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

A panic attack often comes out of nowhere, unexpectedly hits us – with a racing heartbeat, shortness of breath, chest tightness, as if our body and mind were losing control at the same time. Many people experience the first attack as a heart attack, and do not even realize that it is actually a mental health reaction. Although a panic attack is scary, it is not dangerous, and it can be managed. In this article, we go through the symptoms of a panic attack, what may be behind it, and how you can build the right treatment for panic attacks – at home or with help from a professional.

• A panic attack is a natural but not dangerous physical and emotional reaction.

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

• If the attacks repeat or get worse, it is important to seek professional help (psychologist/psychiatrist).

A quick look at panic attacks

A panic attack is a sudden, intense anxiety episode, that often appears without warning. During the attack, the body switches into emergency mode: heart rate speeds up, shortness of breath, chest tightness, trembling, sweating, dizziness, numbness, or a feeling of choking may appear. Many people feel like they are going to die or go crazy – even though these symptoms are the body’s natural, but overactivated stress response.

Behind a panic attack there may be past trauma, long-term stress, unprocessed emotional tension, or even physical causes. Although it feels frightening and hard to understand at first, a panic attack has a course: it usually eases on its own within 10–30 minutes, and then gradually fades away.

The biggest challenge is that after the attack, people start fearing the next one, and this worry can trigger the so-called panic cycle, which in severe cases can lead to panic disorder.

It is best if panic attack treatment starts already after the first episode, and for that you only need a little awareness from your side. Soon I will show you how to do it!

Panic attack or anxiety attack? What is the difference?

Although the two states can feel similar, it is still important to tell them apart. An anxiety attack usually develops more gradually, and is more dominated by worry, restlessness, and negative thoughts.

A panic attack, on the other hand, hits suddenly, is very intense, comes with physical symptoms, and often appears without a clear reason.

Anxiety is often tied to a stressful situation, while a panic attack can appear even in a calm situation, seemingly without any warning.

It is important to understand that although both are based on anxiety, a panic attack is much more like an overactive alarm system, while anxiety is a more lasting, lower-intensity state.

Diagnosing panic attacks

Diagnosing a panic attack is the job of a psychologist or psychiatrist, but the first stop is often the medical on-call service or emergency room, because the symptoms strongly resemble heart problems. In these cases, medical causes must be ruled out – for example, arrhythmia, low blood sugar, overactive thyroid, or another neurological illness.

If physical causes can be ruled out and the attacks repeat, a psychologist can help identify the triggers and confirm the diagnosis. Panic disorder is present when the attacks keep coming back and affect everyday life – for example, when the person starts avoiding situations where an attack has happened before.

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

Managing panic attacks at home

A panic attack is sudden and unpredictable, so it is frightening – but once we know what is happening to us, we feel much less helpless.

One of the most important steps toward calm is to realize that the attack is not dangerous, just very unpleasant.

The body sends out an emergency signal, as if we were in danger, while in reality there is no outside threat. This internal “false alarm” can be influenced with a number of small tools – especially breathing, distraction, and conscious coping skills.

Breathing techniques – to calm things down fast

Breathing is one of the most effective tools we can use right away for panic attack treatment . During an attack we often hyperventilate – meaning we breathe too fast and too shallow, which can lead to dizziness, numbness, and even more panic. But the slower and more consciously we breathe, the sooner the body’s calming system is activated. The goal is to slow the breathing down, so we send a signal to the nervous system: there is no emergency.

Some tried-and-tested techniques:

• 4–4–6 breathing: Count to 4 while breathing in, hold for 4, then slowly breathe out over 6 counts.
  
  

• Box breathing: This method helps restore different balance processes – it works not only during an attack, but also before or after one.

  The “box” has four equal parts, as if you were walking around its 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, even with your eyes closed. It helps regulate your pulse, reduces shortness of breath, and brings you back to the present.

  

  
  

• “Two hands on the chest” exercise: lying down or sitting, place both hands on your chest and notice your breathing slow down – just feel it, do not force it.
  
  

• Straw breathing: This exercise helps slow the exhale, which reduces the feeling of shortness of breath and calms the nervous system. Take a straw (or slightly purse your lips as if you were breathing through one), and:
  – Slowly breathe in through your nose,
  – then breathe out very slowly through the straw/imaginary straw, as if blowing out a candle – but without using full force. The key is a long, controlled exhale.

Grounding techniques – getting back to the present

A panic attack often feels like we are “slipping out of reality.” In that moment, it is important to reconnect your senses to the present moment – this is grounding.

Practical methods:

• 5-4-3-2-1 technique: name 5 things you can see, 4 you can hear, 3 you can touch, 2 you can smell, and 1 you can taste.

