“Oh God, I’m shaking, I feel sick!” (the physiology of fight or flight / panic attacks)

Evolution produced us: today’s fabulous human beings. But… there are a few design flaws. And some primitive automatic responses we’ve been saddled with that often do more harm than good these days. But we can learn to understand and control them with CBT…


What is ‘fight or flight’? When we perceive a threat, our bodies go into ‘fight or flight’ mode in an instant – this physical energising response was developed during evolution to help us survive the sabre-toothed tiger, or that troublemaker that was trying to oust us from the tribe, or indeed anything that threatened our survival in a physical way.

Fight or flight is a scientific term for the instant pumping up of our bodies, (with a series of physiological changes), when our brain has identified a threat or danger – this pumping up equips us to fight hard or run fast from the ‘threat’ – it prepares us for extreme physical action in an instant – and that’s great, and it is why we survived and still walk the earth. What is not so great though, is that our brain uses the same ‘pump up for ‘social or psychological’ threats or challenges, when ideally it would cool down instead. Pumping up messes with your data and how you explain the world to yourself – and CBT helps you to unmess that data…

Download this post as a printable PDF worksheet: CBTAFG_Extract_FightorFlight


Here are a couple of examples that will explain the immediacy and effects of fight or flight:-

  • You walk over to your lovely bowl of fruit. Reach in, and… OH! A big SPIDER! EEK’. The natural instinctive reaction is ‘DANGER!’ – to freeze or jump back – our bodies instantly revving into fight or flight, our hearts thump, our stomachs tighten into a knot etc. But within a few moments, we (well most of us) realise there is no extreme danger here, our rational brain comes up behind the primitive emotional brain and evaluates the situation, and concludes that A COGNITIVE ERROR HAS OCCURRED, that the situation is not very dramatic and that we have the resources to cope with it – and our bodies return to a natural balance very quickly, and we deal with the situation (bye bye spider).
  • You’re in bed. In a lovely deep sleep. You’re woken by a crash sound somewhere in your home. A BURGLAR?! WHAT?! You are instantly alert – tilt your head back, eyes focussing in the middle distance for danger, ears straining to hear what’s going on, your heart pumping and lungs expanding to take more oxygen, heat rising in your body, ready to take whatever action is required (this can include ‘freezing’ which protected us from notice of predators etc)… then your flatmate shouts in ‘sorry, only me, I dropped a plate’. Deep sigh as your body returns to balance…

Those are examples of real practical problems that would benefit from fight or flight… after all, if you had to deal with a giant tarantula or a violent intruder, you would make good use of your body in its prepped and revved up state. And in both instances, within a very short time, we realise there has been a mistake in processing the event, and our body returns to balance (homeostasis) quickly. But – many of us have stress disorders that mean we are fighting ‘invisible tigers’ constantly – perceiving dangers and threats and ‘paper tigers’ in everyday situations, which brings on flight or flight even when there is no actual physical danger present or requirement for the pumping up.

Stress triggers that cause uncomfortable fight or flight symptoms are different for everybody, any number of things can mistakenly appear as a hazard or danger to our well being that we feel unable to cope with… General examples?  having to give a presentation, attend an interview, go on a date, drive in bad traffic, cope with your noisy children, sort out the bills, busy social occasions, talking to people you’re attracted to, oh… take your pick, you know who you are!


Click to read the new Berkeley study on how stress changes brain structure, and causes the brain to miscommunicate the need for fight or flight…

If you have anxiety (or label yourself a ‘worrier), the chances are that you are have normalised an inappropriate simmering in and out of fight or flight during the course of the day, with low to moderate stress hormone releases, which may cause general fatigue, confusion, and ill health – this could also contribute to a distorted view of the world and self sabotaging decisions and behaviours. You may think it’s just how it is, or it’s just how you are, but it’s not, it’s as real a physical issue as diabetes is, and it can be managed with CBT.

Or – you might have occasional situational anxiety – with conditioned triggers of fight or flight in specific situations – examples: public speaking anxiety, exam anxiety, social anxiety, office meeting anxiety …

Fight or flight has a lot of unhelpful and very real physical effects – whether low or moderate or high – recognise any of these classic physical changes when we’re in ‘it’s not ok’ mode? Heart racing, brain racing, over breathing, blushing, sweating, butterflies or sick feeling, trembling, tense muscles… (click on the image for a hi res view, and/or to print):


Of course, situations are only ‘it’s not ok!’ and a ‘fight or flight’ danger if you perceive them as such – today’s dangers are often psychological and /or social rather than physical, and those situations would benefit from a cooling down rather than a pumping up, wouldn’t they? That’s the human species design flaw. Our default response to threats is pumping up, no matter what the situation.

