How to Handle a Panic Attack in the Moment: A Step-by-Step Guide

To handle a panic attack in the moment, slow your breathing with long, gentle out-breaths, ground yourself by naming what you can see, hear and feel, and remind yourself that the surge will peak and pass. Stay where you are if it is safe. If you have chest pain or it is your first episode, get urgent medical care.

This guide is for adults and teens who have had panic attacks, people worried they might have one, and friends or family who want to help. It covers what panic feels like, a step-by-step plan, what to say to yourself, emergency red flags and what helps over the long term.

What does a panic attack feel like?

A panic attack is a sudden wave of intense fear with strong physical symptoms, often with no clear danger. The National Institute of Mental Health (NIMH) lists symptoms such as a racing heart, sweating, trembling, trouble breathing, dizziness, chest pain and a feeling of doom or loss of control.

Many people also notice tingling hands, chills or hot flashes, nausea or a sense that things are not real. Because the symptoms are so physical, people often think they are having a heart attack or are about to faint. That fear can make the attack feel even bigger.

Why does panic happen in the body?

Panic happens when the body's alarm system fires at full strength without a real threat. Heart rate and breathing speed up, muscles tense and attention narrows, as if you needed to run or fight.

Fast breathing can then cause more symptoms. MedlinePlus, from the National Library of Medicine, notes that panic attacks are one emotional cause of hyperventilation, which can bring lightheadedness, a sense of not getting enough air and chest pain. Knowing this loop can make the sensations less frightening while they happen. For a deeper look, see why you just had a panic attack.

Step by step: what to do during a panic attack in the moment

A simple, repeatable sequence helps most, because panic makes complex thinking hard. Try these steps in order.

1. Pause and stay put if you are safe. If you are driving, pull over when it is safe to do so. Running out of a room can teach your brain the place is dangerous.
2. Slow your out-breath. Breathe in gently through your nose for about four counts, then out through pursed lips for about six. MedlinePlus describes pursed-lip and belly breathing for hyperventilation.
3. Put a hand on your belly. Let your belly rise as you breathe in, rather than your chest.
4. Ground your senses. Name five things you can see, four you can feel, three you can hear, two you can smell and one you can taste.
5. Use a short phrase. "This is panic. It peaks and passes. I can ride it out."
6. Relax one muscle group. Tense your shoulders for five seconds, then let them drop. Repeat with your hands.
7. Move to a quieter spot if you can. Fresh air or a cool drink of water can help.
8. Afterward, be gentle. Rest, eat something and note what happened, without judging yourself.

The National Center for Complementary and Integrative Health (NCCIH) says relaxation techniques are generally considered safe for healthy people, though occasionally people report increased anxiety. If a technique makes you feel worse, switch to another one.

What should you tell yourself during a panic attack?

Tell yourself short, true statements that name what is happening and remind you that it passes. Arguing with the fear or trying to force it away tends to backfire. Pick one or two lines and practice them on calm days so they are ready. MedlinePlus notes that people with panic disorder often worry about future attacks, and calm self-talk can interrupt that worry loop.

• "This is a panic attack. It feels awful, and it will pass."
• "My body is sounding a false alarm."
• "I do not have to fight this. I just have to breathe slowly."
• "I have gotten through this before."
• "I can stay here for one more minute."

If you are helping someone else, say: "I am here. You are safe right now. Breathe with me." Then breathe slowly where they can see you.

How can you help someone who is having a panic attack?

You can help most by staying calm, staying close and keeping things simple. Your steady presence signals safety more than any words. NIMH lists chest pain and a feeling of doom among panic symptoms, so take the person's fear seriously rather than brushing it off.

• Move with them to a quieter spot if they want to, but do not drag them out.
• Ask, "Have you had this before? What usually helps?"
• Breathe slowly where they can see you, and invite them to match your pace.
• Offer water, and keep sentences short and kind.
• Avoid "calm down" or "it is all in your head."
• Stay until it passes, then let them rest.

Example (hypothetical): a friend at a concert suddenly says they cannot breathe. You walk with them to a quieter hallway, sit down, and breathe out slowly together. If they had chest pain that did not ease, or said it had never happened before, the right move would be to call 911.

Is it a panic attack or a medical emergency?

Sometimes you cannot tell, and that is why new or unusual symptoms need urgent medical care. The Centers for Disease Control and Prevention (CDC) lists chest pain or discomfort, feeling weak, light-headed or faint, pain in the jaw, neck, back, arm or shoulder, and shortness of breath as major heart attack symptoms, and says to call 911 immediately.

Call 911 or get emergency care if:

• It is your first episode of this kind.
• Chest pain is crushing, spreading, or comes with exertion.
• Symptoms feel different from your usual attacks.
• Breathing does not improve, or you faint.
• You have heart disease, diabetes or other risk factors.

MedlinePlus also notes that a first episode of hyperventilation may be an emergency. It is always reasonable to get checked.

What helps prevent the next panic attack?

Prevention focuses on lowering your baseline stress and reducing fear of the sensations themselves. MedlinePlus explains that people with panic disorder often worry about future attacks and may avoid places where attacks have happened. That worry and avoidance can keep the cycle going.

• Practice slow breathing for a few minutes daily, not only during attacks.
• Keep regular sleep and meals.
• Notice how caffeine, alcohol and nicotine affect you.
• Stay active; movement teaches your body that a fast heartbeat can be safe.
• Gently return to places you have started avoiding, ideally with a therapist's guidance.

Lyte Psychiatry's article on your first anxiety attack covers what to do in the days after.

How are panic attacks treated?

Panic attacks and panic disorder are treatable, most often with therapy, medication or both. NIMH advises seeing a health care provider, who can examine you to rule out other causes. MedlinePlus notes that evaluation may include blood tests to check for thyroid problems.

Cognitive behavioral therapy for panic teaches you to understand the alarm response and to face feared sensations and situations step by step. Medication may be considered when attacks are frequent or severe, decided with a prescriber. To compare these paths, see when therapy is enough for panic and when medication helps.

When should you get help sooner?

Get help soon if panic is shaping your life, not just interrupting it. NIMH advises seeing a provider when distressing symptoms last two weeks or longer.

• Attacks are happening weekly or more.
• You are avoiding driving, stores, work or leaving home.
• You are using alcohol or other substances to cope.
• You feel hopeless, or have thoughts of suicide.

Thoughts of suicide need same-day help. Call or text 988 in the United States.

What about panic attacks in Texas schools and workplaces?

In Texas, as elsewhere, a panic attack in the moment at school or work is easier to manage with a plan made ahead of time. Students can ask a school counselor or nurse about a quiet place to go and a simple signal for leaving class. Adults can identify a private spot at work and a trusted coworker.

If you are seeking care by telehealth, the U.S. Department of Health and Human Services explains that providers must be licensed or legally permitted to practice in the state where the patient is located, and these rules vary by state. For more quick techniques, see ways to stop a panic attack.

Getting support in Texas

Lyte Psychiatry offers therapy, psychiatric evaluation and medication management in Texas. 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.

Most new patients are seen within 1–2 business days. Weekend appointments are limited. All Lyte Psychiatry services are available in Spanish. Availability, insurance and clinician fit require confirmation, so contact the practice to check before you book.

Learn more about anxiety and panic care at Lyte Psychiatry.

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.