Panic attack help: what to do right now, and what helps after
If you are having a panic attack now: 1. If you have chest pain, have never had a panic attack before, or this one feels different, call 911 in the US or your local emergency number. 2. Stay where you are, or pull over if driving. 3. Breathe out slowly, longer than you breathe in. 4. Tell yourself, “This is panic. It will pass.”
Most attacks peak within 10 to 20 minutes, according to MedlinePlus, the US National Library of Medicine’s health site. The health facts on this page come from official health pages. This page is not medical advice.
What to do this minute, step by step
Check for danger, stay put, name it, slow your breathing, and let the peak pass. Skip any step that is not helping, and stop any that makes you feel worse.
For something to follow on screen, the Health and Kind toolkit has a 5-4-3-2-1 grounding exercise. The toolkit’s 60-second breathing exercise uses a different pattern from step 4 below: four counts each to breathe in, hold, breathe out and hold. Use whichever feels easier.
1. Check for danger signs
Chest pain, a first ever attack, or symptoms unlike your usual ones: call 911 in the US or your local emergency number now.
2. Stay where you are
This is the first step on the NHS page on panic disorder, from the UK’s National Health Service. If you are driving, pull over somewhere safe first.
3. Name it
The NHS also advises reminding yourself that the attack will pass and is not life-threatening. Say it or type it: “This is a panic attack. It will pass.”
4. Slow the out-breath
The NHS says to breathe slowly and deeply. Hand on your stomach, breathe in until it rises, as the MedlinePlus guide to relaxation techniques describes. Then breathe out slowly through pursed lips, as if blowing out a candle, a method the MedlinePlus page on hyperventilation gives for fast breathing linked to panic.
5. Tense, then let go
From your toes up, tighten each muscle group for a few moments, then release it. The same MedlinePlus guide calls this progressive relaxation.
6. Check the time
Note when it started. The next section says how long attacks usually last, so the clock tells you where you are in one.
7. Text one person
Copy this: “Having a panic attack. Can you call me and talk for a few minutes?”
Try this
Write one line in your phone’s notes now, while you are calm: “This is a panic attack. It peaks and it passes. Breathe out slowly.” Pin it where you will find it when the next one starts.
How long a panic attack lasts, and why it feels so physical
A panic attack usually peaks within 20 minutes, though some symptoms can last longer. The MedlinePlus page on panic disorder says an attack most often peaks within 10 to 20 minutes, and some symptoms continue for an hour or more. The NHS says most attacks last 5 to 20 minutes.
The NIMH page on panic disorder, from the US National Institute of Mental Health, puts an attack at a few minutes to an hour or longer, and says one can come at any time, sometimes even during sleep. It states that panic attacks themselves are not life-threatening.
Why so physical? NIMH reports that some researchers see panic attacks as “false alarms”, where the body’s survival instincts fire too often or too strongly. Its symptom list includes a racing heart, sweating, trembling, dizziness, tingly or numb hands and chest pain. MedlinePlus also lists a fear of dying.
Fast breathing adds to it. MedlinePlus explains that overbreathing lowers the carbon dioxide in your blood, causing light-headedness and tingling in the arms or around the mouth. You may not notice the fast breathing itself.
The symptoms are physical, not imagined. The attack also passes. Both are true at once.
Panic attack or heart problem: when to call for help
Call 911 in the US, or your local emergency number, if you have chest pain, if it is your first attack, if it feels unlike your usual ones, or if you are not sure it is panic. Do not try to judge it by feel. NIMH says panic attacks often include symptoms that might feel like a heart attack, and MedlinePlus notes that many people with panic disorder first seek treatment at an emergency room. It also says fast breathing for the first time may be a medical emergency. Being checked and told it was panic is a good outcome, not a wasted trip.
The NHLBI page on heart attack symptoms, from the US National Heart, Lung, and Blood Institute, lists chest pain, pain in the arms, back, neck or jaw, shortness of breath, sweating, nausea, light-headedness and a rapid heartbeat. It says to call 911, the emergency number in the US, any time you think you might be having a heart attack, even if you are not sure, and to go by ambulance, not by car.
In the UK, the NHS page on chest pain says to call 999 for sudden chest pain that does not go away, pain spreading to an arm, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light-headedness or breathlessness. Heart problems are more likely, it adds, if you are older, smoke, or have high blood pressure, diabetes or high cholesterol. These call-999 signs apply to everyone, whatever your age or health. Elsewhere, call your local emergency number.
