Most stress advice assumes you're calm enough to follow it. Deep breathing. Meditation. Regular exercise. All good for prevention, and close to useless when your heart is pounding, your chest is tight and you can barely think.
So start with the one fact worth holding on to. A panic attack is usually at its worst within about ten minutes, and it often lasts around half an hour. It is frightening, it is often mistaken for a heart attack, and in itself it is not physically dangerous.
Your job is to get through those minutes, and there are things that help. None of them needs you to be calm first.
Is this a crisis?
Ordinary stress builds slowly and answers to the usual fixes: a break, a walk, a talk with a friend. A crisis overwhelms them.
The body's signs are a racing or pounding heart, feeling you cannot get enough air, a tight or painful chest, dizziness, tingling or numbness in the hands and feet, hot flushes or chills, nausea, and shaking you cannot stop. The mind's signs are thoughts racing too fast to grab, feeling detached from yourself as if watching from outside, a sense of doom, an urge to run without knowing where, and being unable to make even a simple decision. One sign on its own is ordinary stress. Several at once is a crisis.
It does not always look like panic. For some it comes out as rage. For others it is a shutdown: going numb, feeling nothing, too exhausted to move.
Why thinking goes first. Even mild stress that you cannot control causes "a rapid and dramatic loss" of what the prefrontal cortex does, the part of the brain that plans and reasons. That is why advice that needs thinking fails in the moment. Body first. Words second.
The first minute
One or two sighs. Breathe in through the nose, top it up with a second short sniff, then let it all out slowly through the mouth, longer than the breath in. Once or twice is enough. More can make you watch your own breathing, and that can make it worse. As a daily five-minute practice, this "cyclic sighing" did more for mood over a month than meditation did, and How to Build Resilience When Everything's Falling Apart, linked below, has that test.
Cold water on the face. Chilling and wetting the face while you hold your breath sets off the diving reflex, which slows the heart. It has to be the face: cold hands do not trigger it. Splash cold water over your face and hold your breath for a moment, or press a cold, wet cloth or a from the freezer over your eyes and cheeks. If you wear contact lenses, take them out first or use the cold pack. In humans the reflex can also upset the heart's rhythm, so if you have a heart condition, use another tool. When Sunday Night Feels Like Preparing for War: Emergency Workplace Survival Tactics has how much the reflex slowed the heart.
Your senses. Name three things you can see, three you can hear and three you can feel, out loud if you can: the blue mug, the crack in the wall, the tree outside; traffic, the heater, a voice next door; the chair under you, your feet in your shoes, the keyboard under your fingers. Press your feet flat into the floor and push. Grip something cold or textured and describe it to yourself: temperature, weight, shape. Nothing tests this exact routine. It pulls your attention into the present, and it costs nothing to try.
A sharp taste. Bite into a lemon wedge. An intense sour taste drags attention out of the spiral. If you hate sour things, skip it, because it will only add to the distress. The sour sweets sold for this are mostly sugar; a lemon gives the same jolt without it. It is the cheapest tool on this page.
Choose by how you are. If you can move freely, start with cold water or hard movement. If you feel frozen, start with tiny movements, wiggling your toes or blinking on purpose, then a sigh. If you are raging, burn it off first with hard movement or a pillow to punch, and leave calming for afterwards. If you feel detached, use strong sensation: cold, sour, texture. If breathing feels impossible, skip the breathing and go to cold water first.
The next ten minutes
Once the first wave breaks, these help keep it from coming back.
Tense, then let go. Make tight fists, hold for a few seconds, then let go completely and notice the difference. Work through the arms, the shoulders pulled up to the ears, the face, the jaw, the stomach, the legs and the feet. Edmund Jacobson first presented this progressive muscle relaxation in 1908, and his work is the reason "relax" came to mean becoming less tense. In a crisis the aim is to give the energy somewhere to go. Deep calm can come later.
If you are frozen, start smaller: one toe, one hand, one deliberate blink. Then build.
Move. Your body has just been readied to run or fight, and sitting still leaves that charge with nowhere to go. Walk fast, jog, run on the spot, dance hard. If you have been frozen, shake out your hands and legs before going hard.
