Experiencing a panic attack can feel intensely frightening, like an attack on one’s very being, leading to a sense of being gripped and paralysed. These attacks can happen for seemingly no explanation and are often described as the most alarming experiences of a person’s life. A panic attack is characterised by the sudden onset of intense physical symptoms of anxiety, peaking quickly, often seemingly out of the blue, with strong physical symptoms that typically affect breathing rate and produce a faster heartbeat. The symptoms are an exaggeration of a normal bodily reaction to stress and are related to the amygdala’s attempts to prepare the body for action, such as pounding heart, trembling, stomach distress, and hyperventilation. While unpleasant, a panic attack is not dangerous and will not physically harm you. The maximum duration of a panic response is typically around ten minutes, even without interference.
Managing the immediate experience involves both physical and mental approaches.
Immediate Physical and Sensory Techniques
- Breathing: Focus on your breathing. When anxious, breathing tends to become quick and shallow, which can lead to hyperventilation, causing symptoms like dizziness or tingling. Consciously slowing down your breathing can help. Techniques include taking slow, full, deep breaths that extend your chest and diaphragm, or using methods like inhaling through the nose for a count (e.g., 4) and exhaling through the mouth for a slightly longer count (e.g., 5 or 6). The aim is to breathe into your belly, not just your chest, to boost oxygen to the brain and regain control. Some approaches suggest that during a full panic attack, it is best not to interfere with breathing and simply allow the body to restore itself. If experiencing hyperventilation, closing your mouth can help prevent it from worsening. Practising proper breathing regularly, not just during panic, can make it an automatic response when needed.
- Muscle Relaxation: The amygdala is responsive to muscle tension, and tight muscles can increase its activation. Learning and practising muscle relaxation techniques can help shorten panic attacks and make them less likely. This involves identifying tension in your body and consciously releasing it, starting from the top of your head and working downwards. Relaxing your muscles helps you let go of the control response, which is part of the fight-or-flight arousal.
- Physical Action/Movement: Exercise or pacing during a panic attack can help burn off excess adrenaline and may shorten the attack. Your body is prepared to fight or flee, so physical exertion aligns with this readiness. Some techniques involve intentionally evoking feared physical symptoms, such as running in place to increase heart rate or spinning in a chair to feel dizzy, to teach your body that these sensations are not harmful.
- Self-Soothing Touch: Gentle, soothing touch on areas like the arms, face, or hands can be used while focusing on calming techniques like breathing or visualisation. This self-havening touch can help regulate the nervous system and create a sense of safety. Hands-On Grounding, which involves stroking and soothing your body, can help panic and anxiety realise you are in a safe place.
- Sensory Input: Sudden sensory input like placing a cold cloth on your neck, holding an ice cube, or taking a cold shower can “shock” the anxiety out of your system. Eating something with a strong taste, like a lemon, or having a snack can also help.
Mental and Cognitive Approaches
- Acceptance and Non-Resistance: A powerful strategy is to accept the anxiety and the physical sensations it brings, rather than fighting or trying to wish them away. Allowing the feelings to be present can make them less intense over time. This involves being willing to experience the anxiety that is already there, which is the opposite of trying to control it. Sitting with the feelings without trying to change them allows you to learn to relate to them differently.
- Mindfulness and Awareness: Cultivating awareness of your internal experience is key. This involves noticing your thoughts, emotions, physical sensations, and actions without judgment. Mindfulness helps pull your mind out of racing thoughts and spiralling emotions, which can be calming. Techniques include paying attention to your breath or focusing on specific bodily sensations. Noticing and labelling thoughts or feelings as they arise (e.g., “There’s a thought,” or “I feel tension”) can help you step back from them.
- Cognitive Defusion and Reappraisal: Challenge the tendency to interpret physical symptoms catastrophically (e.g., thinking you are having a heart attack or losing your mind). Remind yourself that you are experiencing a panic attack and nothing more. See anxious thoughts as just thoughts, not literal truths. Techniques like prefacing thoughts with “I am having the thought that…” can create distance. Reappraising the situation or your reaction to it can help change its emotional impact.
- Distraction and Refocusing: If experiencing intense anxiety, distracting yourself by focusing on a simple, manageable task can help redirect your attention away from the anxiety-triggering thoughts. Healthy distractions like hands-on activities, entertainment, or being social can also be helpful. Refocussing your attention away from symptoms onto the external environment or a neutral focus can also assist.
- Questioning Anxious Thoughts: Ask questions about your anxious thoughts, such as “Is it true?” or “Can I absolutely know that it’s true?”. Challenge the lies that panic tells you. Ask if worrying is making the problem go away. Remind yourself that you do not need to know when the next panic attack is coming.
- Self-Compassion: Treat yourself with kindness and understanding during a panic attack. Remind yourself that panic is a physiological response, not a sign of weakness or failure. Let go of embarrassment and shame that may arise. Validate your feelings by acknowledging that it is understandable to feel that way.
- “Do the Opposite”: A key strategy is to resist the urge to flee the situation, which is the primary instinct during panic. Staying in the situation allows your amygdala to learn that it is not dangerous. This active responding is necessary to overcome avoidance.
Longer-Term Strategies and Perspective
- Understanding Anxiety: Learning about the nature and purpose of the stress response and panic attacks, and understanding that they are not indicators of actual danger, can provide a foundation for coping. Realising that anxiety is complex and not your fault can help shift perspective.
- Exposure Therapy: Gradually and systematically facing the situations or internal sensations that trigger your panic responses, without using avoidance or safety behaviours, helps to rewire the brain’s fear circuits and reduce the power of panic. This involves staying in the situation or with the sensation until the anxiety diminishes.
- Identifying Triggers: Understanding the situations, thoughts, or physical cues that are connected with your anxiety responses helps identify what needs to be addressed.
- Journaling: Writing down your worries, thoughts, and experiences during or after anxiety can provide perspective, help identify patterns, and allow the brain to feel that these concerns are stored somewhere permanent.
- Seeking Support: Talking to friends, family, or professionals can provide emotional and practical support.
- Focus on Workability: Instead of arguing with anxious thoughts or focusing on why things are happening, focus on what strategies are workable for you and what actions move you towards your goals.
Ultimately, mastering panic attacks involves learning new ways of responding to your internal experiences, practising these skills consistently, and trusting that your body can regulate itself. It requires persistence, patience, and taking action.