If you are thinking about suicide, in the US call or text 988, the 988 Suicide and Crisis Lifeline. If you might act on those thoughts, call 911 in the US or your local emergency number now. For crisis lines outside the US, findahelpline.com lists helplines in more than 175 countries.
Try this
What to say when you call: first give your exact location, then say, “I have chest pain and a racing heart. I get panic attacks, but this feels different.” If you have never had a panic attack, say that. Answer every question the call-taker asks, and do not hang up until they tell you to.
After it passes: the next hour and the next week
Rest, then write down what happened while you still remember it. Over the next week, try not to avoid the place where it happened, and see a primary care doctor if it was your first, to rule out physical causes.
If it helps to put the attack into words afterward, you can type it out to Kind Mind, Health and Kind’s AI Companion. It is free, needs no account to start, and is there at any hour. It is an AI, not a person, a therapist or a crisis service. Account chat saving is paused. Conversations are saved in your browser only. Each message goes to Anthropic, the AI provider, which writes the reply.
Next hour: rest
Sit for a few minutes before you drive or start anything that needs your full attention.
Next hour: write four lines
When it started, how long it lasted, what you were doing, what helped. NIMH says a provider may ask when symptoms began, how long they have lasted, how often they occur, and how they affect your life.
Today: skip caffeine and alcohol
MedlinePlus says alcohol and stimulants such as caffeine may trigger or worsen symptoms. The NHS adds sugary food and drinks, and smoking.
This week: do not avoid it
The NHS says avoiding situations you fear will trigger an attack can create a cycle of living “in fear of fear”. If it happened on a bus or in a shop, try not to avoid that place for long. MedlinePlus describes cognitive behavioral therapy (CBT) as including gradual practice in real situations, and a therapist can help you do this step by step.
How to help someone through a panic attack
Stay calm, stay close, and keep your words short. If they have chest pain, have never had a panic attack before, or say this feels different, call 911 in the US or the local emergency number and stay with them.
If they know it is panic, your calm voice is the main tool. The MedlinePlus hyperventilation page says reassurance from a friend helps, in a soft, relaxed tone, with words like “you are doing fine” and “you are not going to die”. That advice assumes a provider has already linked their fast breathing to panic, so check for danger signs first.
“Is this a panic attack? Any chest pain?”
Ask first. The answer tells you whether to call for help or help them ride it out.
“I’m here. I’m staying with you.”
Say it, then stay. Sit at their level, and ask before touching them.
“Breathe out with me, slowly, like blowing out a candle.”
Breathe out audibly yourself, so they can follow your pace without counting.
“You’re doing fine. This will pass.”
Repeat it calmly. Save explanations for later.
“What usually helps you?”
If they have had attacks before, they may know. Follow their lead.
Skip “calm down” and “it’s all in your head”
Both can sound like blame to someone whose body is doing something they cannot control.
Try this
Later, when things are quiet, NIMH suggests setting aside time to express your concern and reassure the person of your support. You could say: “That looked frightening. I’m on your side. Would it help if I came with you to a doctor?”
When it keeps happening: is it panic disorder?
NIMH says it may be panic disorder if unexpected attacks keep coming and, for a month or more, you worry about having more or change what you do to avoid them. A health care provider can tell you. NIMH states that an isolated panic attack is not a mental disorder, and the MedlinePlus overview of panic disorder says many people have only one or two panic attacks in their lifetime and get better without treatment.
Do not wait a month if attacks get in the way of work, school or relationships. NIMH says that is the time to seek professional help. A primary care provider is the place to start and may do a physical exam. MedlinePlus says checks may include blood tests for thyroid problems and heart tests.
Bring your four lines of notes. The NIMH tips for talking with a health care provider also suggest a list of questions, every medicine and supplement you use, and a friend or relative for support. Mention any cold medicines: MedlinePlus lists certain cold medicines among things to reduce or avoid.
What treatment for repeated panic attacks involves
Treatment for panic disorder is usually talk therapy, medication or both, according to NIMH. MedlinePlus says the two together work best, and that most people get better when treated correctly.
The NCCIH fact sheet on relaxation techniques, from the US National Center for Complementary and Integrative Health, reports a 2018 review of 16 studies and 856 people with anxiety disorders, panic disorder included, in which relaxation therapy reduced anxiety symptoms. It also notes that people occasionally report more anxiety during relaxation exercises.