• Cold water or ice: a sip of cold water, an icy towel, or a cold compress on the wrist can help break the momentum of the attack.

• Say it out loud: say your name, the date, where you are, what you were doing that day – this helps the brain “return” to the present.

Movement and muscle relaxation

During panic, the body mobilizes energy – but cannot release it. Mild trembling or stillness can often feel paralyzing. Light physical activity, such as:

• walking around the apartment,

• slow stretching or

• progressive muscle relaxation (tighten and release tension muscle group by muscle group)
  can help drain the tension out of the body.

Herbs and natural calmers

Certain herbs can help ease the post-attack nervous tension or evening restlessness.

• Lemon balm: calming, mildly sleep-inducing effect

• St. John’s wort: mood-lifting – but be careful, because it can interact with some medicines

• Valerian root: anxiety-reducing and sleep-inducing effect

• Lavender: effective as an essential oil too, either diffused or added to bath water.

It is important to know that these are mild, not medicine-based supports, so you should not expect them to stop attacks or resolve your anxiety long term – for that, psychotherapy and, if needed, medication support are necessary.

Managing evening/night panic attacks

Panic attacks can also strike at night – during sleep or shortly after falling asleep. This is especially draining, because it is even harder then to stay in control while you are between waking and sleep.

What can you do in that moment?

• Do not suddenly turn on the light – full activation can make the attack stronger.

• Do not jump out of bed; instead, try to stay there, and steady yourself with slow, conscious breathing.

• Use quiet, relaxing audio: for example body scan, nature sounds, guided breathing.

• Know that it passes. One of the most helpful inner phrases is: 

“This is a panic attack. It will not kill me. It will pass, like always.”

Recovery afterward

After a panic attack, many people feel as if they have been wrung out – fatigue, shame, restlessness may remain. In those moments, it is important to:

• do not blame yourself,

• take some recovery time,

• write the experience out of you (journaling),

• or talk to someone you trust.

The goal is not to avoid attacks at any cost – but to know what is happening, and have a few tools in your hands to ease the process. This alone reduces fear – and with it, the power of panic.

Managing panic attacks in children

In children, panic attacks are less common, but they can happen – especially in more sensitive or highly anxious children. In their case, the symptoms often show up as stomachaches, crying, a choking feeling, or outbursts of anger.

It is important that the child does not feel guilty or “weird” – instead, try to teach them that what they are experiencing is not dangerous, and help them calm down.

A calm presence from the parent, breathing together, and a fixed ritual or object (for example, a soft plush toy or scent pillow) can give a sense of safety. If the attacks repeat or are followed by strong anxiety, it is worth reaching out to a child psychologist.

Medication treatment for panic attacks

For more severe or frequently recurring panic attacks, a psychiatrist may also recommend medication treatment. The most commonly used medicines are anxiolytics (benzodiazepines) and certain types of antidepressants, especially SSRIs (selective serotonin reuptake inhibitors).

Medicine does not solve the root cause, but it can help stabilize the nervous system and reduce the frequency and intensity of attacks.

It is important to always take medicine on medical advice and under supervision, and not stop it suddenly. In most cases, the goal is to provide temporary support alongside psychotherapy.

Managing panic attacks with a professional

In the long run, panic attacks are best treated with the help of a psychologist or psychotherapist.

A professional helps map the thought and emotional patterns that trigger the attacks, and teaches methods that help the person regain control over body sensations and thoughts.

One of the most effective methods is cognitive behavioral therapy, where we gradually work on calming the fears linked to panic, so the attacks are no longer seen as a catastrophe to avoid, but as a manageable experience. During therapy, self-knowledge deepens, which helps attacks become less frequent or disappear over time.

Frequently asked questions

What should I do if a panic attack hits me in a public place such as the bus or the store?

Try not to run away from the place, because that can lock in the fear. Instead, try to find a fixed point to focus on, and use cyclical slow breathing until the wave of the attack eases.

Can a panic attack cause permanent physical damage to my heart or brain?

Although the symptoms (shortness of breath, chest pain) can feel very real, a panic attack is a temporary stress response that does not damage your organs and does not lead to cardiac arrest.

Is there a link between caffeine, alcohol, or nicotine use and the frequency of panic attacks?

Yes, stimulants and withdrawal symptoms make the nervous system more sensitive to body signals, which can more easily trigger the panic cycle. It is a good idea to avoid these during recovery.

How can I help my partner or friend if they are having a panic attack in front of me?

Stay with them calmly, and ask them to try slowing their breathing with you in a steady rhythm until they feel safe. Avoid instructions like "calm down" or "don’t worry, it is nothing."

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