A FRIGHTENING combination of physical and psychological symptoms, panic attacks are extremely unpleasant. "It is estimated that most people will experience at least one of these out-of-the-blue attacks at some point," says Dr Andrea Reinecke, from the University of Oxford's Department of Psychiatry.

However, some people may be more susceptible than others, says Dr Lynne Green, chief clinical officer at mental wellbeing app, Kooth: "There are lots of factors that might increase the risk of an individual having panic attacks, including certain medications, traumatic events and memories, substance misuse and pre-existing health conditions. The number one factor is significant stress."

To mark April's Stress Awareness Month, we asked mental health experts to answer some frequently asked questions...

What is a panic attack?

"During a panic attack, the body's autonomous fight-or-flight response takes over," Dr Green explains. "This is a stress reaction that likely evolved out of the survival needs of our early ancestors, and activates the nervous system to help prepare the body to fight or flee."

The result is a very overwhelming sense of anxiety, fear, or a feeling of dread that something terrible is going to happen, at the same time as one or more physical symptoms. "We can feel shortness of breath, tight chest, tingly fingers or hands, slightly sweaty, dizzy, fast pulse," says Stefan Chmelik, integrated healthcare expert and inventor of Sensate neural acoustic technology.

What are the common causes of panic attacks?

"Panic attacks tend to occur in cases of severe anxiety," says Dr Green. "They can happen without an obvious cause, or they may be expected, for example in relation to a known trigger such as exposure to something that feels scary."

A trigger could be something like having to do a presentation at work, being stuck on crowded public transport, or driving in heavy traffic. Or simply reaching peak overwhelm at the end of a very stressful period of time.

What should you do when a panic attack hits?

As a racing heartbeat is common, focusing on your breathing can help. "Breathing out is the key during a panic attack," says Chmelik. "Say to yourself, 'When in doubt, breathe out'. Breathe out and say, 'It's OK, thank you highly evolved nervous system for alerting me to what you think is a problem. But I see it and it's OK– you can step down now. I'm not in danger'."

If you've experienced a panic attack before, you can practise breathing techniques to prepare in case it happens again.

When should you seek professional help for panic attacks?

"Whilst panic attacks themselves are not life threatening and usually pass within 30 minutes or so, they can lead to serious complications, for example through unhelpful behaviours such as self-medicating with alcohol to avoid feelings of anxiety which precede the panic," says Dr Green.

Dr Reinecke advises: "If they happen repeatedly over six months, and you are starting to be worried about when your next attack will strike, you [could be] on the path towards an anxiety disorder."

What is the treatment for panic attacks?

People who experience panic attacks are often worried, and sometimes even convinced, that their physical symptoms are caused by a medical condition.

"The first step would be to have one proper physical check-up, for peace of mind – thyroids, heart, hormones (eg menopause, the pill) etc can all contribute," says Dr Reinecke.

Once any underlying physical issues have been checked, talking therapy can be very helpful. "Exposure therapy is a form of cognitive-behaviour therapy [CBT], where the patient learns to react differently to fear triggers. In our research, we have for instance developed a highly effective single-session treatment that leads to improvements in most of our panic disorder patients, and to life-changing improvements in a large number of patients," says Dr Reinecke.

However, counselling and CBT through NHS services is also a very helpful option to explore – ask your GP or see if you can self-refer online.