There is a test of this, from the other direction. Twelve people with panic disorder and twelve without were given a drug that brings on panic attacks, once after half an hour of rest and once after half an hour on a treadmill. After rest, 15 of the 24 had a panic attack. After the treadmill, 5 did. Fifteen panic attacks against five. The treadmill won. The patients with panic disorder felt more physical symptoms straight after the exercise itself, without feeling more anxious. Across 36 tests, a single bout of exercise lowered anxiety a little.
So after you move, notice the difference: your heart is racing from effort now, not from fear. That is a lesson worth letting your body learn.
Hum, sing, or say it. Hum a single note for as long as one breath out lasts, a few times over, or sing, loudly, wherever nobody minds. Then name what is happening: "I'm having a panic attack. My heart is racing. My hands are shaking. I'm safe right now, even though it doesn't feel that way." Putting a feeling into words has been tested. In a brain-scan test, naming the emotion in a picture dampened the brain's alarm centre, the amygdala, more than other ways of responding to it did. It feels silly. Do it anyway, even in a whisper.
Breathe slowly. Put a hand on your stomach. Breathe out fully, then breathe in slowly through the nose, belly first and then the chest, and keep going for a few minutes. Box breathing, in which you breathe in, hold, breathe out and hold again for the same count, is another option. Breaking Free from Low Moods: Powerful Strategies to Reset Your Mind and Energy has the test in which it was one of three breathing methods tried.
Slow beats deep. 37 people with panic disorder were taught to breathe more slowly, guided by a meter that reads the carbon dioxide in each breath out, with the aim of raising it. Their panic and their avoidance of places both improved, and the gains held at a year. It was a small first test, and it is one more reason not to gulp air.
Leave the paper bag alone. Breathing into one is the old remedy, and it is no longer advised: slowing the breath by counting does the same job more safely.
Your plan
Write it while you are calm. In a panic, the ability to remember options and choose between them collapses, and a written plan does the choosing for you.
The evidence for having one is strong. 1,640 American veterans seen in hospital emergency departments for suicide-related concerns were followed for six months. Those given a written safety plan, with follow-up calls to review it, had 45% fewer suicidal acts than those given usual care. A sheet of paper and a few phone calls did that. A panic plan is a gentler thing, and the principle is the same: the plan makes the decisions you cannot make in the moment.
What goes in it. First, a short list of actions, in order: two sighs, cold water on your face, three things you see, hear and feel, two minutes of hard movement, then a call to one named person, with the number written out. Then a last line: if it is not easing after half an hour, or if you are thinking of harming yourself, call a crisis line or emergency services. Then the numbers: one or two people you trust, your crisis line, and the nearest hospital with an emergency department. In the United States and Canada the crisis line is 988, open day and night, and if speaking is impossible you can text HOME to 741741. Anywhere else, look up your local number now and write it in. Finally, your medicines, your allergies, and what helps or makes things worse, so whoever is with you knows.
The kit. A small bag with a soft gel cold pack that bends round the face, a bottle of cold water, a lemon or something else sharp to taste, something textured to grip, such as , the plan on a card, and anything that is yours alone: a playlist, a photo. Keep one at home, one in your bag or car, one at work. Build it while you are calm.
One limit. The kit is for a crisis. In a test with people who had panic disorder and avoided places because of it, those who dropped their usual safety habits during a short spell in a feared situation had lost more of their fear two days later than those who kept them. So use the kit when you need it, and do not let carrying it become the only reason you dare to go out.
Test it. A plan you have never tried is usually too long to use. Try it on a mildly stressful day, before a difficult phone call or while waiting for news, and cut whatever you could not follow. A fire drill is dull for the same reason it works. Do not use coffee to raise the stakes. In all eight controlled tests in people with panic disorder, caffeine raised anxiety or set off panic. Keeping caffeine out of your day is part of the plan.
Share it. Tell the people on it what helps ("Stay with me and remind me to breathe") and what does not ("Don't tell me to calm down").
