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Panic Attacks

What to Do During a Panic Attack: Minute-by-Minute Guide and 5-Action Framework

Panic Attack Guide Team29 min read
What to Do During a Panic Attack: Minute-by-Minute Guide and 5-Action Framework

DO THIS RIGHT NOW if you are having a panic attack

If you are in the middle of a panic attack, do these five actions right now. Do not finish reading first. Do it:

  1. Sit and ground. Feet flat on the floor or pressed into the ground. Hand on a chair, wall, or your own body. Feel the contact. Lower yourself if dizzy. Stay where you are if safe.
  2. Slow your exhale longer than your inhale. Breathe in through your nose for a count of 4. Breathe out through your mouth for a count of 8. Repeat 6 to 10 times. Slowly.
  3. Name what you see (5 things). Look around. Say or think: "I see the wall. I see a lamp. I see my hand. I see a door. I see the ceiling." Five things, any five. Use your senses.
  4. Tell yourself: "This is panic. It will peak in about 10 minutes and then pass." Say it. Do not argue with your fear. Just say the words and keep breathing.
  5. Stay where you are if you are safe. Do not flee. Avoidance teaches your brain to fear this place. Staying teaches your brain it is not actually dangerous. This is the hardest step and the most important one.

GO TO THE ER NOW

If you are reading this with any of the following, call 911 (US) or 999 (UK) or 112 (EU) immediately. Do not wait:

  • Chest pain that is heavy, crushing, or radiating to your arm, jaw, or back
  • Severe shortness of breath at rest
  • Fainting or feeling like you will faint
  • Slurred speech, confusion, or difficulty speaking
  • First-ever episode of these symptoms (cannot assume it is panic without medical evaluation)

This guidance follows Mayo Clinic and American Heart Association protocols. A chest pain ER visit is the correct call, even if it turns out to be panic. Anxiety is a diagnosis of exclusion, meaning cardiac disease must be ruled out first. See PAG row 17 for full panic attack vs heart attack guidance.

Direct Answer: What to Do During a Panic Attack

During a panic attack, focus on five actions: stay where you are if safe, slow your breathing with longer exhales than inhales (inhale 4, exhale 8), ground your senses by naming what you see or feel around you, label what is happening as panic not danger, and wait for the peak (about 10 minutes) and full resolution (20 to 30 minutes total). The key is not to fight the panic or flee from it. Panic is a time-limited biological response that peaks and resolves on its own. Your job is to activate your parasympathetic nervous system (your body's brake pedal) through breathing and grounding, prevent the reactive spiral (panic about the panic), and learn by direct experience that panic is survivable. Per Mayo Clinic and Craske (2009), this approach is the foundation of cognitive behavioral therapy for panic.

Minute-by-Minute Timeline: What to Do in Each Phase

Panic follows a predictable timeline. Knowing what to expect at each stage reduces catastrophic thinking and helps you respond effectively.

Minute 0 to 1: Onset and Immediate Grounding

The panic has just started or you have just noticed it starting. Your body is flooding with adrenaline. Your heart races. Your mind shouts danger.

What to do right now:

  • Notice and name it. "This is a panic attack. It is uncomfortable, but it is not dangerous."
  • Stop moving if possible. Do not pace. Do not try to escape. Sit or lean against something solid.
  • Feel your body. Press your feet into the floor. Feel your back against a chair. Feel your hands on your lap. This signals safety to your nervous system.
  • Slow your breathing immediately. You may feel breathless, but you are not. Breathing faster makes it worse. Slow down. Inhale 4, exhale 8.

Why this matters: The first minute is when panic feels most real and dangerous. Naming it ("This is panic") and grounding your body (sit, feel the floor) interrupt the fight-or-flight cascade and signal safety to your amygdala.

Minutes 1 to 3: Breathing Reset and Sensory Grounding

You are sitting. Your adrenaline is still high, but you have stopped the reactive spiral of "I must escape now."

What to do:

  • Continue slow exhalation breathing. Inhale 4, exhale 8, repeat. Do 6 to 10 cycles. Do not take big gasping breaths; slow and steady.
  • Feel your body contact. Press your feet into the floor. Feel the chair holding you. Feel the texture of your clothes.
  • Name three things you see. "I see the wall, the door, the window." Shift your attention from internal panic sensations (racing heart, dizziness) to external, neutral sensations.
  • If possible, drink a sip of water or touch something cold. The sensation is grounding.