NIMH says sleep, exercise, a healthy diet and trusted people help but cannot replace treatment. It also notes that agoraphobia, an intense fear of places where escape or help might be hard during an attack, can sometimes develop alongside panic disorder. For cost and insurance, see the guide on finding mental health support near you and the guide on using insurance for therapy.
Cognitive behavioral therapy (CBT)
NIMH describes CBT as the “gold standard” psychotherapy. It teaches new ways to think about and react to the sensations of an attack, and NIMH says attacks can become less frequent once a person reacts differently to them.
Interoceptive exposure
A CBT technique that, as NIMH puts it, exposes you to the bodily sensations linked with panic. It may be combined with breathing and relaxation training.
Therapy by video
NIMH notes that psychotherapy delivered by telehealth can work too.
Medication
NIMH lists SSRI and SNRI antidepressants, which can need several weeks to help; beta-blockers for symptoms like a racing heart; and benzodiazepines, which act fast but can lead to dependence, so they may be prescribed only briefly. The NHS says antidepressants can take up to 8 weeks to work fully. Talk with your provider before stopping any.
Outside the US
In England, you can refer yourself directly to an NHS talking therapies service for CBT. Elsewhere, ask a family doctor where to start.
Common questions
How long does a panic attack last?
MedlinePlus says a panic attack most often peaks within 10 to 20 minutes, though some symptoms can continue for an hour or more. The UK’s National Health Service says most attacks last 5 to 20 minutes. If one runs well past your usual pattern or brings a new symptom, call your local emergency number.
How do I know if it is a panic attack or a heart attack?
Do not try to tell by feel. Chest pain, a racing heart, sweating, nausea and shortness of breath are on both the panic attack symptom list from the US National Institute of Mental Health and the heart attack list from the US National Heart, Lung, and Blood Institute. That institute says to call 911 whenever you think it might be a heart attack, even if you are not sure. Elsewhere, call your local emergency number.
Should I go to the ER for a panic attack?
Call 911 in the US, or your local emergency number, if you have chest pain, if it is your first attack, or if it feels unlike your usual ones. Many people with panic disorder first seek treatment there, MedlinePlus notes. If a doctor has checked your attacks before, this one matches them, and you have no chest pain, start with the numbered steps at the top of this page.
Can you die from a panic attack?
NIMH states that panic attacks themselves are not life-threatening and that the physical symptoms usually resolve with time. The NHS says an attack will not cause you any physical harm. The danger is mistaking a heart problem for panic, so chest pain or a first attack still means calling 911 in the US or your local emergency number.
What should I say to someone having a panic attack?
Keep it short and calm: “I’m here.” “Breathe out slowly with me.” “You’re doing fine. This will pass.” MedlinePlus lists reassurance such as “you are doing fine” as helpful for people whose fast breathing comes from panic. First ask whether they have chest pain or have never had an attack before. If so, call emergency services.
Why do panic attacks come out of nowhere, even in my sleep?
NIMH says panic attacks can strike with no clear danger or trigger, at any time, sometimes even during sleep. Some researchers see them as false alarms of the body’s survival instincts. MedlinePlus adds that recalling a past attack may trigger one. If they keep coming, a primary care doctor can check for physical causes and talk through treatment.
What is the best treatment for panic attacks?
NIMH names cognitive behavioral therapy (CBT) as the “gold standard” psychotherapy for panic disorder, and says medication, such as SSRI antidepressants, can also help. MedlinePlus says using medicines and talk therapy together works best, and that most people get better when treated correctly. A primary care doctor can rule out physical causes and refer you.
Sources and resources
- 5-4-3-2-1 grounding exercise (healthandkind.com)
- 60-second breathing exercise (healthandkind.com)
- NHS page on panic disorder (nhs.uk)
- MedlinePlus guide to relaxation techniques (medlineplus.gov)
- MedlinePlus page on hyperventilation (medlineplus.gov)
- MedlinePlus page on panic disorder (medlineplus.gov)
- NIMH page on panic disorder (nimh.nih.gov)
- NHLBI page on heart attack symptoms (nhlbi.nih.gov)
- NHS page on chest pain (nhs.uk)
- Findahelpline.com
- MedlinePlus overview of panic disorder (medlineplus.gov)
- NIMH tips for talking with a health care provider (nimh.nih.gov)
- NCCIH fact sheet on relaxation techniques (nccih.nih.gov)