‘When the sirens go off, it feels like a heart attack’: Anxiety increases during war

Her story reflects the complex reality that Israeli civilians have faced for more than two and a half years, one that has taken a toll on people’s mental health. Over the weekend, Israel marked one month since the start of the second Iran war, during which more than 82,000 sirens were sounded across the country – fueling the protracted conflict on multiple fronts.

Dr. Gilad Bodenheimer, head of the Ministry of Health’s mental health department, said the term “panic disorder” refers to a wide range of psychological reactions to traumatic events, not just classic panic attacks. In the past, many such patients ended up in hospitals, but in recent years – including the current operation – fewer have sought care in emergency rooms than in previous wars. “This is a positive development,” he said.

He noted that the goal is for people to get support through hotlines, resilience centers, field responses and social services, which will reduce the burden on emergency rooms. However, in cases of mass casualties, hospitals activate special protocols, including the opening of stress treatment sites, such as the one established at the Soroka Medical Center after the missile attack near Ard and Dimona. At the same time, resistance teams are being strengthened across the country, and first aid is being provided in hotel accommodations.

Dr. Oren Tan, director of the Department of Psychiatry at Achilov Hospital and head of the Institute of Mental Health, said that people who come to emergency rooms are usually people who are physically injured and very anxious, or people who come directly from an accident with severe distress. Treatment varies, he said, because “anxiety victims” are not the same group. “Some experience short-term anxiety due to an acute traumatic event, while others develop severe panic attacks due to chronic security conditions. It is important to recognize that anxiety attacks can occur in mental health conditions including OCD, post-traumatic stress disorder (PTSD) and depression, not just panic disorder.

Tan explained that treatment for severe anxiety is focused on restoring a sense of safety and control, with medication used only in rare cases — when anxiety persists or interferes with sleep and activity. “The key principle is not to argue with the patient’s experience. Saying that there is no reason to worry or that they should relax does not help. Anxiety is a very personal experience, and such responses can make patients feel misunderstood.”

“The main goal is to help the person understand that what they are experiencing is very unpleasant, but it will pass and is not dangerous,” he added. “People don’t die from anxiety, pass out and go crazy – even though that’s a common fear. Cases of cardiac arrest due to anxiety, despite the media attention, are very rare.”

An anxiety attack is defined as an intense, often sudden wave of anxiety, accompanied by the feeling that something bad is about to happen or is about to happen. “Some people think, ‘I’m dying,’ ‘I’m fainting,’ or ‘I’m losing control,'” Tan said. These thoughts are accompanied by physical symptoms, sometimes preceding the attack itself. “The wave combines destructive thoughts with physical symptoms such as chest tightness, rapid heart rate, difficulty breathing or swallowing, shaking and dizziness.”

He added that symptoms, such as burning in the fingers and around the mouth, or a cold feeling in the feet, are caused by hyperventilation – when the body goes into “fight or flight” mode without taking action. Other symptoms may include disorientation and alienation, where a person feels detached, as if seeing themselves from outside or living in a movie.

Bodenheimer noted that in rare cases, anxiety attacks can cause a loss of muscle control or even control of bodily functions. Regardless of severity, an anxiety attack—especially in response to trauma—is not considered an anxiety disorder, which involves repeated episodes. He said that stress reactions to a life-threatening event fall within the normal range, although prolonged exposure to repeated trauma increases the risk of conditions such as PTSD, depression and anxiety.

Cecil Prinz, 39, from Crete Bialik, has worked in mental health for more than a decade as a social worker and therapist with the Enoch Community, which supports people with mental health challenges. He also lives with complex PTSD.

“The feeling of insecurity is something I understand, but when there’s a real threat, it gets stronger,” she said. “Every time there’s an alert and a siren, I feel a lot of stress — heartburn, sweating, shaking, thoughts that I’m losing control, and panic.”

She said the attacks also lead to prevention. “My mother lives in Haifa – it’s not far – but I haven’t seen her in a month because I’m afraid a siren will hit me on the way. My husband’s workplace agreed to let me come, and I work there from a safe place. It’s the only way I can maintain a routine.”

“Living through such a period, with such intense anxiety attacks, is exhausting. It’s debilitating both physically and mentally,” she said, stressing the importance of community support. “When someone sees you, gives you space, reaches out — even just a hug — it’s important.”

Tan emphasized that panic attacks are self-limiting. “People try to fight anxiety in every way, but then the body doesn’t know that it’s a wave that rises and falls on its own. In most cases, an anxiety attack lasts 30 to 40 minutes.”

Experts say that one of the most important factors in coping is the presence of another person. “During anxiety, there’s a sense of losing control, so we look for an anchor—someone stable to help us, like something to hold on to,” Bodenheimer explained.

Even the presence of a stranger can help, experts say. “Look out for people who need help outside,” ex-hostage Romi Gonen wrote on Instagram last week, describing a severe anxiety attack she experienced on the street during sirens. “I had the worst anxiety ever since I got back, and I was alone. Thank God there were good people who stepped in to help me right away – thanks to them for pulling me through.”

Tan said that human contact is important. “If someone close to you can calmly talk and say, ‘I’m here with you as long as this goes,’ it can only be very helpful.” Providing simple explanations for what a person is experiencing can also reduce anxiety, as can help restore a sense of control.

The Ministry of Health recommends immediate aid in cases of acute trauma using the Masiya model – which is the Hebrew acronym for the National Psychological First Aid Method developed by Professor Moshe Farchi. The model includes four principles: providing commitment and a sense of security; encourage effective action; asking simple, basic questions; and the structure of the sequence of events. “In a traumatic event, the first goal is for the person to feel safe and know that we are with them,” Bodenheimer said.

He added: “We ask simple questions that activate thinking – like who was with you, how many people were around – and encourage action. This strengthens a sense of control and competence, disconnects from paralyzing emotions and helps the person learn how to process and organize the brain.”

In stressful situations, when there is no immediate danger, Bodenheimer recommends breathing exercises, guided imagery, muscle relaxation, talking to someone close to you, listening to calming music, and even watching familiar content. He said: “I hear a lot of people returning to heartwarming comedies these days, from ‘Friends’ to ‘Modern Family’ – shows they know by heart. Familiarity helps and comforts.”

The health system is preparing for a wave of post-war mental health cases. “We have a comprehensive, structured plan, and it will continue to be developed,” Bodenheimer said in a briefing two weeks ago. Tan noted that psychological responses to dramatic events are not always clear when they occur. Many conditions, such as depression or OCD, do not “take into account” external circumstances and can worsen during or after a conflict. He said there has been an increase in the number of patients experiencing deterioration, including individuals who were previously stable.