Why this matters: Slow breathing activates your vagus nerve, the parasympathetic brake. Zaccaro et al. (2018) showed that breathing with a longer exhale than inhale significantly reduces heart rate, blood pressure, and anxiety within minutes. You are literally shifting your nervous system from fight-or-flight to rest-and-digest.

Minutes 3 to 8: Grounding and Discomfort Peak

This is the hardest part. You are at or near peak intensity. Your heart is pounding. You feel dizzy, chest tight, terrified. Your mind screams catastrophe.

What to do:

  • Continue slow breathing. Do not stop. If you stop, your heart rate will spike again.
  • Use the 5-4-3-2-1 grounding technique to shift your brain away from catastrophic thinking:
  • Name 5 things you see
  • Name 4 things you feel on your body
  • Name 3 things you hear
  • Name 2 things you smell (or 1 if that is all you notice)
  • Name 1 thing you taste
  • Press your feet hard into the floor. Feel your hands on your body. The stronger the physical sensation, the more you interrupt the panic circuit.
  • Repeat your phrase: "This is panic. My body is safe. The sensations are real, but they are not dangerous. This will peak and pass."
  • Do NOT check your pulse, ask "Am I okay?", or reach for medication. Reassurance-seeking and self-monitoring extend panic.
  • Do NOT try to escape. Do NOT call an ambulance unless you have red-flag symptoms (see ER NOW box). Fleeing teaches your brain to fear this place.

Why this matters: Minutes 3 to 8 are when panic feels most intense and "real." Your amygdala is in charge of your brain, not your logical prefrontal cortex. Grounding your senses shifts attention away from the amygdala (which processes internal threats) to the prefrontal cortex (which processes external reality). This dampens the panic signal.

Minutes 8 to 12: Peak and the Hardest Moment

You may be at the absolute worst point. The discomfort is maximal. Your body is screaming that something is terribly wrong.

What to do:

  • Keep breathing. Slow exhale. In 4, out 8. Keep going.
  • Keep grounding. Keep naming what you see, feel, hear.
  • Speak your phrase again and again: "This is the peak. This is where it is most intense. I can sit with this. It always passes. I have survived every panic moment before this. I will survive this one."
  • Do not move. Do not flee. Do not call anyone unless you are truly unsafe.
  • Know this: adrenaline runs out. Your body cannot sustain this intensity. The peak is a biological event, not a mental failure.

Why this matters: The peak is hardest because it feels like "this will never end." It will. Panic has a ceiling. Adrenaline is metabolized within minutes. The parasympathetic nervous system is already engaging (especially if you are doing slow breathing). You are closer to relief than your mind believes.

Minutes 12 to 20: Decline Phase

Adrenaline is depleting. Your parasympathetic nervous system is taking over. Physically, the worst is over, even if you do not feel it yet.

What to do:

  • Continue slow breathing. The technique that saved you at peak will carry you through decline.
  • Continue grounding. The symptoms are fading, but grounding keeps you anchored to the present moment.
  • Notice the decline. Your heart rate is slowing. Your chest is less tight. Your breathing is easing. Say: "I can feel it getting better."
  • Do not relax too hard. Trying to force relaxation can trigger another spike. Just let the decline happen naturally.
  • Do not jump up and do something productive. Stay where you are until full resolution.

Why this matters: The decline phase is when you learn (in your body) that panic always passes. This is inhibitory learning, the most powerful tool in CBT for panic. Each time you stay through the decline, you train your brain that panic is survivable.

Minutes 20 to 30: Resolution and Fatigue

The panic attack is over. Physical symptoms have mostly resolved. You feel exhausted, shaky, foggy, or tearful. This is normal.

What to do:

  • Hydrate. Drink water. Panic causes dehydration.
  • Eat something light. Your body used glucose. A banana, crackers, or a sandwich are fine.
  • Rest. Lie down or sit quietly. Do not push yourself to be productive to prove you are fine.
  • Do not blame yourself. You did not cause this. Your nervous system misfired.
  • Do not ruminate. Avoid obsessive thinking about what triggered it or what might happen next. Acknowledge it occurred, note any patterns, and move on.

Why this matters: The post-panic period is crucial for recovery. Your nervous system is still settling. Rest and self-compassion allow full resolution. Rumination or self-criticism can trigger another attack.

The 5-Action Framework, Expanded

These five actions form the core of in-the-moment panic management. Use them as your foundation.

Action 1: Stay (Do Not Flee)

The urge to flee is intense during panic. You think: "I must leave this place. I cannot be here when something terrible happens."

Do not do it.