Between crises
Learn your early signs. A crisis usually builds before it breaks. After each one, write down what you were doing, thinking and feeling in the hours before, and what you felt first: a tight jaw, a knotted stomach, a headache in a particular place, a slide into catastrophic thinking, pulling away from people. Read the notes back once a month. Catching the build-up lets you act before the break.
Sleep. Even modest cuts in sleep, the ordinary night-to-night kind, predicted more anxiety the next day. A short night lowers the threshold.
Eat real meals. Low blood sugar brings a fast heart, sweating, shakiness and nervousness, the same signs as panic. Meals built on meat, fish and eggs, with the sugar left out, keep the floor steady.
Move every day. Any kind, any amount. Defy Aging with Movement: How Exercise Keeps You Strong, Sharp, and Independent for Life has how little it takes to count.
Prepare your answers. In a crisis the inner voice turns on you: "I can't handle this." "Something terrible is happening." "I'm losing control." Write true, specific replies while you are calm, and say them out loud on ordinary stressful days, so they are there when you need them. "I can't breathe" gets "I am breathing right now." "I'm losing control" gets "I'm having a panic attack. It will pass. I've got through this before." The reply does not have to make you feel better. It has to be true.
A racing heart can be renamed too. Before singing karaoke, speaking in public or doing maths, people who said "I am excited" out loud felt more excited and did better than people who tried to calm down. And people told to see their racing heart as their body getting ready had a more efficient heart response under stress. Those were tests of ordinary nerves, not panic attacks. Still, on a bad day, "My heart is getting me ready" is truer than "I'm dying".
Ask two questions. When everything piles up at once, ask: what do I know for certain, and what can I control right now? At work: the project is late, I am at my desk, I have my phone; I can email my manager about the delay, ask one colleague for help, and finish the task in front of me. In a row: my partner is angry, I am upset, we are both saying things we will regret; I can stop talking, go to another room, and text "I need 20 minutes, then we can talk." With money: I am short on rent, I have $200, it is due at the end of the week; I can call the landlord today and sell something this week. Do the one thing you can do. Then the next.
Helping someone through one
Their thinking has gone offline, so they cannot pick a technique. You become the calm one: structure, presence and simple physical steps.
Read the state. In panic, they breathe fast, clutch their chest or throat, and may say they are dying. Do not tell them they are fine; offer something physical: "Let's put some cold water on your face," or "Can you feel your feet on the floor?" In rage, they shout, square up or throw things. Step back, do not argue, and wait for the peak to pass. If violence looks likely, leave and call for help: your safety comes first. In dissociation, they stare, do not answer and seem not to be there. They need grounding more than calming: use their name, ask them to name things in the room, hand them something cold. In a freeze, they cannot move or speak. Start tiny: "Can you blink twice? Can you squeeze my hand?"
Mind the place. In a car, get them to pull over if they are driving, and do not grab the wheel; once stopped, open the windows, use cold water from a bottle, and do not drive on until they are steady. At work, get them somewhere private, and do not announce what is happening. In public, find a quieter corner, use your body as a screen, and keep hold of their phone and bag. On the phone, coach the breathing and the grounding by voice, stay on the line through the silences, and get their exact location early.
Mind the space. Stay about two arm-lengths away, at their eye level, with your hands visible and still. Do not touch them unless they ask, and ask first: "Would a hug help?"
What to say. Acknowledge without arguing. "That sounds terrifying" works better than "There's nothing to be scared of." "I can see you're really upset" works better than "Calm down." "I'm here with you" works better than "I understand", which can sound dismissive to someone in the middle of it. Do not hand them a paper bag; count slow breaths with them instead. Do not tell them to calm down, relax or breathe: orders they cannot obey only add failure to fear. "Calm down" has a poor record. Do not take what they say personally. Speak more quietly if they are loud, and move slowly if they are frantic.
Offer two choices at most. "Sit or stand?" "Stay here or go outside?" A small choice gives back a little control. If behaviour becomes unsafe, say so calmly and follow through: "I want to help you, but I can't stay if you're throwing things." If someone threatens harm to themselves or anyone else, call for help even if they beg you not to.
