How to stop a panic attack: what helps now, and what helps for good

How to stop a panic attack: what to do right now

You cannot switch a panic attack off. But these steps, from NHS advice, can help it pass. Each one says how strong the evidence is.

You can do all of this quietly, in public or at work. The NHS breathing exercise “can be done anywhere”^[5]. Tips such as cold water on your face or holding your breath are popular online, but none of the official sources we read recommends them. Afterwards, practise the breathing on calm days too: “You will get the most benefit if you do it regularly”^[5].

Is it a panic attack or a heart attack?

“Panic attacks often include physical symptoms that might feel like a heart attack”^[14], and “most of these symptoms can also be symptoms of other conditions or problems”^[1]. You cannot reliably tell them apart yourself. In a study of 338 people who went to an emergency department with chest pain, the usual signs and symptoms “cannot be used to distinguish patients with and without panic disorder”^[11].

Getting checked is the right thing to do. UK guidance says people who go to A&E with a panic attack should have the “minimum investigations necessary to exclude acute physical problems”^[12]. Once a doctor has ruled out a heart problem, the steps above are for future attacks that feel the same. Panic attacks are frightening, but the NHS says “they’re not dangerous”^[1].

What does a panic attack feel like?

The NHS says “It can come on very quickly and for no apparent reason”^[1]. Common symptoms include^[13]:

• a pounding or racing heart
• sweating, trembling or shaking
• feeling short of breath, or as if you are choking
• chest pain
• feeling sick, or a churning stomach^[1]
• feeling dizzy or light-headed, or having chills or hot flushes
• tingling in your fingers or lips^[16]
• feeling detached from your body, or as if things around you are not real
• fear of losing control, of “going mad”, or of dying

You will not have all of them: “several of these symptoms occur in combination”^[15]. Attacks “can appear ‘out of the blue’ or can be triggered by particular situations”^[13]. If yours tend to come around other people, see our post on social anxiety. For everyday worry, see stress vs anxiety.

How long do panic attacks last?

“Most panic attacks last between 5 and 20 minutes. Some have been reported to last up to an hour,” says the NHS^[1]. NHS inform gives 5 to 30 minutes^[4], and NIMH says “a few minutes to an hour or sometimes longer”^[14]. So: usually a few minutes to around 20, occasionally longer.

How often they happen varies a lot, from “several times a day” to “a few times a year”^[14].

Why do panic attacks happen?

“When you’re feeling anxious or scared, your body releases stress hormones, such as adrenaline and cortisol”^[16]. In a panic attack, this alarm goes off when there is no real danger. “Some researchers think panic attacks are like ‘false alarms,’ where our body’s typical survival instincts are active either too often or too strongly”^[14].

Fear of the feelings can make them stronger. Someone “might feel their heart pounding and assume they’re having a heart attack. This may lead to a vicious cycle”^[14]. This is the idea behind the cognitive model of panic: a body sensation is read as a sign of disaster, the fear rises, and the sensation gets stronger^[17].

The exact cause is “not fully understood”. Things thought to play a part include “a traumatic or very stressful life experience, such as bereavement”, a close family member with panic disorder, and an imbalance of brain chemicals called neurotransmitters^[1]. Caffeine, alcohol, sugary food and drinks, and smoking “can all make attacks worse”^[1]. Coffee, cocaine, and withdrawal from alcohol or some sedatives can cause panic symptoms by themselves^[13].

Panic attack vs anxiety attack: what is the difference?

What sets a panic attack apart, the WHO says, is its “sudden onset, rapid peaking, unexpected nature and intense severity”, which separates it from “normal situationally bound anxiety that may be experienced in everyday life”^[13]. “Anxiety attack” is not a diagnosis. People often use it for anxiety that builds up more slowly around a worry, and some references use it as another name for a panic attack. We compare the two side by side in panic attack vs anxiety attack.

Panic attacks at night

Some people wake “from sleep in a state of panic”^[13]. Night-time panic is common among people with panic disorder, but two studies give quite different figures, so we will not give one number^[18][19]. It is “distinct from sleep terrors, sleep apnea, nightmares or dream-induced arousals”, and checking for it focuses on “ruling out other explanations”^[18]. So if you wake up gasping or choking, see a doctor to rule out causes such as sleep apnoea.

In one study, night-time attacks did not seem to mean the panic disorder was more severe^[19]. The same steps above can help, and CBT has some evidence behind it for night-time panic^[18]. If sleep itself has become a struggle, see our page on insomnia.

Panic attacks, panic disorder and agoraphobia

Panic attacks are common. In surveys of nearly 143,000 adults in 25 countries, 13.2% had had at least one in their life, about 1 in 8^[20]. In a US survey, more than 1 in 5 adults had had panic attacks at some point without the disorder^[21].

“An isolated panic attack is not a mental disorder”^[14]. Panic disorder means “recurrent, unexpected panic attacks”, followed by “at least 1 month worrying about having more panic attacks, feeling scared about what the attacks mean, or changing their behavior to try to avoid future attacks”^[14]. The WHO gives “several weeks” as its example, rather than a fixed month^[13]. Only a professional can diagnose it.

In a large US survey from the early 2000s, 2.7% of adults had panic disorder in the past year^[22]. It is about twice as common in women^[13], and it often starts in the late teens or early adulthood^[14].