Every time you escape from a panic situation (by leaving, driving away, asking someone to rescue you, or calling an ambulance when you are physiologically safe), you teach your brain one thing: "Panic is dangerous. I need to escape."

This reinforces panic disorder. Your brain learns to fear the situation. The next time you approach it, panic anticipates the threat, and the loop repeats. This is avoidance conditioning, and it is the primary mechanism maintaining panic disorder per Barlow (2002).

The alternative: Stay where you are (if safe).

  • If you are at work, stay at work.
  • If you are at a store, stay in the store.
  • If you are on public transit, stay on the transit.
  • If you are driving, slow down safely and keep going (unless truly unsafe).

By staying, you learn, in your body, that the situation is not actually dangerous and that panic is survivable. This is inhibitory learning, the foundation of cognitive behavioral therapy for panic.

Exception: If you are truly unsafe (dizzy and driving on a highway, in a dangerous neighborhood), move to a safe location. Then use the 5-action protocol.

Action 2: Slow Your Exhale (Longer Than Inhale)

Panic causes hyperventilation: rapid, shallow breathing that drops CO2 levels, worsens dizziness and tingling, and keeps your nervous system in fight-or-flight mode.

The fix is counterintuitive: slow your breathing, especially the exhale.

The technique:

  • Breathe in slowly through your nose for a count of 4.
  • Pause briefly (1 second).
  • Breathe out slowly through your mouth for a count of 8 (twice as long as the inhale).
  • Pause briefly (1 second).
  • Repeat 6 to 10 times (about 2 to 3 minutes).

Critical: Do NOT take huge deep breaths. That is hyperventilation and makes panic worse. Slow and steady. Normal-sized breaths, just extended on the exhale. If you feel lightheaded, you are breathing too fast. Slow down even more.

Why this works:

The extended exhale activates your vagus nerve, the main parasympathetic nerve, the brake pedal of your body. Zaccaro et al. (2018) conducted a meta-analysis of breathing interventions and found that slow breathing with a longer exhale than inhale significantly reduces heart rate, blood pressure, and anxiety. This is not placebo. This is physiology.

Additionally, the slower breathing corrects respiratory alkalosis (too much CO2 loss), which reduces the dizziness, tingling, and unreality that panic causes. Your body chemistry stabilizes.

Action 3: Ground Your Senses (5-4-3-2-1 or 3-3-3)

During panic, your attention is trapped in your body: racing heart, tight chest, dizziness. This internal focus amplifies the panic signal. You need to break this loop by shifting attention to external, neutral sensations.

The 5-4-3-2-1 technique:

  • 5 things you see: Colors, shapes, objects. "I see a blue wall, a lamp, my hand, a doorframe, the floor."
  • 4 things you feel: Texture, temperature, pressure. "I feel the chair against my back, my shirt on my skin, my socks on my feet, my hands on my lap."
  • 3 things you hear: Sounds, even quiet ones. "I hear the hum of the refrigerator, traffic outside, my own breathing."
  • 2 things you smell: Even faint. "I smell the air in this room, my shampoo." (If you cannot smell anything, name one. That is fine.)
  • 1 thing you taste: Your mouth, your tongue. "I taste the dryness in my mouth." Or drink a sip of water or suck on an ice cube.

This takes about 3 to 5 minutes. It shifts your brain from the amygdala (alarm center, internal threat) to the prefrontal cortex (logic, external reality).

Simpler option (if 5-4-3-2-1 feels overwhelming):

Do 3-3-3: Name 3 things you see, 3 things you feel, 3 things you hear. That is it. Simpler is still effective.

Why this works:

The default mode network (the part of your brain that worries and catastrophizes) runs during panic. By shifting attention to your five senses, you interrupt the worry cycle and engage the prefrontal cortex instead. This is the principle behind DBT's TIPP skills developed by Linehan (1993) and Najavits's "Seeking Safety" grounding techniques (2003). Sensory awareness quiets the amygdala and brings you back to the present moment, where you are actually safe.

Action 4: Label Without Judgment ("This Is Panic, Not Danger")

During panic, your brain produces catastrophic thoughts: "I am dying. Something is terribly wrong. I cannot handle this. I am losing my mind."

These thoughts feel like facts in the moment. They are not. They are symptoms of panic. Your amygdala is in control, not your logical brain.

You do not need to argue with these thoughts or convince yourself they are false. You need to label them and move on. This is called cognitive defusion per Craske (2009).

What to say to yourself:

Pick one simple phrase and repeat it:

"This is panic. It is uncomfortable. It will not hurt me."

Or:

"This is a panic attack. My body is safe. The sensations will peak and pass."