Check yourself first. Two slow breaths, feet on the floor. If you are too shaken to help, say so and call someone who can. Expect to be tired afterwards.
Words to borrow. For panic: "You're having a panic attack. It feels terrible, but you're not in danger. I'm staying right here." For rage: "I can see you're really upset. I'm going to give you some space. I'll be in the kitchen when you're ready." Then go. For dissociation: "[Their name]. Look at me. Tell me what colour my shirt is. Name three things you can see." For a freeze: "You don't have to move yet. Just blink if you can hear me. Good. Now can you squeeze my hand?"
When it is not panic
Call emergency services straight away for chest pain that does not ease, breathing that keeps getting worse, confusion, hallucinations, a threat of violence to anyone, or someone unable to look after their basic needs. A panic attack is often mistaken for a heart attack, and the opposite mistake is the dangerous one. If you are unsure, get checked. A wasted trip is better than a missed emergency.
If there are thoughts of suicide or self-harm, or the panic will not ease whatever you do, call a crisis line: 988 in the United States and Canada, or your local crisis line or emergency number anywhere else. 988 puts you through to trained crisis counsellors, day and night. If you cannot speak, in the United States and Canada you can text HOME to 741741 instead, free and confidential.
Some crises do not answer to any technique, because the cause is physical. Medicines: stopping or cutting down a medicine can bring on panic that no breathing will touch, so get medical help. The body: an overactive thyroid, heart disease, lung disease and low blood sugar can all produce the same signs as panic, so new symptoms, or symptoms worse than any attack you have had before, mean getting checked. Substances: caffeine, nicotine, cannabis and withdrawal from a drug can all set off panic, and withdrawal from heavy drinking can bring seizures and can be fatal untreated, so it needs medical help.
Asking for help is not overreacting. Crisis lines exist for the moments when you are not sure.
When attacks keep coming
If attacks keep returning, or the fear of the next one starts to shape your days, it has a name: panic disorder. Between 1 and 4% of people have it at some point in their lives, and it is treatable. Across 54 tests with 3,021 people, talking treatments did better than waiting, and the one with the most tests behind it was cognitive behavioural therapy. The evidence was rated low quality, and it still points one way. It is worth seeking out.
Watch for avoidance too. After panic attacks, some people begin to fear places where escape feels hard: public transport, shops, crowds, queues, being out alone. That fear is called agoraphobia, and the avoidance can grow until, in severe cases, a person cannot leave home. The tests above included people with agoraphobia, and it is one more reason to keep the kit a tool and not a crutch.
, by Edmund Bourne, is a long-running self-help workbook for anxiety and panic, for the time between attacks.
Afterwards
Rest, but do not force sleep. Lie down somewhere quiet. Shower if it helps. Walk slowly or stretch gently.
Drink water, and eat a proper meal. Meat, fish or eggs, not something sweet.
Expect waves. The hours and days after can bring exhaustion, numbness, poor concentration, sore muscles and a feeling of being fragile. Feeling better, then crashing again, is normal.
Decide nothing big for a day. Give your thinking a day to come back before you make a major decision, or pick over what the attack meant.
Reach out. Tell someone you trust: "I had a really hard time today and I'm okay now." If you are not ready to talk, go somewhere with people around you: a café, a library, a park.
Drop the shame. The embarrassment afterwards often hurts more than the attack. Your body did what it is built to do when it sensed a threat. Judging yourself for it is like criticising yourself for bleeding when cut. You would not apologise for a sprained ankle. It is common, too: in a given year, about 3% of people in Europe and about 11% in the United States have a panic attack.
Test everything before you need it
Most stress advice assumes you are calm. The point of everything above is that you will not be, and you can prepare anyway: the first minute, the next ten, the plan, the kit, the people.
Keep your plan where you can find it. Build the kit. Share the plan with the people on it. Test all of it.
You will not be calm next time. You can be ready.
Tonight, while you are calm, write the plan: five steps, two names and the numbers to call.
Want the everyday side of this? How to Build Resilience When Everything's Falling Apart — sleep, the month of daily sighing, money and people, for when life itself is the crisis.