CBT teaches us real and practical skills to build awareness and management of our thinking styles using evidence based science, to recognise that our perception and thinking largely causes our ‘upsettness’ and the idea that we are unable to cope, and that we can un-upset ourselves with deliberate thought stopping and reframing and breathing it down. We can literally learn to build new healthy rational clear thinking that changes the default of perceiving hazards where there are none – literally rewiring new pathways in the brain and dismantling the old ones, developing new practical coping skills for a better and more comfortable life experience.

But… for the purpose of this post – let us just look at the physiology of fight or flight here – as it is shown to help people better manage the situation if they understand, scientifically, exactly what is happening and why. Understanding that fight or flight is a natural bodily reaction with a beginning, a middle and an end – and that it is actually a sophisticated elaborate chain developed to help and protect you – can be hugely helpful. YOUR BODY IS TRYING TO HELP YOU. This learning and awareness helps us to break down the cycle of fear that can happen otherwise, and can even calm us down – ideally halting the symptoms, or at least decreasing their ferocity and duration – helping us to ‘right our body balance’ in a shorter time frame.

OK … here is a list of the full Fight or Flight physicality ‘behind the scenes’ – (the science, the things we don’t realise are happening that result in the symptoms) – get familiar with them and take the mystery and fear out of your very human response:

  • Thoughts racing and disjointed – caused by an adrenaline release.
  • Dizzy / lightheaded –due to adrenaline and increased oxygen levels.
  • Surroundings seem distant or visual ‘tunnel’ –your pupils dilate to allow you to take in as much visual information as possible. Eyes refocus to the distance to spot danger.
  • Heart pounding – The heart starts beating faster to increase circulation, since the body anticipates it will be working harder to service the muscles.
  • Difficulty breathing – the lungs throat and nostrils open up to flood the lungs with enough oxygen to keep up with the increased circulation of blood (re-oxygenating it) – this can trigger shallow rapid breathing.
  • Shaky voice: an overload of oxygen (stimulous) interferes with vocalising.
  • Neck and shoulder tension – caused by oxygen pumping to muscles, and after effects as the oxygen reduces.
  • Blushing – Adrenaline causes your blood vessels to dilate in order to improve blood flow and oxygen delivery. As a result, the veins in your face dilate, allowing more blood to flow through them than usual.
  • Sweating – The body heats up because it is working harder to circulate blood. And then sweats so it can cool itself down / regulate temperatures.
  • Butterflies/’sick’ feeling – Cortisol shuts down your digestive system, (as it is not needed to fight or run), redirecting blood to essential systems such as the heart, lungs, legs and arms. This can also cause irritable bowel syndrome, nausea and diarrhea
  • Dry Mouth Cortisol shutting down inessential systems reduces saliva in the mouth.
  • Need to urinate (and maybe even pass a stool) The bladder and bowels may open out to reduce the need for inessential internal actions (and faeces & urine may have put off our attackers)
  • Trembling, wobbliness, tingling and shaking – an effect of adrenaline stimulus and oxygen stimulus (overloads).
  • Tightness in the chest and throat, difficulty breathing – the body is overloading on oxygen – which is dangerous if you do not burn the extra oxygen off. Therefore the body tries to reduce the levels by constricting the chest and the lungs, reducing breath intake…

It is common that some people feel even more anxious and scared when these physical effects of fight or flight kick in (they start out feeling anxious about the situation, then they get the physical symptoms and are freaked out by them as well – which accelerates and amplifies the symptoms in a vicious circle, and may even escalate up to an actual ‘panic attack’). For many, it quickly becomes the fear of the physiology itself that causes a major and ongoing problem (we want to avoid panicking, blushing, sweating, breathlessness – and we absolutely don’t want others to witness it, so worrying about panic makes us panic. THE THREAT RESPONSE BECOMES THE THREAT). You need correct data and rational thinking to understand and manage your body.

Simply put: physically you have pumped up with adrenaline and cortisol and oxygen – control all three of them by grabbing one, the OXYGEN with belly breathing…

Belly breathing: because so many symptoms are caused by the overload of oxygen/rapid breathing physiology – breathing control exercises are hugely helpful in easing them, and returning your body to homeostasis.

Click the soundcloud audio below for a super quick intro


Here’s a super simple illustration of what’s happening physically:


Journal and track your thoughts and beliefs around your particular situational anxieties – what are you thinking? How are you explaining the situation to yourself? Is it overdramatic and unhelpful? What is the evidence for your statement? What is the evidence against it? Can you moderate the language to stick to facts.

Attempting to ‘fight’ against the physical manifestations of anxiety almost always has the opposite effect and intensifies them. Try instead to understand them for the nuisance that they are, and ‘let them happen’ – try to ‘observe’ outside of yourself… tell yourself the science of what is happening to your body and why – e.g.:

“This sweating is simply my bodies way of regulating it’s temperature as it’s overheated because I’m scared of this situation and I’ve gone into fight or flight – it will stop as soon as I calm down – I’ll breath in and out slowly and deeply… I am ok, I can cope, this is ok…

There is no tiger. Feelings are not facts.”