Or:

"I am having panic. The feeling is real, but it is not dangerous."

Or:

"This is panic, not danger."

Repeat your phrase 5 times slowly while you are breathing and grounding. Do not try to feel calm. Do not try to convince yourself the fear is illogical. Just say the words. The label itself reduces amygdala activity and prevents the catastrophic thought spiral from amplifying the panic.

Why this works:

Research on affect labeling (Lieberman et al., 2007) shows that putting a name to an emotion reduces its emotional intensity. Labeling "this is panic" rather than believing "I am dying" creates psychological distance from the thoughts. Your prefrontal cortex engages (the part that names and categorizes) while your amygdala quiets. You are telling your brain: "I see what is happening. This is a known pattern. It will pass."

Action 5: Wait (The Attack Will Peak and Resolve)

Panic follows a biological timeline. Know it. Trust it.

  • Minutes 0-3: Onset. Adrenaline surge.
  • Minutes 3-10: Peak. Maximum intensity. Hardest part.
  • Minutes 10-20: Decline. Adrenaline depletes. Intensity decreases.
  • Minutes 20-30: Resolution. Symptoms fade. You feel tired and shaky but safe.

Your job during the attack is to do actions 1 through 4 (stay, breathe, ground, label) and then wait. The peak will pass. It always does. It has never lasted forever for anyone, ever. Your body will run out of adrenaline. The wave will decline.

Critical: Do not panic about the panic ("Oh no, this is happening again! This is terrible!"). Do not check your watch obsessively. Do not seek reassurance ("Am I okay? Is this a heart attack?"). All of these extend the attack by triggering more adrenaline release.

Just breathe, ground, label, and wait. The peak is temporary. Resolution is automatic.

Context-Specific Variations: How to Adapt During Panic in Different Settings

Panic can happen anywhere. Use these context-specific variations to apply the 5-action framework to your situation.

At Work (in your office, at your desk, on a call)

You cannot always lie down or cry openly. You need the discreet version.

  • Sit at your desk. Feet flat on the floor. Back against your chair.
  • Slow breathing: Quiet, slow breathing at your desk. Inhale 4, exhale 8, silently. Place one hand on your stomach and feel the rise and fall.
  • Grounding: Feel your feet in your shoes. Feel the chair holding you. Look around: "I see the ceiling tile, the wall, the door, my desk, my keyboard." Use your senses silently. Feel a pen in your hand. Notice the texture.
  • Self-talk: Repeat silently: "This is panic. I am safe at my desk. I can stay here and breathe. It will pass in about 10 minutes."
  • Option: If panic is intense, excuse yourself to the bathroom or an empty conference room for 3 to 5 minutes. Do the full protocol. Then return. Do not always escalate to "I need to leave the day." That reinforces avoidance.
  • After: Once you feel grounded, take 5 minutes if possible. Drink water. Use the bathroom. Return to work when ready. Do not catastrophize about your performance.

In Public (at a store, restaurant, on public transit, in a crowded space)

  • Grounding: Sit if possible. If standing, hold a handrail or lean against a wall. Feel your feet in your shoes. Feel the ground under you.
  • Slow breathing: Quiet, slow breathing. Inhale 4, exhale 8. Keep breathing normal-looking to the outside world.
  • Sensory focus: Name things you see silently: "I see the exit sign, the floor, the counter, people around me, the door." Count them on your fingers if you need to feel grounded. Feel your clothes on your body.
  • Self-talk: Repeat silently: "This is panic. It will peak in 10 minutes. I can stay here. It will pass. No one is watching me as closely as I think they are."
  • If needed, find a quieter area: Walk to the bathroom, step outside, sit in a quiet corner. Do not flee the building. A short move to a less stimulating space is fine.

At Home

You have privacy. Use it fully.

  • Posture: Sit on the couch or floor. Lean against a wall. If very dizzy, lie down.
  • Breathing: Full protocol. Slow inhale, extended exhale. 6 to 10 cycles.
  • Grounding: Use all five senses. Name things you see, feel, hear, smell. Cool water on your wrists. A weighted blanket if helpful. Touch something textured (a pillow, a blanket).
  • Self-talk: "This is panic. I am at home. I am safe. The feeling will peak and pass. My family is here (or I am safe alone). I can breathe through this."
  • After: Hydrate, eat something light, rest. Do not push yourself to be productive to prove you are fine.

While Driving

Driving during panic is dangerous for you and others. Your reaction time is slow. Your attention is on your body.