Fear of the next attack can shrink your life. The NHS describes living “in fear of fear”^[1]. Some people start avoiding places where escape or help might be hard, such as public transport or shops. That is agoraphobia^[15]. It “can develop as a complication of panic disorder”, though “Not all people with agoraphobia have a history of panic attacks”^[6].

How to help someone having a panic attack

You do not need to fix it. You just need to stay steady. A Canadian government health website advises^[23]:

• “Stay with the person and keep calm.”
• “Move the person to a quiet place,” if you can.
• “Ask what the person needs.”
• “Speak to the person in short, simple sentences.”
• Breathe slowly with them, or count slowly to 10.

Calm phrases can help, such as “You can get through this” and “What you are feeling is scary, but it’s not dangerous”^[23]. If they have chest pain, or you are not sure whether it is a medical emergency, call 911 or 999. If you notice heart attack symptoms “in yourself or someone else, call 9-1-1 immediately”^[10].

What to text someone having a panic attack

Keep messages short and calm. These are our suggestions, based on the phrases above:

• “I’m here. You can get through this.”
• “Breathe with me: in for five, out for five.”
• “What do you need right now?”

If they mention chest pain, tell them to call 911 or 999, or call for them if you know where they are.

Supporting a partner or friend over time

Choose a calm moment “to express your concern and reassure them of your support”^[14]. If attacks keep happening, encourage them to get help, and “Allow the person to proceed in therapy at their own pace. Be patient”^[23]. Be patient with yourself too: managing panic “may involve setbacks along the way”^[14].

How to stop panic attacks coming back

There is no guaranteed way to stop panic attacks forever. But panic disorder is treatable, and treatment helps many people have fewer attacks and stop avoiding things. “Treatment for panic disorder typically involves psychotherapy, medication, or both”^[14].

CBT

CBT is the best-studied talking therapy for panic. NIMH calls it the “gold standard”^[14], and UK guidance says “CBT should be used”, usually about 7 to 14 hours in total over up to four months^[12]. The evidence is good but not perfect. A Cochrane review of 54 studies found CBT “was often superior to other therapies, although the effect size was small”, and rated the evidence as low quality^[24].

The part of CBT with the strongest support is interoceptive exposure. With a therapist, you bring on mild versions of the feelings you fear, such as a fast heartbeat, until they stop feeling dangerous^[14]. In an analysis of 72 studies, interoceptive exposure was linked with better results, and muscle relaxation with worse ones^[25]. It is done with a trained therapist, not alone.

What about breathing training?

Fast breathing (hyperventilation) has many “links to anxiety and panic”^[26], but as a treatment on its own the evidence is mixed^[7]. In one trial of 74 people, two opposite breathing methods worked about equally well, so the benefit seems to come from what they had in common^[8]. Within CBT, breathing retraining seems to make treatment easier to accept but adds little to how well it works^[25].

Self-help

For mild to moderate panic disorder, UK guidance starts with self-help^[12], such as a self-help book based on CBT, plus regular exercise^[1]. Self-help works better with some guidance^[28]. In a review of 74 trials, guided self-help worked about as well as CBT face to face, but unguided self-help did not beat usual care, and no finding was rated high confidence^[27].

Medication

Medicine is also a main treatment, alone or with therapy^[1][14]. Antidepressants, usually SSRIs, are the medicines UK guidance recommends for longer-term use, and stopping them suddenly can cause withdrawal symptoms^[12]. They can take 2 to 4 weeks to start working^[1]. Benzodiazepines can ease symptoms quickly, but some people become dependent on them, so in the US they may be prescribed “only for brief periods of time”^[14], and UK guidance says they “should not be prescribed” for panic disorder^[12]. Short term, research has found no clear difference between talking therapy and SSRIs, though the evidence is low quality^[29]. Whether medicine is right for you is a decision to make with a doctor or psychiatrist.

Therapy for panic attacks on Bliss Therapy

Panic can be hard to put into words. The WHO notes that “The symptom presentation of panic attacks may vary across cultures”^[13], and UK guidance on anxiety says “consideration should be given to providing psychotherapies in the person’s own language if this is not English”^[12]. Therapy for panic “can be effective when delivered in person or virtually via telehealth”^[14].

On Bliss Therapy you choose a therapist who speaks your language, by video, with no waitlist. 52 psychologists and counsellors list anxiety and stress, with sessions from €30 (about £25); 42 of them list CBT.

Our therapists are based outside the UK and the US, so they are unlikely to be on UK registers or covered by US health insurance. Ask any therapist about their training and their registration in the country where they practise.

When to get help

See a doctor if you have had panic attacks, so they can rule out physical causes^[1][15]. Get help too if attacks keep coming, you dread the next one, or you have started avoiding things. NIMH says that when anxiety “starts to cause problems in everyday life”, “it’s time to seek professional help”^[14]. See a GP if “things you’re trying yourself are not helping”^[16]. “Panic disorder is treatable so it’s best to get medical help as soon as you can”^[1].

Teenagers with panic disorder are at greater risk of depression, including suicidal thoughts^[13]. If you or someone you know is having thoughts of suicide, in the US call or text 988 or chat at 988lifeline.org, and in life-threatening situations call 911^[14]. The 988 Lifeline “is available 24/7/365”^[30]. In the UK, call Samaritans on 116 123, day or night^[16], or 999 in an emergency.