What to Do During a Panic Attack

If you're reading this in the middle of one, start here: what you're feeling is awful, and it is not dangerous. Your heart is pounding, your breath won't catch, the room feels unreal, and some part of you is certain something is terribly wrong. That certainty is the panic talking. A panic attack is a false alarm, your body's emergency system firing at full strength when there's no actual emergency. It cannot hurt you, and it will end.

The most important thing to hold onto is the shape of it. Panic attacks rise fast, peak within about ten minutes, and then come down on their own, usually settling within twenty to thirty minutes. They have a ceiling and an end. You don't have to make it stop. You have to get through the next few minutes, and your body will do the rest.

Why it feels so physical

Every symptom that scares you is part of one ancient, protective response, sometimes called fight-or-flight. Your brain has decided there's a threat and flooded your body with adrenaline to deal with it.

That's why your heart races, it's pushing blood to your muscles. It's why your breathing speeds up and your chest feels tight, you're taking in oxygen for action that never comes. The dizziness, the tingling fingers, the feeling of unreality: all of it comes from rapid breathing and a surge of adrenaline, not from anything breaking down inside you. Many people going through their first panic attack are convinced they're having a heart attack or losing their mind. That fear makes complete sense, and it's also part of the trap, because the fear feeds the symptoms, which feed more fear.

Knowing what's actually happening takes some of the fuel away. When the sensations stop meaning "I'm in danger" and start meaning "my alarm is misfiring," they lose much of their grip.

A plan for the moment

You don't need all of these. Pick whatever you can reach.

1. Name it. Say to yourself, plainly: "This is a panic attack. It's horrible, and it's not dangerous, and it will pass." Naming it reminds the thinking part of your brain that you are not, in fact, in danger.
2. Slow your exhale. Don't try to take big gulps of air, that often makes it worse. Instead, make your out-breath longer than your in-breath. Breathe in for a count of four, out for a count of six. The long exhale is the signal that tells your body the threat is over.
3. Come back to your senses. Look around and name five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste. This pulls your attention out of the spiral of "what if" and into the room you're actually in.
4. Try something cold. Cool water on your face or wrists, or holding an ice cube, can interrupt the surge surprisingly fast.
5. Stop fighting it. This is the hard one and the important one. Bracing against a panic attack, trying to force it away, tends to stretch it out. Letting the wave rise and fall, trusting that it will fall, lets it move through faster.
6. Stay where you are if you safely can. The urge to flee is strong. But running from a place teaches your brain that the place was dangerous, which makes the next time harder. Riding it out where you are teaches your brain the opposite.

When it begins to ease, and it will, be gentle with yourself. Getting through a panic attack takes real effort, even though from the outside it might look like you just stood there breathing. You did something hard.

A note on the body, and on being sure

Panic and serious medical problems can share symptoms, and that overlap is part of what makes panic so convincing. If you've never had these sensations checked by a doctor, or if something feels genuinely different from your usual pattern, pain spreading down an arm, a kind of chest pain you haven't felt before, it's wise to get evaluated rather than assume it's panic. Taking your body seriously and managing your anxiety are not opposites.

After the storm

A single panic attack is exhausting but not, on its own, a diagnosis. Many people have one and never have another. What turns panic into something larger is often the fear of the next one, and the slow shrinking of your life as you start avoiding the places and situations where one might happen.

That's the part worth taking seriously, and the good news is that it responds remarkably well to help. Panic is one of the most treatable things a therapist works with. If attacks are recurring, or if you've started steering your days around the fear of them, please reach out to a professional. You don't have to white-knuckle this alone, and you don't have to wait until it's unbearable to deserve support.

Sources

• National Institute of Mental Health, Panic Disorder: When Fear Overwhelms
• Cleveland Clinic, Panic Attacks and Panic Disorder: Causes, Symptoms and Treatment
• Cleveland Clinic, Grounding Techniques to Calm Anxiety