemiology of panic attacks. Arch Gen Psychiatry, 63(4). DOI: 10.1001/archpsyc.63.4.415
  2. Gorman JM, et al. (2000). Neuroanatomical hypothesis of panic disorder. Am J Psychiatry, 157(4). DOI: 10.1176/appi.ajp.157.4.493
  3. Clark DM. (1986). A cognitive approach to panic. Behav Res Ther, 24(4). DOI: 10.1016/0005-7967
  4. Thayer JF, et al. (2012). Heart rate variability meta-analysis. Neurosci Biobehav Rev, 36(2). DOI: 10.1016/j.neubiorev.2011.11.007
  5. Porges SW. (2007). The polyvagal perspective. Biol Psychol, 74(2). DOI: 10.1016/j.biopsycho.2006.06.009
  6. Thayer JF & Lane RD. (2000). Neurovisceral integration model. J Affect Disord, 61(3). DOI: 10.1016/S0306-4522(00)00230-2
  7. Wilhelm FH & Roth WT. (2001). Somatic symptom paradox in DSM-IV. Biol Psychol, 57. DOI: 10.1016/S0005-7916
  8. Ma X, et al. (2017). Diaphragmatic breathing and stress. Front Psychol, 8:874. DOI: 10.3389/fpsyg.2017.00874
  9. Simons DG, Travell JG. (1999). Myofascial Pain and Dysfunction: Trigger Point Manual, 2nd ed. Williams & Wilkins.
  10. Schweitzer I, et al. (1992). Hypoglycemia and panic attacks. Biol Psychiatry, 32(1). DOI: 10.1016/0006-3223