What is happening in your body
A panic attack is a sudden rush of fear with strong physical symptoms: a pounding heart, fast or shallow breathing, sweating, shaking, dizziness, tingling hands, a churning stomach, and often a feeling that you are dying, losing control or not quite real. The NHS describes panic as the most severe form of anxiety.
The National Institute of Mental Health (NIMH) notes that some researchers think of panic attacks as "false alarms": the body's survival response switching on when there is no real danger. A pounding heart gets read as a heart attack, that thought adds more fear, and the fear produces more symptoms. Knowing this loop exists is useful, because the steps below work by interrupting it.
Timing matters too. Cleveland Clinic says symptoms usually peak within 10 minutes, and both Cleveland Clinic and the NHS say most attacks last between 5 and 20 minutes, with some reported to last up to an hour. NIMH adds that panic attacks are not life-threatening and that the physical symptoms usually resolve with time. You do not have to make the attack stop. You have to get through a short, intense stretch.
First, rule out a medical emergency
Panic and heart problems can feel alike, and only a medical evaluation can tell them apart. The National Heart, Lung, and Blood Institute (NHLBI) lists heart attack symptoms that overlap with panic, including chest pain or discomfort, shortness of breath, sweating, nausea, light-headedness and a racing or irregular heartbeat. It also says heart attack symptoms can be mild. Its advice is plain: call 911 any time you think you might be having a heart attack, even if you are not sure.
Cleveland Clinic gives the same advice for panic specifically: seek emergency care for chest pain, trouble breathing or fainting. If this is your first attack, if the symptoms feel different from your usual panic, or if you have heart risk factors, get checked. Being told "it was panic" in an emergency department is not a waste of anyone's time.
What to do during the attack
Cleveland Clinic is honest that there is no way to switch a panic attack off once it has started. What you can do is manage the symptoms until it passes. The steps the NHS and Cleveland Clinic suggest are simple:
- Stay where you are if it is safe. The NHS suggests staying put if possible rather than rushing to escape.
- Slow your breathing. Breathe in gently through your nose and out slowly through your mouth. Fast breathing feeds panic, so a longer, slower breath out is the goal, not a huge gulp of air.
- Name it. Say to yourself, "This is a panic attack. It is not dangerous, and it will pass." Cleveland Clinic notes that knowing you are having a panic attack, not a dangerous health event, can ease the fear.
- Loosen your muscles. Cleveland Clinic suggests relaxing one muscle group at a time: unclench your jaw, drop your shoulders, open your hands.
- Bring your attention to the present. Notice your feet on the floor or name a few things you can see.
The NHS also suggests focusing on calm, peaceful images and reminding yourself the attack is not life-threatening. If grounding through your senses helps you, Grounding Strategies: What They Can and Cannot Do covers more options and the cases where they do not fit.
A breathing pattern to practice when you are calm
Breathing is hard to learn mid-panic. The NHS offers a calming breathing exercise for stress, anxiety and panic and says it works best when done regularly, as part of a daily routine. Sit or lie comfortably with your feet flat on the floor. Let your breath flow down into your belly without forcing it. Breathe in through your nose, counting steadily from 1 to 5 if that helps, then let the breath flow out through your mouth for another count of 1 to 5. You may not reach 5 at first. Repeat for at least five minutes.
A few minutes a day, on ordinary days, means the pattern is familiar when you need it. Some people practice in the car before work or at bedtime.
What tends to make attacks worse
Both the NHS and Cleveland Clinic list caffeine, alcohol and smoking as things that can make panic attacks worse, and the NHS adds sugary food and drinks. Cleveland Clinic suggests checking with a provider before taking herbal supplements or over-the-counter medicines, since some can increase anxiety. Regular exercise appears on both lists as a way to lower stress and tension between attacks.
Avoidance is the less obvious one. NIMH notes that people may start avoiding places where attacks have happened, and the NHS describes how this can create a cycle of living "in fear of fear." Why Avoidance Makes Anxiety Grow explains that cycle and how people step back out of it.
If you are with someone who is panicking
Cleveland Clinic suggests staying with the person and staying calm yourself, asking what they need, speaking in short, simple sentences, and helping them focus on the present. You can breathe with them, counting slowly to five on each breath in and each breath out. Reassure them, gently and confidently, that the attack is temporary. If they have chest pain or cannot breathe, call 911 rather than guessing.
When panic needs more than self-help
NIMH is clear that an isolated panic attack is not a mental disorder. Panic disorder involves repeated, unexpected attacks plus at least a month of worry about more attacks or changes in behavior to avoid them. What Is Panic Disorder? explains the difference in more detail.
Cleveland Clinic suggests seeing a provider if attacks come with long-lasting anxiety that affects daily life, trouble concentrating, extreme irritability, fear of leaving home, symptoms that last longer than 15 minutes, or sleep problems. A good first step is a primary care visit; Cleveland Clinic notes that providers may check for heart, thyroid and breathing problems that can cause similar symptoms. It helps to bring notes: when attacks happen, how long they last, what you were doing, and how much caffeine, alcohol or medication was involved.
NIMH describes treatment for panic as psychotherapy, medication or both. Medication decisions belong with your physician, psychiatrist or psychiatric nurse practitioner; talk with your prescriber before changing anything. In anxiety therapy, Dr. Lehmann, a licensed clinical psychologist in Franklin, works in an insight-oriented, integrative way: practical ways to manage symptoms alongside a look at what the panic is connected to in your life and history. If you want a specific method, such as cognitive behavioral therapy, ask any therapist you consider about their training in it.