Panic Attack: What to Do

Is it a panic attack or a heart attack?

You cannot reliably tell by how it feels, so when in doubt, call. Panic attacks often include symptoms that feel like a heart attack, such as a racing heart, chest pain and trouble breathing ^[2]. The American Heart Association says to call 911 if you have heart attack warning signs, "even if you're not sure" ^[3].

Even if everything matches the left column, a heart problem is still possible. Don't drive yourself to the hospital with these signs; the AHA says calling 911 is almost always the fastest way to get treatment ^[3]. An unneeded ambulance is a much better outcome than a missed heart attack.

Panic attack vs anxiety attack: what is the difference

"Anxiety attack" is not a formal medical term, so people use it for different things. A panic attack is the sudden kind: a rush of intense fear with a pounding heart, fast breathing or shaking that usually passes within 5‑20 minutes ^[1]. What people call an anxiety attack is often worry that builds more slowly and can last longer. That is everyday usage, not a diagnosis, and you don't need the right label to start: we use the same steps for both. For anxiety that builds slowly, see how to calm down. If this feels unlike your usual attacks, or there is chest pain, go back to when to call 911.

What to do during a panic attack, and why each step helps

Each step in the tool answers one thing panic pushes you to do.

• If your mind says "I'm dying": naming the attack answers that thought. The NHS advises reminding yourself that the attack will pass and that it is not life-threatening ^[5].
• If you feel you can't get enough air: slow the out-breath instead of gulping in more. In a trial of 74 people with panic disorder, two opposite breathing programs both reduced symptoms for at least 6 months. The authors think what helped was the part they shared: slow, regular breathing and getting used to the scary body sensations ^[6].
• If your legs feel weak or the room spins: sit, or lean on something. Pressing your feet down gives your attention one solid thing.
• If your attention is stuck on your heartbeat: turn it outward to what you can see and hear. The grounding techniques page has more options.
• If you want to leave right now: stay if the place is safe. The NHS advice for the next attack starts with "stay where you are, if possible" ^[5]. Staying lets you see the attack end without escaping.

The 4 in, 6 out count is our choice because it is easy to follow; no trial tested this exact pace for panic. If counting makes it worse, drop the numbers and just breathe out slowly. For the evidence on slow breathing in general, see how to calm your nervous system.

What not to do during a panic attack

Do not breathe into a paper bag, even if someone hands you one. An emergency doctor described three patients who died after this treatment: they were breathing fast because of low oxygen or a heart problem, and it was taken for panic. In the same paper, 20 healthy volunteers who rebreathed into a bag saw the oxygen level fall within 30 seconds, and it kept falling for the full 3 minutes ^[7].

• Don't hold your breath or take huge breaths. Both can add dizziness. Slow the out-breath instead.
• Don't run from every place where it happens. Avoiding places for fear of another attack can turn into living "in fear of fear," and that can bring more attacks ^[5].
• Don't use alcohol, cigarettes or someone else's pills to stop it. The NHS says alcohol and smoking can make attacks worse ^[5].

How to help someone having a panic attack

Stay with the person and keep your words few. These steps follow guidance from MyHealth Alberta, a Canadian health service ^[8]:

1. Ask: "Has this happened before? Is it like your usual attacks?" If it is the first time, or there is chest pain, call 911.
2. Stay with the person, and if you can, move somewhere quieter.
3. Ask what they need. Speak in short, simple sentences, and avoid surprises.
4. Breathe with them, slowly, or count slowly to 10 out loud.
5. Give them one easy task: name what they see, or raise their arms over their head and lower them again.

Things you can say, slowly:

• "I'm right here."
• "What you are feeling is scary, but it's not dangerous." ^[8]
• "Breathe out with me. Long and slow."
• "Tell me what you need now." ^[8]

Skip "just calm down" and "it's all in your head": both tell her the feeling is wrong. Afterward, let her rest, and later ask what helped and what didn't, so you both know for next time. These two points are our advice, not study findings.

Over the phone or by text: stay on the line and don't hang up first. Ask where they are and whether they are sitting down, and breathe slowly so they can hear it. By text, send short lines, one at a time. If they stop answering, mention chest pain or are confused, call 911 yourself and give their address if you know it. This last part is our advice; we found no study of helping remotely.

Panic attacks at night or while driving

Panic attacks can happen at any time, the NIMH says, sometimes even during sleep ^[2].

• If you wake up with your heart pounding: turn on a light, sit up and put your feet on the floor. Then use the same steps. If it is the first time, or there is chest pain, call 911. If mornings are often like this, see morning anxiety.
• If it starts while you drive: signal, pull over where it is safe, put the hazard lights on and stop the car. Do the steps there. Drive on only once it has passed.
• If night attacks keep happening: tell your doctor. They are worth checking out like any other repeated symptom.

What to do after a panic attack

Plan for a slow half hour. Drink some water, eat if you are hungry, and wait until the shakiness settles before you go back to what you were doing.

Later, you can write down where it happened, what came before it and how long it lasted. That makes it easier to talk to a doctor. Go back to the place when you can, because avoiding places can lead to more attacks ^[5].

When panic attacks keep coming back

In a survey of 9,282 U.S. adults, 22.7% had had isolated panic attacks at some point in their lives without panic disorder, and about 5% had panic disorder ^[9]. A single attack is not a mental disorder ^[2].

Panic disorder is when attacks keep coming without warning, and you spend at least a month worrying about the next one or changing your life to avoid it ^[2]. A doctor can check for that and rule out other causes; we can't diagnose it here.

Panic disorder is treatable, the NHS says ^[5]. The British NICE guideline recommends cognitive behavioral therapy (CBT), usually 7 to 14 hours in total ^[10]. In a review of 136 randomized trials, CBT beat usual care and stayed ahead even after trials at high risk of bias were removed ^[11]. If you also feel anxious most days, the GAD-7 anxiety test gives you a score to bring to your appointment.

Frequently asked questions