How to Calm Down

During an anxiety or panic attack

You are in the supermarket and your heart is pounding. A panic attack can be frightening, but the NHS says it is not dangerous ^[2]. "Anxiety attack" is not a formal medical term ^[4]. We treat both the same way here. For a full walk-through of how to calm down in a panic attack, one step per screen, see panic attack: what to do.

1. Tell yourself what it is. Say "This is a panic attack, and it will pass." NHS inform advises reminding yourself that attacks feel terrible but do not cause anything bad to happen ^[5].
2. Stay where you are, if you can. NHS inform says staying shows you that you do not have to escape for the panic to stop ^[5]. Don't rush to fix it.
3. Breathe slowly. Use the timer above. NHS inform says to focus on breathing slowly to help you feel calmer ^[5].
4. Look around. Name 5 things you can see. NHS inform suggests counting red objects ^[5].

Call 911 if you have chest pain that feels tight or like squeezing, chest pain that spreads to your arms, neck or jaw, or severe difficulty breathing. The NHS lists these as signs of a heart attack and says not to drive yourself to the hospital ^[6]. A panic attack can feel the same, so call instead of guessing.

When you're angry

Step away, then come back. The APA says that if you need to step away to cool down before continuing a conversation, you should promise to return later ^[7].

Then slow your breathing. The APA calls shallow breathing "angry breathing" and suggests slow breaths that you picture coming up from your belly ^[7]. For a timed pause and what studies found, see anger management techniques.

Research has found that "letting it rip" with anger actually escalates anger and aggression. (APA) ^[8]

Yelling to blow off steam is a poor plan. Walk or breathe instead. Then talk. For belly breathing in detail, see belly breathing.

Cold water on your face: what it does and doesn't do

Cold on the face slows your heart rate in lab tests; we found no trial of it for anxiety or panic. In a physiology experiment with 10 healthy volunteers, cold packs on the face slowed the heart rate in all of them, and systolic blood pressure rose in eight of the 10 ^[9].

A meta-analysis of 17 studies (311 people) found a vagal heart-rate measure rose during exposure to cold (g = 0.59) but not afterward, and rated the evidence as low quality ^[10]. Both studies measured the heart, not how people felt.

Neither study measured anxiety, so the 15 to 30 seconds and the advice to use cool rather than ice-cold water are our suggestion, not evidence. Skip it with a heart condition, and ask your doctor if unsure.

If calming down makes you more anxious

Some people feel more anxious when they try to relax; researchers have named this relaxation-induced anxiety ^[11]. PubMed lists no abstract for that paper, so we have no numbers from it. If it happens to you:

• If counting breaths makes you tense, drop the numbers and breathe normally, or stop.
• If you feel stuck in the feeling, put it into words: "I'm feeling anxious right now." In a brain-imaging experiment, putting feelings into words reduced the amygdala's response to upsetting pictures ^[12]. That was a lab experiment with healthy people.
• If your body is restless, walk for a few minutes (our suggestion). A meta-analysis of 36 trials tested a single bout of exercise and found a small reduction in state anxiety (g = 0.16) ^[13]. It did not test a few-minute walk.
• If breathing is the problem, keep your eyes open and use 5-4-3-2-1 grounding, which does not ask you to control your breath. A PubMed search for it returned no studies ^[14], so we offer it as a way to point your attention outward.
• If a frightening thought set it off, see intrusive thoughts.

Why a longer out-breath comes first

Most guides say to breathe out longer. Trials support slow breathing, but a longer exhale has not been shown to beat an equal one.

A meta-analysis of breathwork trials found a small effect on anxiety (20 trials, g = -0.32), and its authors urged caution about the gap between hype and evidence ^[1]. In a trial of 66 people, a prolonged exhale and box breathing both blunted the rise in heart rate and anxiety after a stress test, while heart rate variability and cortisol did not change ^[15].

In a 12 week trial of 100 healthy adults, slow breathing lowered anxiety scores, and the breath ratios did not differ significantly in their effect on stress ^[16]. So the slowness may be what counts. Across 223 studies, slow breathing also raised a heart rate variability measure ^[17].

The 4 in, 6 out pace is our choice, because it is easy to count. No trial tested this exact routine. The full research table is on how to calm your nervous system, and the "vagus" claims are checked on vagus nerve exercises.

Helping someone else calm down

Skip "just calm down." Try short, steady sentences. These are our suggestions.

Frequently asked questions