How to Stop a Panic Attack

What to do during a panic attack

A panic attack is a sudden surge of intense fear with strong physical symptoms. It usually peaks within 10 minutes.¹ The aim is not to fight it. It is to ride it out without adding more fear.

1. Name it. Tell yourself: “This is a panic attack. It feels awful, it isn’t dangerous, and it will pass.”
2. Slow your breathing. Breathe in gently through your nose for about three seconds, then out for longer than you breathed in. Keep the breaths small. Panic makes you over-breathe, and big gulps of air make the dizziness and tingling worse.^2,3
3. Drop your shoulders and unclench your hands and jaw.
4. Fix your attention on something outside you. The feel of your feet on the floor, five things you can see, the sounds in the room.
5. Stay where you are, if it is safe to. Leaving teaches your brain that the place was the danger.
6. Let it peak and fall. The physical symptoms can’t keep rising. The stress response burns itself out and your body settles on its own.

What does a panic attack feel like?

Common symptoms include:^1,2

• A racing or pounding heart
• Shortness of breath, or fast, shallow breathing
• Chest pain or tightness
• Sweating, trembling and feeling dizzy
• Tingling in the hands and arms
• A fear of losing control, “going crazy”, having a heart attack or dying

See what is a panic attack? for more on why they happen.

How long does a panic attack last?

Symptoms build quickly and usually peak within 10 minutes.¹ An attack can last from a few minutes to half an hour, and you may feel washed out for a few hours afterwards.²

What not to do

• Don’t breathe into a paper bag. It is an old remedy that is no longer recommended
• Don’t take huge deep breaths. Slow and gentle works better than deep
• Don’t run from the situation unless you need to for safety
• Don’t reach for caffeine or alcohol afterwards. Too much caffeine is a known trigger²

Is it a panic attack or a heart attack?

The symptoms overlap, and a panic attack can feel exactly like a medical emergency.¹ If you have chest pain and think you may be having a heart attack, call triple zero (000) and ask for an ambulance.¹ That is always the right call the first time it happens, or if the pain is severe, getting worse, or different from your usual panic. See anxiety chest pain.

How common are panic attacks?

In the World Mental Health Surveys, about 13 per cent of people had experienced at least one panic attack in their lives. Two-thirds of them had more than one. Only about one in eight of those who’d had an attack went on to meet the definition of panic disorder, which affects about 1.7 per cent of people.⁴

Panic disorder means repeated attacks together with ongoing fear of having more.¹

How to stop panic attacks coming back

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) is the best-studied treatment. An analysis of 72 trials with more than 4,000 people looked at which parts of it do the work. The most useful part was “interoceptive exposure”: deliberately bringing on the body sensations of panic, such as a fast heartbeat or dizziness, in a safe setting until they stop being frightening. Therapy packages that included muscle relaxation did worse.⁵

The logic is that panic is driven by fear of the sensations themselves. Once a pounding heart no longer reads as danger, the spiral has nothing to feed on.

Online therapy

CBT delivered online also works. A meta-analysis found that internet programs for panic disorder clearly outperformed waiting lists, and three trials suggested results similar to face-to-face therapy.⁶ Australian programs are available, either self-guided or guided by a clinician.⁷

Cut back on caffeine

People with panic disorder are unusually sensitive to caffeine. In studies using a dose equal to about five cups of coffee, half of those with panic disorder had a panic attack, compared with fewer than 2 in 100 people without it.⁸

Exercise

Exercise brings on a fast heartbeat and heavy breathing in a setting that is clearly safe, which works a little like exposure. In a small laboratory study, people with panic disorder who exercised hard beforehand had a milder panic response to a test designed to trigger one.⁹

Breathing training

Breathing retraining made therapy easier to stick with but added little to its effect.⁵ It is a useful tool in the moment, not a cure.

Medicines

Prescription medicines are another option for panic disorder. Your doctor can explain whether they are suitable for you.¹

When to see a doctor

• You have had more than one panic attack
• You worry about the next one, or avoid places in case it happens
• You aren’t sure your symptoms are panic
• Panic is affecting your work, study or relationships

If you are having thoughts of suicide, call Lifeline on 13 11 14. In an emergency, call 000.

References

1. healthdirect. Panic attacks and panic disorder.
2. Better Health Channel (Victorian Government). Panic attack.
3. Better Health Channel (Victorian Government). Breathing to reduce stress.
4. de Jonge P, Roest AM, Lim CC, et al. Cross-national epidemiology of panic disorder and panic attacks in the world mental health surveys. Depress Anxiety. 2016;33(12):1155-1177.
5. Pompoli A, Furukawa TA, Efthimiou O, et al. Dismantling cognitive-behaviour therapy for panic disorder: a systematic review and component network meta-analysis. Psychol Med. 2018;48(12):1945-1953.
6. Stech EP, Lim J, Upton EL, et al. Internet-delivered cognitive behavioral therapy for panic disorder with or without agoraphobia: a systematic review and meta-analysis. Cogn Behav Ther. 2020;49(4):270-293.
7. THIS WAY UP (St Vincent’s Hospital Sydney). THIS WAY UP online programs.
8. Klevebrant L, Frick A. Effects of caffeine on anxiety and panic attacks in patients with panic disorder: A systematic review and meta-analysis. Gen Hosp Psychiatry. 2022;74:22-31.
9. Esquivel G, Díaz-Galvis J, Schruers K, et al. Acute exercise reduces the effects of a 35% CO2 challenge in patients with panic disorder. J Affect Disord. 2008;107(1-3):217-20.