  • Priority: Safety first. If panic starts, turn on your signal, slow down, and move to the right lane or exit. Look for the next safe exit, parking lot, or shoulder with good visibility.
  • Park safely. Turn off the engine or keep it on with hazard lights flashing. You are now safe to do the protocol.
  • Use the 5-action protocol: Sit in the car. Feet on the floor or pedals. Slow breathing (inhale 4, exhale 6 to 8). Name what you see outside: "I see trees, buildings, the sky, parked cars." Feel the seat. Repeat: "This is panic. I am parked safely. I will breathe until it passes."
  • Wait 10 to 15 minutes. The peak will pass. Anxiety typically declines naturally.
  • Resume when ready. Merge back into traffic only when you feel able. Do not drive while panic is active. Your safety and the safety of others depend on it.
  • Prevention: If panic while driving is a pattern, discuss it with a therapist. Avoidance (not driving anymore) is the trap to avoid. Gradual exposure (short drives, quiet roads first) plus CBT will help.

At Night (lying in bed, waking from panic)

Nighttime panic is terrifying because you are in the dark, alone, and confused about what is happening.

  • Posture: Sit up in bed or on the edge. Do not lie flat (can feel suffocating). Turn on a low light.
  • Breathing: Slow exhalation breathing. Inhale 4, exhale 6 to 8. Feel your body on the bed.
  • Grounding: Name sounds: "I hear the refrigerator, the air conditioning, my own breathing, a car outside." Feel the texture of your sheets. Feel your feet on the floor.
  • Self-talk: "This is a panic attack at night. It is not a heart attack. I am safe in my bed. The feeling will peak in about 10 minutes and pass in about 20-30 minutes. I can go back to sleep once I am calm."
  • Do not: Check the time obsessively (it prolongs the sense of duration). Do not panic about losing sleep. Sleep will return.

What NOT to Do During a Panic Attack

Certain actions make panic worse. Avoid these:

Hyperventilate or gasp for air. Rapid, shallow breathing drops CO2, which worsens dizziness, tingling, and unreality. This reinforces the "something is wrong" belief. Instead: slow your breathing. Extend your exhale. If you feel breathless, you need slower breathing, not faster breathing.

Flee the situation. Avoidance is the most powerful reinforcer of panic disorder per Barlow (2002). Every time you escape panic by leaving a place, driving away, or calling an ambulance unnecessarily, you teach your brain that panic is dangerous and that you need to flee. This makes the next panic attack more likely and more severe. Stay where you are (if safe). Breathe. Let the panic peak and pass. This breaks the cycle.

Chug caffeine, alcohol, or energy drinks. Caffeine increases heart rate and anxiety. Alcohol is a depressant that worsens anxiety in the rebound. Both disrupt sleep, which worsens panic over time. In the moment, avoid all three.

Call 911 reflexively if you are safe and have a confirmed panic disorder diagnosis. If you have had panic attacks before and this feels like your typical attack, use the 5-action protocol first. Do go to the ER if this is your first severe episode or if you have red-flag symptoms (chest pain, severe dyspnea, fainting, slurred speech, confusion). If in doubt, ER is the right call.

Reach for a benzodiazepine (Xanax, Ativan) for every attack. Benzodiazepines work quickly and feel very effective. The problems: they carry risks of dependence, tolerance, cognitive impairment, and rebound anxiety. More critically, they interfere with extinction learning (inhibitory learning) that happens in CBT for panic per Otto (2010). If your doctor prescribed one, use it as directed, but pair it with CBT or an SSRI. Do not let benzos become your only tool.

Interrogate yourself mid-attack about triggers or what is "wrong." Your amygdala is in control during peak panic, not your logical brain. Analysis is futile mid-attack. Label the thoughts ("I am having the thought that I am dying, but I am not actually dying"), breathe, and ground. Logic returns once the peak declines. Analyze your triggers after the attack, not during.

After the Attack: The Post-Panic Hangover (30 to 60 Minutes and Beyond)

The panic attack is over, but you do not feel fine. You feel exhausted, tearful, shaky, foggy, sore, hungry, or thirsty. Your chest or jaw aches. This is completely normal and is called the post-panic hangover. It is recovery, not continuation.

