What to do during a panic attack

A panic attack is a sudden surge of intense fear with strong physical symptoms: a pounding heart, breathlessness, chest tightness, trembling, dizziness, tingling, a feeling of unreality, or a sense that something terrible is about to happen. It can feel like a heart attack, or like losing control. It is frightening. It is also, for most people, not dangerous, and it usually peaks within about ten minutes.

If this is the first time, or you are not sure whether it is panic, seek medical help. Some physical conditions cause similar symptoms. See urgent help.

While it is happening

Let it rise and fall

Panic grows when you fight it or try to escape it. If you can, stay where you are and tell yourself plainly: this is panic, it will pass. You don't need to make it stop. You need to let it move through.

Slow the breath out, gently

Panic often comes with fast, shallow breathing, which makes dizziness and tingling worse. Don't try to take big breaths. Instead, make the exhale slow and long: out through softly pursed lips, as if cooling a drink. If you can, breathe in for about four and out for about six. (Why the exhale matters.)

If breath focus makes it worse, skip it and go straight to the next step.

Find something solid

Press your feet into the floor. Hold something cold. Name five things you can see. Anchoring to physical sensation pulls attention away from the alarm. This is grounding.

Follow something outside yourself

When you can't hold a count in your head, follow something external. That's why Calmalo uses a slowly breathing shape and sound instead of numbers: you only have to watch.

Afterwards

You may feel exhausted, shaky or tearful. That's normal. Drink some water, rest, and be kind to yourself. You did nothing wrong.

When to get support

If panic attacks keep happening, or you start avoiding places or situations in case one happens, talk to a doctor. Panic disorder is common and very treatable, and cognitive behavioural therapy in particular has strong evidence.