Managing Panic Attacks: From the First Wave to Lasting Calm

Managing panic attacks takes two plans: one for the attack itself and one for the weeks between attacks. During an attack, slow your breathing, name what is happening and let the wave peak and pass. Afterward, reduce the fear and avoidance that keep panic coming back, ideally with cognitive behavioral therapy. New chest pain always needs emergency care first.

This article is for adults in Texas who have had one or more panic attacks, live with ongoing fear of the next one, or support someone who does. It explains what happens in the body, what helps, and when to get evaluated.

What is a panic attack?

A panic attack is a sudden episode of intense fear with powerful physical symptoms, often without an obvious danger. The National Institute of Mental Health (NIMH) lists symptoms including a pounding or racing heart, sweating, trembling, trouble breathing, dizziness, chest pain and feelings of doom or being out of control.

Attacks usually build quickly and peak within minutes. Some happen during stress; others seem to come from nowhere, even during sleep. NIMH explains that panic disorder is diagnosed when a person has recurrent, unexpected panic attacks and spends at least one month worrying about more attacks or changing behavior to avoid them.

Having one panic attack does not mean you have panic disorder. Many people have a single attack during a stressful period and never have another. The pattern that matters is repetition plus fear and avoidance.

What happens in your body during a panic attack?

During a panic attack, your body's threat response fires as if you were in danger. MedlinePlus explains that stress hormones make the brain more alert, tense the muscles and increase the pulse.

That response produces the sensations people fear most:

• A fast or pounding heartbeat.
• Rapid, shallow breathing, which can cause lightheadedness and tingling.
• Chest tightness or pressure.
• Shaking, sweating, or feeling hot or cold.
• Feeling unreal or detached.

MedlinePlus notes that a panic attack is one cause of hyperventilation. Understanding these sensations as the alarm system working too hard, rather than a sign of collapse, is a core part of recovery. For more, read why you just had a panic attack.

Is it a panic attack or a medical emergency?

A panic attack can feel like a heart attack, so new or unexplained chest symptoms should be treated as an emergency first. The Centers for Disease Control and Prevention (CDC) lists heart attack symptoms such as chest pain, feeling weak or lightheaded, discomfort in the jaw, neck, back, arm or shoulder, and shortness of breath, and advises calling 911 immediately.

MedlinePlus also notes that a first episode of hyperventilation may be an emergency. Once a clinician has ruled out heart and other medical causes, you and your provider can build a plan for recognizing panic. Even then, call 911 if symptoms differ from your usual pattern.

Step-by-step: what should you do during a panic attack?

During a panic attack, the goal is to ride out the wave rather than fight it. Fighting tends to add fear on top of fear. Try these steps:

1. Name it. Say to yourself, "This is panic. It is uncomfortable, and it will pass."
2. Slow your breath. Breathe in through your nose, then out slowly through pursed lips, longer than the inhale.
3. Use your belly. Place a hand on your stomach and let it rise as you breathe in.
4. Ground your senses. Name five things you can see and four you can feel.
5. Stay if you safely can. Leaving teaches your brain the place was dangerous.
6. Let it peak. Notice the intensity rise and then begin to fall.
7. Return to your activity once the wave eases.

MedlinePlus describes pursed-lip and diaphragmatic breathing for hyperventilation. Practice these daily when calm so they come naturally during an attack. For more quick techniques, see how to stop a panic attack.

Why do panic attacks keep coming back?

Panic attacks often keep coming back because fear of the next attack and avoidance of triggers keep the alarm system sensitive. MedlinePlus notes that people with panic disorder often worry about future attacks and avoid places where attacks have happened.

The cycle usually looks like this:

1. A body sensation, such as a skipped beat, is noticed.
2. The mind reads it as danger: "Something is wrong."
3. Fear rises, producing more sensations.
4. Panic peaks, then passes.
5. The person avoids the situation or sensation next time.
6. Avoidance brings short-term relief but strengthens the fear.

Breaking any link in that chain, especially avoidance, is how lasting change happens. That is why managing panic attacks well means looking beyond the attack itself to the fear and habits that follow it.

How is panic disorder treated?