What to do:

  • Hydrate. Drink water. Panic causes dehydration.
  • Eat something with protein and carbohydrates. Your body used glucose. Replenish. A banana, crackers, nuts, yogurt, a sandwich, or an apple are fine.
  • Rest. It is okay to lie down, watch TV, or sit quietly. Your nervous system has been activated. Let it settle. Do not push yourself to be productive to prove you are fine.
  • Journal or write what happened. Write down: the trigger (if known), what you felt, when it peaked, how long the full episode lasted, and how you handled it. This data is gold for therapy. It shows patterns and proves to your brain that panic is predictable and time-limited.
  • Do not blame yourself. You did not cause this. Your nervous system misfired. That is it.
  • Do not ruminate. Thinking obsessively about the panic ("Why did this happen? What if it happens again? I am weak") starts the cycle again and can trigger another attack. Acknowledge it happened, note what you learned, and move on.

When to Call 911 or Go to the ER (Red Flags Only)

See the "GO TO THE ER NOW" box at the top of this post. Go if you have:

  • Chest pain (heavy, crushing, radiating to arm, jaw, or back)
  • Severe shortness of breath at rest
  • Fainting or feeling like you will faint
  • Confusion or slurred speech
  • First-ever panic attack (to rule out medical mimics: thyroid storm, hypoglycemia, stimulant use, medication side effect, arrhythmia)

Do not guess. Cardiac disease must be ruled out first. A "false alarm" ER visit is the right call. The cost of missing a heart attack is fatal.

See PAG row 17 for full panic attack vs heart attack guidance.

Who Can Help: Support During and After an Attack

If someone is available and you trust them:

  • Ask them to sit with you. Their presence is calming.
  • Ask them to model calm breathing. You can breathe along with them. This is powerful.
  • Ask them to ground you. They can say: "What do you see? What do you feel?" and listen as you name things.
  • Ask them to reassure you once, then not repeatedly. Say: "This is panic. It will peak and pass. I am here with you." Say it once. Repeating reassurance keeps you anxious.
  • Tell them not to say "Just calm down" or "You are fine." It feels invalidating. Instead: "This is scary and uncomfortable, and you can handle it. I am here."

If you are alone, that is fine. You can do the 5-action protocol solo. Panic is not dangerous even if you are by yourself.

For caregiver guidance, see PAG row 26.

Long-Term: Daily Skills Practice and Treatment

Panic attacks happen moment to moment. Long-term recovery happens day to day through practice.

Between attacks: Daily practice

  • Practice slow exhalation breathing 1 to 2 times daily, even when not in panic. This makes it automatic during panic. When you are calm, your nervous system learns the pattern and accesses it more easily under stress.
  • Practice grounding (5-4-3-2-1) daily, even when calm.
  • Notice your thoughts without judgment in everyday life. This trains cognitive defusion (the skill of labeling thoughts without believing them) so it is accessible during panic.

Formal treatment: CBT-Panic

If you have 2 or more panic attacks per month, see a therapist or psychiatrist trained in cognitive behavioral therapy for panic (CBT-Panic). This is first-line treatment and has the strongest evidence base per the APA Practice Guideline for anxiety disorders.

CBT-Panic typically lasts 12 to 16 weeks and includes:

  1. Psychoeducation: Learning the physiology of panic (adrenaline, fight-or-flight, the panic curve).
  2. Skills practice: Mastering the breathing, grounding, and self-talk techniques in this post.
  3. Interoceptive exposure: Deliberately triggering mild panic sensations in a safe, controlled way (e.g., running in place to raise your heart rate, spinning to trigger dizziness) so you learn that these sensations are not dangerous.
  4. Situational exposure: Gradually returning to places you avoid (grocery stores, driving, crowds) so you learn that the situation itself is not dangerous.

Each time you face a feared situation or sensation and survive, you train your brain through inhibitory learning: "This is not actually dangerous."

Medication: SSRIs or SNRIs

If a psychiatrist prescribes an SSRI (sertraline, paroxetine, fluoxetine) or SNRI (venlafaxine, duloxetine), take it as prescribed. These antidepressants reduce the frequency and severity of panic attacks over 4 to 6 weeks. They are not sedatives. They are not habit-forming. They work on the brain's underlying panic circuitry. Full effects take 4 to 6 weeks.

Combined approach (CBT plus medication) is often most effective.

FAQ: What to Do During a Panic Attack

Q: What is the first thing I should do when a panic attack starts? A: Sit and ground. Stop moving. Feel your feet on the floor. Feel a surface supporting your body. This signals safety to your nervous system immediately. Then slow your breathing. The first action is to ground your body; the second is to regulate your nervous system through breath.

