What to Do When You Are Having a Panic Attack

By William Schroeder, LPC, NCC and clinically reviewed by Teri Schroeder, LCSW

A panic attack feels like you are going to die, and then it gets worse. For me it has felt like someone wrapped wire around my ribs and pulled it tight. My lungs couldn’t get enough air and my heart raced. If you are having a panic attack, the most important thing to know is that it will pass, and it will not kill you. It can feel miserable in the moment. Knowing that alone helps a lot.

This post covers what to do when you are having a panic attack, why your body does this, and how therapy helps panic fade over time.

What to Do During a Panic Attack

The goal in the moment is to ground yourself, which means connecting to where you are right now. Try these, in whatever order works for you:

• Orient to the room. Look around and name where you are, the day and the time.
• Use your senses. Notice things you can see, things you can touch and anything you can smell.
• Slow your breathing. Breathe in through your nose, and make the exhale longer than the inhale.
• Hold onto a grounding thought. Something like “This is panic. It feels awful, and it will pass.”

Skip the paper bag. It used to be common advice, but it isn’t recommended anymore. Our post on paper bag breathing explains why and what to do instead.

Sometimes the thing that grounds you is surprisingly simple. Some people find that just knowing their as-needed anxiety medication is in their pocket is enough. They may never take it, and over time they stop needing to carry it.

Waking Up in a Panic

Some people wake up in the middle of the night already panicking. When that happens, the same grounding steps help: notice the room you are in, the time, what you can see and touch, and slow your breathing down.

Over the long run, it helps to understand what the trigger is. Was it a dream? Is it tied to something that happened to you, like a trauma connected to PTSD? Those are good things to work on in therapy.

Why Your Body Does This

A panic attack is your fight-or-flight response going off when there is no real danger. Your heart speeds up, your breathing gets fast and your chest muscles tighten. Your hands may tingle, and you may feel dizzy or unreal.

These sensations are uncomfortable, but they are not dangerous. A healthy heart can beat fast for a long time without harm. Chest tightness comes from tense muscles, not from running out of air. The trouble starts when we read a harmless sensation as a sign of disaster. That fear makes the sensations stronger, and the cycle spirals.

Panic is also more common than most people think. A large World Health Organization survey of nearly 143,000 adults in 25 countries found that about 13% of people have a panic attack at some point in their lives.

It Happens to the Strongest People

Panic attacks happen to everybody, including people you would never expect. Soldiers who have been to war, police officers and firefighters all have them.

Part of the reason is that in the moment, they have to swallow down what is happening to them and keep going. They have to cope with it later. There is also the fear of something worse happening, like having a panic attack in the middle of a dangerous call. That fear can bring on more panic.

Panic is not a sign of weakness. It is a sign that your nervous system has been carrying a lot.

When to See a Doctor

Panic can feel a lot like a heart attack, and many people end up in the emergency room. If you have chest pain, especially if it is new, get checked. If you think you might be having a medical emergency, call 911.

If you haven’t had a physical in a while, I always suggest getting one. You want to rule out a real health condition before assuming it is panic. Your primary care doctor is a good first stop.

How Therapy Helps Panic Fade

One of the hardest things about panic is the avoidance it causes. People start skipping places and situations where they had an attack. Working with a therapist helps you find what grounds you and slows things down when you feel out of control.

Depending on what is driving the panic, therapy might include:

• Interoceptive exposure. You practice bringing on the body sensations of panic on purpose, like a racing heart or dizziness, in a safe way. You learn to ride the wave and get through the worst part. Each time you do, you learn it won’t pull you under.
• Cognitive behavioral therapy (CBT). You learn to catch the scary thoughts that fuel the spiral and answer them with calmer, more accurate ones.
• EMDR. When panic is tied to a trauma, EMDR can help you work through the original event and build up inner resources.

The research on interoceptive exposure is strong. A 2018 analysis in Psychological Medicine looked at 72 studies of CBT for panic disorder with more than 4,000 people. Programs that included interoceptive exposure, and face-to-face sessions, worked better and were easier for people to stick with.

Over time, the symptoms lessen. That is what exposure and treatment do: each panic attack you get through teaches your body that you can get through the next one.

Getting Support in Austin

If panic attacks are getting in the way of your life, read more about our anxiety counseling, or tell us what is going on and a real person on our client care team will match you with a therapist who fits.

If you are thinking about suicide, call or text 988, the Suicide & Crisis Lifeline, any time.