Mine manifests both ways-seems like it's always a different combo of each-a lot of times I try & walk or shake it off, go to a quiet place, journal, have some tea, listen to relaxations music etc. I'm taking propranolol 10mg twice daily to address the physical symptoms. I tend to hyperventilate when it gets really bad so I have small paper bags (from the pharmacy-the perfect size) stashed in the house, my purse & in the car.