What to Do During a Panic Attack: Calming Down in 5 Steps

A panic attack is an intense wave of fear that most people experience at least once in their lives, peaking within minutes. A pounding heart, tight breathing, trembling, sweating and the feeling of "I am going to die" or "I will lose control" are typical signs. Although an attack is very frightening, it is not dangerous and usually passes by itself in 10–20 minutes.

5 steps during an attack

1. Name it: Tell yourself "This is a panic attack, it will pass." Interpreting bodily sensations as danger creates more fear than the attack itself.
2. Slow your breathing: Breathe in through the nose for 4 seconds and out through the mouth for 6 seconds. A long exhale calms the nervous system.
3. Return to your senses: Name 5 things you see, 4 things you touch, 3 sounds you hear. This "5-4-3-2-1" technique moves attention away from fear.
4. Do not flee: Leaving at once brings short-term relief but reinforces the brain's lesson that "that place was dangerous." If you can, stay where you are and ride the wave.
5. Be kind to yourself afterwards: Drink water, rest a little and note the event without judgement: when, where you were, what you were thinking.

What feeds panic attacks

Too much caffeine, irregular sleep, alcohol, long periods without food and ongoing stress raise the chance of an attack. If, after one attack, a person starts avoiding certain places for fear of another, panic disorder can develop.

When to see a specialist

• If attacks recur more than once a month
• If you avoid certain places for fear of a new attack
• If attacks began for the first time without a cause or are accompanied by chest pain (a medical evaluation is needed first)

Cognitive-behavioural therapy (CBT) is one of the most effective methods for panic disorder; most people feel clear relief within 8–14 sessions. In therapy you learn how an attack forms, get used to bodily sensations in a controlled way and reduce avoidance behaviours.

This article is for information only and does not replace a medical diagnosis. If there is chest pain, fainting or severe shortness of breath, call 112.

After the attack: anticipatory anxiety

Even after the attack itself has passed, many people carry the worry "will it happen again?" This is called anticipatory anxiety and pushes a person to monitor bodily sensations constantly: heartbeat, breathing, dizziness. But monitoring strengthens sensations. The way to break this cycle is to look at sensations with curiosity but without interfering, and to return gradually to the places you avoid.

How can people close to you help?

A person who is with you during an attack should speak in a calm voice and, instead of saying "calm down", say "I am here, let us breathe together." Belittling the attack or answering with panic increases the person's fear.