Summary: what is happening with a person who reacts with anxiety and inappropriate physical symptoms is that their body is reacting to the situation as if were as dangerous as, say, a tiger or lion approaching to tear them apart. A false perception has occurred, triggering a very basic and automatic response. Your brain and body are trying to help you. We can learn to challenge our perception of events, and because the fight or flight response occurs only when we perceive danger, it can be avoided or minimized if we can convince ourselves there is nothing to fear.

We can challenge and relearn our behaviour and responses to stress triggers by restructuring our thoughts in a more rational and healthy way with CBT – but we also need practical management strategies for the physicality – this can help us to stave off panic and remain reasonably calm.


Medication: if your anxiety is extreme and affecting your life, please go to your doctor and discuss the situation, there is no shame – if you had high blood pressure or diabetes you’d accept it and address it pragmatically, right? treat this in the same way.  If necessary, there are several medication options that can relieve your symptoms immediately while you work on your new coping skills (e.g. Betablockers, which suppress the stress hormone involved in the fight-or-flight response. This helps control the physical symptoms of anxiety, or a benzodiazepine/tranquiliser…).

Exercise – when you feel your body go into fight or flight jitters, do 5 minutes of physical exercise if possible in the environment you’re in (run up and down stairs, do sit ups… something that uses your revved up state. Why do you think teachers are trained to get kids to do star jumps to manage their overexcitement?). The body has primed itself for something physically dramatic (the fighting the tiger or running away very quickly..) – and if you stay immobile it will be confused and take longer to return to homeostasis – the exercise will restore balance more quickly.

Walking – for people with ongoing general anxiety, it is a great idea to make long walks a regular part of your routine, a discipline that is part of your life. It will help to keep your digestive system and immune system stable, and will use up adrenaline and oxygen, and will counteract exposure to poor health issues.

Relaxation – choose deliberately to do something you find relaxing (movie, book, candles and music, a walk in park, whatever) – the body has a ‘relaxation’ physical response, which releases chemicals that reduce stress hormones, this slows your heart rate and lowers blood pressure and relaxes muscles, returning you homeostasis (balance). Click the soundcloud link below to play a guided muscle relaxation + guided imagery 15 minute audio:


Headach Clipart WomanEXTRA IMPORTANT NOTE – BEWARE CORTISOL (the stress hormone, or the ‘death hormone’ as it’s scarily called!) – it gets secreted when we are under physical and/or emotional stress. No matter what the source of stress, cortisol is released into the blood stream to help us cope, aiding our fight and flight response by putting sugar into the blood stream so our muscles and brain have the fuel needed to react.

Cortisol is generally high in the morning, but should subside by evening when our rest and repair system (parasympathetic system) is supposed to take over and return us to metabolic equilibrium (homeostasis).  Or… at least that scenario is the appropriate stress response by the body – BUT, todays lifestyles and challenges mean that more and more of us are in a state of high cortisol most of the time – as our system keeps us in a constant state of ‘readiness’ for the perceived danger/threat of our ‘stressors’.

This is very dangerous to our health as cortisol curbs functions that are not essential for fight or flight, which alters the immune system responses and suppresses the digestive system, the reproductive system and the growth process. Long-term overexposure to cortisol and other stress hormones can disrupt almost all your body’s processes. This puts you at increased risk of numerous health problems, including:

Irritable bowel syndrom – Heart disease – Sleep problems – Digestive problems – Depression – Obesity (particularly depositing fat around our middle section) – Accelerated aging – Memory impairment – Skin problems – susceptibility to illness, etc.

These physical health implications are why it’s so important to learn healthy ways to cope with the stressors in your life to help the body stay at (or return quickly to) hormonal balance/homeostasis

CBT – learning how to view events and situations in a way that is in proportion to their actual effect on you/your life, will help control your emotional response to them… reducing the instances and strength of fight or flight manifestation. You should also explore relaxation and visualisation exercises, and of course a good diet and time set aside for regular physical exercise will play a part. As will maximising satisfactions and benefits in your ‘life areas’ (You like walking by the sea? Do it more! You dislike something? Do it less!)
Caveman and Tiger

Click to see a short cartoon movie of ‘fight or flight’ (flash only, so won’t work on mobile devices)

Task: create a two column chart, in the first column write out a list of physical symptoms you feel when stressed, and in the second write out the scientific explanation for each one. Study & remember.

DOWNLOAD A PDF WORKSHEET: CBTAFGHandout_fightorflightform

9 thoughts on ““Oh God, I’m shaking, I feel sick!” (the physiology of fight or flight / panic attacks)

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