How to Manage a Panic Attack: What to Do When Having a Panic Attack?

Panic attacks often come on without warning, unexpectedly striking us – with a racing heart, shortness of breath, chest tightness, as if our body and mind lose control simultaneously. Many experience the first attack as a heart attack and do not realize it is actually a psychological response. Although a panic attack is frightening, it is not truly dangerous and can be treated. In this article, we will review the symptoms of a panic attack, what might cause it, and how you can lay the foundation for managing panic attacks – whether at home or with professional help.

• A panic attack is a natural but non-dangerous physical and mental response.

• With awareness and simple tools, it can be managed at home.

• If the attacks recur or worsen, it is important to consult a professional (psychologist/psychiatrist).

A Brief Overview of Panic Attacks

A panic attack is a sudden, intense episode of anxiety that often occurs without any warning. During the attack, the body switches to emergency response mode: heart rate speeds up, breathing difficulty, chest tightness, trembling, sweating, dizziness, numbness, or a feeling of suffocating may occur. Many feel as if they are about to die or go insane – although these symptoms are the body's natural but overactive stress response.

Behind a panic attack may lie past traumas, prolonged stress, unresolved emotional tensions, or even physical causes. Although initially frightening and elusive, a panic attack has a course: it typically eases within 10–30 minutes on its own and then gradually subsides.

The greatest difficulty is that after an attack, one starts fearing the next one, and this anxiety can trigger what is called the panic cycle, which in severe cases may lead to panic disorder.

The best approach is to start managing the panic attack after the first instance, requiring nothing more than a bit of awareness on your part. Soon, I'll explain how to do it!

Panic Attack or Anxiety Attack? What’s the Difference?

While the two conditions might seem similar, it's important to differentiate between them. An anxiety attack generally develops more gradually and is dominated by worry, restlessness, and negative thoughts.

A panic attack, however, strikes suddenly, is very intense, involves physical symptoms, and often occurs without a specific cause.

Anxiety is often linked to a stressful situation, whereas a panic attack can happen in a calm setting, seemingly out of nowhere.

It's vital to understand that though both are anxiety-based, a panic attack is more like an “over-triggered” alarm system, while anxiety is a more persistent, lower-intensity state.

Diagnosing a Panic Attack

The diagnosis of a panic attack is the duty of a psychologist or psychiatrist, though many times the first encounter takes place in the emergency room or ER, where symptoms closely resemble heart issues. It is important to exclude medical causes at such times – for example, cardiac arrhythmia, low blood sugar, hyperthyroidism, or other neurological diseases.

If physical causes can be excluded, and attacks recur, a psychologist can help uncover the triggers and affirm the diagnosis. Panic disorder is diagnosed if attacks are recurrent and affect daily life – for instance, one starts avoiding places where an attack occurred.

If you want to test whether you might be affected by panic disorder, fill out this short, one-minute panic disorder test.

Home Management of Panic Attacks

Panic attacks are sudden and unpredictable, thus frightening – but knowing what is happening to us makes us feel much less vulnerable.

One of the most crucial steps toward calming down is recognizing  that the attack is not dangerous, only very unpleasant.

The body sends out alarm signals as if we were in life-threatening danger, even though there is no external threat. This internal “false alarm” can be influenced by various small tools – primarily with breathing, distraction, and conscious coping techniques.

Breathing Techniques – How to Quickly Control It

Breathing is one of the most effective tools we can immediately utilize for the treatment of panic attacks. During an attack, we often hyperventilate – that is, we breathe too quickly, too shallowly, leading to dizziness, numbness, and even greater panic. However, the slower and more consciously we breathe, the sooner the body's calming system activates. The goal is to slow down the breathing to signal to the nervous system that there is no emergency.

A few tried and true techniques:

• 4–4–6 Breathing: Count to 4 while inhaling, hold for 4, then slowly exhale for a count of 6.
  
  

• Box Breathing: This method helps restore various balance processes – effective not only during an attack but before or after it as well.

  The "box" consists of four equally-long phases, similar to tracing the four equal sides:
  - Inhale for 4 counts,
  - Hold for 4,
  - Exhale for 4,
  - Pause (with empty lungs) for 4.
  Repeat this for 2–3 minutes, possibly with closed eyes. It helps regulate the heart rate, reduces shortness of breath, and brings you back to the moment.

  

  
  

• “Two Hands on the Chest” Exercise: While lying or sitting, place both hands on your chest and watch your breathing slow down – just perceive it, don't try to control it.

  
  

• Sip Straw Breathing: This exercise helps slow the exhale, thus easing the feeling of breathlessness and calming the nervous system. Take a straw (or purse your lips slightly as if blowing through it) and:
  - Breathe in slowly through your nose,
  - then exhale the air very slowly through the straw/imaginary straw, like blowing out a candle – but without full force. The key is a long, controlled exhale.

Grounding Techniques – Returning to the Present

A panic attack often feels like we're