Q: Should I take medication during a panic attack? A: If your doctor prescribed a benzodiazepine (Xanax, Ativan) "as needed," follow their instructions. However, try the 5-action protocol first (stay, breathe, ground, label, wait). Most panic attacks peak and resolve within 10-30 minutes without medication. If panic is severe or you have a pattern of frequent attacks, SSRIs (taken daily, not during attacks) are more appropriate long-term. Benzodiazepines carry dependence risks and can interfere with learning (Otto, 2010). If you do not have a medication prescribed, do not use someone else's or buy medication online.

Q: What should I drink during a panic attack? A: Drink water. Room temperature or cool. Sip slowly. Avoid caffeine (increases anxiety), alcohol (worsens anxiety over time), sugary drinks (spike then crash blood sugar). Water is grounding, hydrating, and safe.

Q: Should I call someone during a panic attack? A: Only if you feel unsafe. If you call a loved one, ask them to listen while you breathe, or to come sit with you. Do not ask them to repeatedly reassure you ("Am I okay? Is this a heart attack?"), as reassurance-seeking extends panic. If you do not have someone to call and you feel very afraid, you can call 988 (US Suicide and Crisis Lifeline) to talk to a trained counselor. They help with panic, not just suicide.

Q: Can I make a panic attack stop by thinking about something else? A: Distraction (thinking about something else) sometimes helps briefly, but it does not address the root: your nervous system is in fight-or-flight. The more powerful approach is to lean into the sensations (grounding, breathing) rather than fight them. This is acceptance-based coping. By accepting ("I feel afraid, and I can sit with this"), you reduce the secondary anxiety (panic about the panic) that extends the attack.

Q: What if breathing exercises make panic worse? A: Some people find slow breathing helpful; others find it makes them feel more aware of their breathing and worsens panic (a phenomenon called "focal attention paradox"). If this is you, skip the breathing focus and instead: (a) do intense physical exercise (20 jumping jacks, running up stairs, push-ups) to burn off adrenaline, (b) use cold water (run cold water on your wrists), or (c) focus entirely on grounding (5-4-3-2-1). Different nervous systems respond to different techniques. Experiment and find what works for you. Tell your therapist which techniques help so they can personalize your treatment.

Q: How long should the 5-action protocol take? A: Each action (stay, breathe, ground, label, wait) is not timed. The whole protocol is: slow breathing (2-3 minutes), grounding (3-5 minutes), self-talk (1-2 minutes), then wait for the peak to pass (about 10 minutes total from onset, sometimes shorter, sometimes longer). The full attack typically resolves within 20-30 minutes. Do not rush. The goal is not speed; it is to activate your parasympathetic nervous system and learn that panic is survivable.

Q: What if my panic attack does not stop after 30 minutes? A: If symptoms are still intense after 30 minutes or worsening, consider: (1) back-to-back attacks (one attack ends and another begins), (2) hyperventilation (breathing too fast even without noticing), (3) a medical condition that mimics panic (thyroid storm, arrhythmia, hypoglycemia, stimulant use, withdrawal). Go to the ER or call your doctor. Do not assume it is "just panic" if it deviates from your typical pattern or lasts longer than 30-45 minutes.

Q: Can panic attacks cause a heart attack? A: Panic attacks do not cause heart attacks in healthy hearts. Panic is not fatal. However, extreme stress can stress a very weakened heart (extremely rare). If you are concerned about your heart, go to the ER for an ECG and troponin test. Cardiac disease must be ruled out first (anxiety is a diagnosis of exclusion). See PAG row 17 for panic attack vs heart attack guidance.

Q: Is it okay to have a panic attack at work? A: Yes. Use the discreet 5-action protocol: sit at your desk, slow breathing silently, ground your senses silently, repeat self-talk silently. If panic is intense, excuse yourself to the bathroom for 3-5 minutes. Do not escalate to "I need to leave all day" unless panic is severe or recurrent. Staying at work teaches your brain the workplace is not actually dangerous.

Q: What if I am alone during a panic attack? A: You can do the entire 5-action protocol solo. Panic is not dangerous even if you are by yourself. You will survive. Your body's panic response will peak and resolve whether or not someone else is present. If you feel very afraid, you can call 988 (Suicide and Crisis Lifeline) or text the Crisis Text Line (text HOME to 741741) to talk to a counselor while you breathe and ground.

