Increased blood flow:

A pounding, racing heart results 
from a surge of adrenaline that 
causes stronger, more rapid 
contractions to increase blood flow. 
The heart compensates for quick, 
forceful beats by taking a pause, 
creating the sensation of thumping, 
or “missing beats.” Palpitations are 
a natural reaction to aerobic 
exercise, infection, exhaustion, 
caffeine, cigarettes, and troubling 
thoughts.

Hot flashes and sensations of 
“heating up” result from blood 
rushing to the center of the body 
due to increased heart action. To 
compensate, perspiration helps cool off the body. Coldness in hands and feet may result from blood rushing toward the center of the body.





Chest muscles contract:

Chest pain that feels like a pinprick 
or stitch is caused when chest wall 
muscles become tense. Sharp pain  is felt when the lungs expand during  inhalation. Deep breaths can be difficult until discomfort passes. A narrowing of arteries causes heart disease.

Trouble breathing can happen when tense chest muscles do not allow enough room for lungs to expand. To compensate, some people take large gulps of air or start breathing fast. Trouble breathing can also result from obesity, pregnancy, colds, asthma, and emphysema.

Hyperventilation happens when too 
much oxygen collects in the lungs 
due to rapid breathing and washes 
out carbon dioxide.

Giddiness, Tingling, or Numbness 
can be caused by oxygen collecting 
in the lungs due to rapid breathing. 
Physical conditions of anemia and 
carpal tunnel syndrome can also 
cause light-headedness or tingling.

Limb muscles tense:

Shakiness is the body’s way of 
releasing muscle tension. It often 
happens after lifting heavy objects.

Trembling can also be caused by 
hyperthyroidism and low blood 
sugar.

Feeling faint happens when blood 
flows away from the brain to “feed” 
tired tense muscles.



Throat muscles tense:

Difficulty swallowing can also feel 
like a “lump in the throat” or choking.




Jaw clenches:

Dizziness, disorientation, and 
floating feelings happen when jaw 
tension puts pressure on the inner 
ear. The same symptoms occur 
when the inner ear is stressed on 
amusement park rides. Fluid 
retention from colds, allergies, and 
thyroid problems can also strain the inner ear.

Nausea, diarrhea, and blurred 
vision happen when pressure on the inner ear irritates nerves to the 
stomach and eyes. Discomfort from 
fluorescent lighting, cloudy days, 
loud noises, and freeway driving 
can stress nerve endings and also 
aggravate inner ear problems.

Think: The heart muscle is very 
strong and cannot burst. A “nervous 
heart” is still in control and will 
always return to its normal rhythm.

Act: Consult a physician to rule out 
any physical problems: high blood 
pressure, mitral valve prolapse, 
menopause, hyperthyroidism, low 
blood sugar, anemia, or a heart 
condition.

Relabel palpitations as anxiety if 
physical problems have been ruled 
out.

Think: “Overheating” is a good 
aerobic exercise. It is identical to 
what occurs during heavy exercise.

Relabel changes in body 
temperature accompanying 
palpitations as a side effect of an 
adrenaline rush and increased 
heart activity.



Act: Have your doctor rule out heart 
problems, particularly if you have 
dull pain or pressure in the center of 
the chest that radiates to the neck, 
jaw, or left arm.

Relabel pain as “chest wall pain” 
due to stress once heart disease is 
ruled out.

Think: Breathing problems due to 
anxiety are no different from having 
trouble catching your breath after 
heavy exercise. It is impossible to 
stop breathing—just try holding your breath.

Relabel symptoms as the result of 
tense chest muscles if physical 
problems aren’t present.

Act: Breath into a paper bag to 
inhale carbon dioxide if too much 
oxygen is causing hyperventilation.

Act: See your doctor if symptoms 
occur at times other than during 
rapid breathing.

Relabel giddiness and numbness 
that accompanies troubled 
breathing as the result of too much 
oxygen from rapid breathing.



Think: Shaking can be a way to 
express joy, as the Shakers and 
other religious groups did.

Act: Unlock knees and let arms 
hang loosely so they can tremble 
freely. This allows shaking to pass 
more quickly.

Act: Slow down to let any faintness 
pass. Put your head between your 
knees to return blood to your brain 
if necessary.




Think: Swallowing is automatic.

Act: Try chewing a cracker without 
swallowing.



Act: Notice how far your jaw can 
drop with your mouth closed when 
you’re not upset. Clenching and 
letting go of your jaw can help 
during panic. Give symptoms time to pass. See your doctor for possible  inner ear problems.

Relabel symptoms as inner ear 
pressure.

Act: Relaxing your jaw may help 
blurred vision or nausea pass more quickly. Without rushing, you can  find a restroom. If you tell yourself it is okay to vomit, nausea often  passes.

Relabel symptoms that happen 
during anxiety as irritation of 
stomach and eye muscles.