Wondering whether a supplement could take the edge off? Why Most Stress Supplements Fail (And the 9 Worth a Look) — which ones have evidence behind them, and which are marketing.
Do you know someone who gets panic attacks? Send them this, and offer to be a name on their plan.
Disclaimer: This article is general information. For advice about your own health, talk to a qualified health professional. If you are in crisis or thinking of harming yourself, call your local emergency number now, or 988 in the United States and Canada.
Affiliate Disclosure: This article contains affiliate links. As an Amazon Associate, All For Life earns from qualifying purchases, at no extra cost to you. We only link to products we would recommend without the commission.
Sources
Wikipedia. Panic attack. en.wikipedia.org
Arnsten AFT (2009). Stress signalling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience 10(6):410–422. doi.org/10.1038/nrn2648
Balban MY, Neri E, Kogon MM, et al. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine 4(1):100895. doi.org/10.1016/j.xcrm.2022.100895
Wikipedia. Diving reflex. en.wikipedia.org
Wikipedia. Progressive muscle relaxation. en.wikipedia.org
Ströhle A, Graetz B, Scheel M, et al. (2009). The acute antipanic and anxiolytic activity of aerobic exercise in patients with panic disorder and healthy control subjects. Journal of Psychiatric Research 43(12):1013–1017. doi.org/10.1016/j.jpsychires.2009.02.004
Ensari I, Greenlee TA, Motl RW, Petruzzello SJ (2015). Meta-analysis of acute exercise effects on state anxiety: an update of randomized controlled trials over the past 25 years. Depression and Anxiety 32(8):624–634. doi.org/10.1002/da.22370
Lieberman MD, Eisenberger NI, Crockett MJ, et al. (2007). Putting Feelings Into Words: Affect Labeling Disrupts Amygdala Activity in Response to Affective Stimuli. Psychological Science 18(5):421–428. doi.org/10.1111/j.1467-9280.2007.01916.x
Meuret AE, Wilhelm FH, Ritz T, Roth WT (2008). Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder. Journal of Psychiatric Research 42(7):560–568. doi.org/10.1016/j.jpsychires.2007.06.005
Wikipedia. Hyperventilation syndrome. en.wikipedia.org
Stanley B, Brown GK, Brenner LA, et al. (2018). Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department. JAMA Psychiatry 75(9):894–900. doi.org/10.1001/jamapsychiatry.2018.1776
Wikipedia. 988 (telephone number). en.wikipedia.org
Wikipedia. Crisis Text Line. en.wikipedia.org
Salkovskis PM, Clark DM, Hackmann A, Wells A, Gelder MG (1999). An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia. Behaviour Research and Therapy 37(6):559–574. doi.org/10.1016/S0005-7967(98)00153-3
Vilarim MM, Rocha Araujo DM, Nardi AE (2011). Caffeine challenge test and panic disorder: a systematic literature review. Expert Review of Neurotherapeutics 11(8):1185–1195. doi.org/10.1586/ern.11.83
Ben Simon E, Rossi A, Harvey AG, Walker MP (2020). Overanxious and underslept. Nature Human Behaviour 4(1):100–110. doi.org/10.1038/s41562-019-0754-8
Wikipedia. Hypoglycemia. en.wikipedia.org
Brooks AW (2014). Get excited: Reappraising pre-performance anxiety as excitement. Journal of Experimental Psychology: General 143(3):1144–1158. doi.org/10.1037/a0035325
Jamieson JP, Nock MK, Mendes WB (2012). Mind over matter: Reappraising arousal improves cardiovascular and cognitive responses to stress. Journal of Experimental Psychology: General 141(3):417–422. doi.org/10.1037/a0025719
Wikipedia. Alcohol withdrawal syndrome. en.wikipedia.org
Pompoli A, Furukawa TA, Imai H, et al. (2016). Psychological therapies for panic disorder with or without agoraphobia in adults: a network meta-analysis. Cochrane Database of Systematic Reviews 2016(4):CD011004. doi.org/10.1002/14651858.CD011004.pub2
Wikipedia. Agoraphobia. en.wikipedia.org