Related Reading: PAG Posts

Tier-1 Medical and Scientific Sources

  • National Institute of Mental Health (NIMH). Panic Disorder: Facts and Statistics. https://www.nimh.nih.gov. [11 percent of US adults have at least one panic attack per year; 2.7 percent meet panic disorder criteria.]
  • Mayo Clinic. Panic Attack and Panic Disorder. https://www.mayoclinic.org. [Clinical overview: in-the-moment management and when to seek help.]
  • Cleveland Clinic. Panic Attack and Panic Disorder. https://my.clevelandclinic.org. [Physiological explanation and management strategies.]
  • Harvard Health Publishing. Panic Attacks and Panic Disorder. https://www.health.harvard.edu. [Patient-friendly clinical guidance.]
  • NHS (National Health Service, UK). Panic Disorder. https://www.nhs.uk. [UK diagnostic and management guidance.]
  • American Psychological Association (APA). Clinical Practice Guideline for the Treatment of Anxiety Disorders. https://www.apa.org. [First-line treatment recommendations: CBT for panic.]
  • American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Panic Disorder diagnostic criteria (300.01).
  • Anxiety and Depression Association of America (ADAA). Panic Disorder Resources. https://adaa.org. [Patient education and specialist directory.]

Key Research Citations

  • Craske, M. G., & Barlow, D. H. (2008). "Mastery of Your Anxiety and Panic: Therapist Guide for Anxiety, Panic, and Agoraphobia." Oxford University Press. [Gold-standard CBT protocol for panic; interoceptive exposure and inhibitory learning principles.]
  • Barlow, D. H. (2002). "Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic." Guilford Press. [Theoretical framework for panic disorder, avoidance conditioning, and inhibitory learning.]
  • Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). "How Breathing Shapes Your Brain." Frontiers in Neuroscience, 12, 353. [Meta-analysis: slow breathing with extended exhale reduces heart rate, blood pressure, and anxiety; vagal activation mechanism.]
  • Craske, M. G. (2009). "Cognitive-behavioral therapy for panic disorder and agoraphobia." In K. S. Dobson (Ed.), Handbook of cognitive-behavioral therapies (3rd ed., pp. 113-139). Guilford Press. [Panic attack physiology, natural curve, extinction learning.]
  • Linehan, M. M. (1993). "Cognitive-behavioral treatment of borderline personality disorder." Guilford Press. [DBT skills including TIPP (Temperature, Intense exercise, Paced breathing, Paired muscle relaxation) for acute emotion regulation; applicable to panic.]
  • Najavits, L. M. (2003). "Seeking Safety: A treatment manual for PTSD and substance abuse." Guilford Press. [Grounding and sensory techniques for trauma and anxiety, including 5-4-3-2-1.]
  • Lieberman, M. D., Eisenberger, N. I., Crockett, M. J., Tom, S. M., Pfeifer, J. H., & Way, B. W. (2007). "Putting feelings into words: Affect labeling disrupts amygdala activity in response to affective stimuli." Psychological Science, 18(5), 421-428. [Affect labeling reduces emotional intensity by engaging prefrontal cortex.]
  • Otto, M. W. (2010). "Benzodiazepines, Cognitive-Behavioral Therapy, and the Treatment of Panic Disorder." Journal of Clinical Psychiatry, 71(5), 668-674. [Effects of benzodiazepines on extinction learning and long-term outcomes.]
  • Laborde, S., Moseley, E., & Thayer, J. F. (2018). "Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research: Recommendations for Experiment Planning, Data Analysis, and Data Reporting." Frontiers in Psychology, 8, 213. [Physiology of vagal activation and the parasympathetic brake.]

Crisis Support: Call or Text Anytime

You are not alone. If you are in crisis or having thoughts of self-harm:

  • 988 Suicide and Crisis Lifeline (US): Call or text 988. Available 24/7. Trained counselors listen and help.
  • 988 then press 1 (Veterans Crisis Line): Staffed by veterans, for veterans.
  • Crisis Text Line: Text HOME to 741741. Available 24/7.
  • UK: Call 111 and select option 2 for mental health support. Available 24/7.
  • UK: Samaritans: Call 116 123. Available 24/7.
  • EU: Call 112 for emergency services. Crisis support lines vary by country; findahelpline.com has a directory.
  • SAMHSA National Helpline (US): 1-800-662-4357. Free, confidential, multilingual. Referrals to local treatment and support.
  • Findahelpline.com: Directory of mental health crisis lines by country and region.

If you believe you are experiencing a cardiac emergency right now, call 911 (US), 999 (UK), or 112 (EU) immediately. Do not delay.

Medical Reviewer: Pending approval by MD or PsyD with anxiety/panic expertise.

Last Updated: 2026-05-04

Disclaimer: This post is for educational purposes only and does not constitute medical advice. Always consult a healthcare provider for diagnosis and treatment of panic attacks, anxiety, or any medical condition. In a medical emergency, call 911 (US), 999 (UK), or 112 (EU) immediately.

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