Panic disorder is commonly treated with cognitive behavioral therapy (CBT), sometimes combined with medication. NIMH describes exposure therapy as a common CBT method, including interoceptive exposure to bodily sensations, sometimes paired with breathing training. CBT for panic usually includes education about the body's alarm, techniques to challenge catastrophic thoughts, and gradual exposure to feared sensations and places.

Exposure might involve deliberately raising your heart rate with stair climbing, then sitting with the sensation until it fades, or returning step by step to a store you have avoided. It is done gradually, with your therapist's guidance.

Medication is also used for some people, typically alongside therapy. Decisions depend on severity, health history and preferences. Do not start, stop or change any medication without talking to your prescriber. Our article on when therapy is enough and when medication helps covers that choice.

What can you do between attacks to build calm?

Much of the real work of managing panic attacks happens on ordinary days. Between attacks, you build calm by lowering baseline stress, practicing skills and gently facing what you have been avoiding. The National Center for Complementary and Integrative Health (NCCIH) describes relaxation techniques as generally safe but notes that some people report increased anxiety, and advises seeing a provider for severe or long-lasting symptoms.

• Practice slow breathing for five minutes twice a day.
• Reduce caffeine, energy drinks and nicotine.
• Keep regular sleep and meals.
• Exercise; it teaches your body that a fast heartbeat can be safe.
• List places you avoid, and rank them from easiest to hardest.
• Track attacks: time, place, sensations, thoughts and what helped.

Example: a hypothetical commuter stopped driving on highways after an attack. With a therapist, he starts with one exit at a quiet hour, then two, then rush hour. Over several weeks, his fear rating drops and he resumes his normal route.

What should you tell a clinician or loved one?

You should tell a clinician the specific details of your attacks and how they affect your life. NIMH advises seeing a health care provider for an exam to understand symptoms. Bring this checklist:

• When attacks started and how often they happen.
• What they feel like, from start to finish.
• Places, activities or sensations you now avoid.
• Caffeine, alcohol, cannabis or other substance use.
• Medical conditions and current medications.
• Any heart, thyroid or breathing evaluations already done.

For loved ones, a short script helps: "If I have an attack, stay calm with me, remind me it will pass, and don't rush me out of the room." Supporters should avoid saying "just calm down."

When should you get help sooner? Red flags

You should get help sooner when panic is changing how you live or comes with warning signs. Seek emergency care for new chest pain, fainting, or symptoms that differ from your usual attacks.

Book an evaluation soon if:

• Attacks happen weekly or more.
• You avoid driving, stores, work or travel.
• You use alcohol or sedatives to cope.
• Panic comes with low mood or hopelessness.
• You have thoughts of suicide; call or text 988 now.

Breathlessness that is not panic needs attention too; see how to tell if shortness of breath is from anxiety.

How does panic treatment by telehealth work in Texas?

Panic treatment by telehealth in Texas uses video visits for evaluation, CBT and follow-up, and many exposure exercises can be done at home or in your community between sessions. An HHS research recap reported no significant differences in quality between remote and in-person care for conditions including anxiety.

Clinicians generally must be licensed in the state where you are located during the visit, and rules vary by state. Medical tests, such as heart or thyroid checks, may still need an in-person visit with a primary care provider.

Getting support in Texas

Lyte Psychiatry offers therapy, psychiatric evaluation and medication management in Texas, which can support managing panic attacks over time. In-person visits are available at Lyte Psychiatry's clinic in Pantego, in the Dallas–Fort Worth area. Lyte Psychiatry offers telehealth visits to patients who are physically located in Texas at the time of the visit; see our Texas telehealth page.

Most new patients are seen within 1–2 business days. Weekend appointments are limited. All Lyte Psychiatry services are available in Spanish. Availability, insurance, specific therapy approaches and clinician fit require confirmation. Learn about anxiety care or contact the practice.

Lyte Psychiatry is an outpatient practice. It does not provide inpatient care, crisis or after-hours coverage, medically supervised detox, or intensive outpatient or partial hospitalization programs.

If you are in a mental-health crisis in the United States, call or text 988. Call 911 for immediate danger.

Educational information, not a diagnosis or individual treatment plan.