What to do during a panic attack (and what not to)
Fighting the alarm makes it worse. What to do in the moment, what to do in the hours after, and when panic needs professional help.
Ricardo De Castro KingPsychologist · Meet the author 
It is 7:40 in the morning and you are standing on the bus, bag between your feet, holding the overhead rail. Without warning your chest tightens. Your heart starts hitting so fast you can hear it in your throat, your hands go numb, and the whole bus slides away from you as if you were watching it through glass.
Within twenty seconds you have the conclusion: you are dying. You scan for the door, calculate whether you can get off at the next stop, and part of you starts rearranging the rest of your life around this moment. Then, somewhere between the third and fourth stop, it eases. You step off soaked in sweat, shaking, with the absurd feeling of having survived something nobody else noticed.
Direct answer. During a panic attack, what helps is not fighting the alarm: name it, lengthen your exhale, and return to what you were doing as soon as you can. What escalates it is chasing the exit, checking your pulse, and repeating to yourself that something serious is happening. The hours afterwards matter too: the hangover is where the fear either settles in or fades.
1. What is happening to you, minute by minute
A panic attack is not an exaggeration and not a loss of control. It is a complete alarm discharge — the same one your body would use for a real threat — fired with no real threat present. And it has a recognisable shape.
| Moment | What you feel | What the body is doing |
|---|---|---|
| Second 0 | A warning: strong heartbeat, heat, dizziness | The autonomic alarm switches on |
| First 2 minutes | Racing heart, air hunger, pressure in the chest | Heart and breathing rates climb |
| Minutes 3 to 5 | Tingling in hands and face, dizziness, unreality | Fast breathing lowers CO2 and produces those symptoms |
| Peak (5 to 20 min) | Certainty of catastrophe: “I’m dying”, “I’m going crazy” | Catastrophic reading feeds more alarm |
| Descent | Fatigue, trembling, urge to cry | The system returns to baseline |
| After | Anticipatory fear: “what if it happens again?” | The place-symptom link gets learned |
The peak row is the hinge. Everything else is predictable physiology; the peak is where your mind enters, and that is where something can be done.
Why do my hands and face go numb?
It is one of the most frightening symptoms and one of the most explainable. When you breathe fast, you blow off too much carbon dioxide, and that shift produces tingling in the hands, feet and around the mouth, plus dizziness and a sense of unreality. It is not nerve damage and not a sign of severity: it is respiratory chemistry, and it reverses on its own once breathing slows.
2. Why it happens: the alarm and the reading
If you look for the cause in your character, you will miss it. Panic runs on two parts that push each other: a body signal and an interpretation.
The body sends an alarm signal — pounding heart, pressure, air hunger — and the mind reads it as immediate catastrophe. That reading raises anxiety, anxiety intensifies the signal, and the signal confirms the reading. That is the cycle, and it is exactly how the cognitive research on panic describes it (Clark, 1986; DOI: 10.1016/0005-7967(86)90011-2): the body is not failing, the alarm is being read as a verdict.
There is also a trait that explains why this hits some people and not others: anxiety sensitivity. Some people fear their own bodily sensations more than the situation itself — the heartbeat, the dizziness, the unreality — and that fear is what turns a discomfort into a full episode (Reiss, 1986; DOI: 10.1016/0005-7967(86)90143-9). It is not weakness: it is a measurable trait, and it responds to work.
People with high anxiety sensitivity fear the sensation more than the situation that triggered it. That is precisely where the work pays off most.
3. The types: not all panic is the same
The same word covers different pictures, and knowing which one is yours changes what is useful.
Uncued panic. It arrives with no identifiable trigger: while sleeping, walking, in a calm meeting. It is the most disorienting kind, and the one that installs anticipatory fear fastest, because there is nothing to avoid.
Cued panic. It fires in specific places or situations — transport, queues, lifts, places you cannot leave quickly. This is the type that pushes toward avoidance and agoraphobia.
Nocturnal panic. It wakes the person in the first half of the night, with a racing heart and a feeling of suffocation. It is common and often mistaken for nightmares or sleep problems.
Anxiety attack. This is not a diagnostic term. It is used in everyday speech for any intense surge of anxiety, and often describes exactly what a panic attack is. The useful distinction is not in the name: it is whether you fear the sensations and whether life is shrinking to avoid them.
| Type | When it appears | What it tends to leave |
|---|---|---|
| Uncued | No visible trigger | Diffuse anticipatory fear |
| Cued | Specific places or transport | Avoidance and agoraphobia |
| Nocturnal | First half of the night | Fear of sleeping |
| ”Anxiety attack” (everyday use) | Under stress, no criteria | Confusion about “what I have” |
4. Which one is yours: four signals
You do not need a diagnosis to recognise the pattern. Look at these four signals in your week, not in your memory.
- You check your body. You notice the pulse, the breathing, the dizziness: you are in monitoring mode most of the day.
- You look for exits. Walking into a room, you work out how you would get out. Before anything happens.
- You monitor in silence. You check whether it is starting, and that checking has a cost: merely being watchful raises the alarm.
- You avoid and then blame yourself. You skip it, and later you resent not going. That back-and-forth is exhausting and it is not a lack of willpower.
People who check their bodily sensations several times a day without realising it. Almost nobody calls it monitoring. They call it “staying aware”, and that awareness keeps the alarm calibrated to the minimum.
5. What to do in the moment: the three anchors
There is no technique that cuts an attack in ten seconds. There are three moves that lower the catastrophic reading, and lowering the reading is what lowers the peak.
| What helps | Why | What does not help |
|---|---|---|
| Naming it: “this is an alarm discharge, I know this one” | It shifts the subject: from “I’m dying” to “an alarm is happening” | Repeating “calm down” or “it’s nothing” |
| Exhaling longer than you inhale | It lengthens the exhale and slows the overbreathing | Breathing into a bag or holding your breath |
| Anchoring three things you can see and touch | It brings back a concrete fact of the present | Checking your pulse or taking your blood pressure |
| Ending the episode while doing something normal | It teaches the body there was no danger | Running out of the place |
The first three fit anywhere. The fourth is the one to handle with care: leaving the place relieves today and confirms tomorrow that the place was dangerous. If you have to leave because you cannot stay, leave — that is not a failure — but come back when you can, even for a few minutes.
People who report more relief from naming the alarm than from trying to control it. Naming is not giving up: it is refusing to add a fight on top of the body’s alarm.
Does breathing into a paper bag help?
No, and it can make the sensation worse. Bag breathing raises carbon dioxide and increases dizziness and tingling, so it targets the wrong symptom. What helps is the opposite of what the body is asking for: exhale slower and longer, without forcing the air in. Air is getting in even when your throat feels closed — what closes is the sensation, not the passage of air.
6. The hours afterwards: the hangover
When the peak drops, almost nobody leaves the episode behind: there is a long stretch of trembling, fatigue, the urge to cry and a watchfulness that will not switch off. That is the hangover, and it is where many people make the decision that keeps the problem alive without noticing.
What to do during the hangover, in order:
- Do not check. Pulse, blood pressure, breathing: every check sends you back to the alarm. If you need a fact, make it an external one: where you are, what time it is, what comes next in your day.
- Drink water and eat something small. The discharge burns energy, and low blood sugar mimics alarm symptoms. This is not a remedy: it is removing one variable from the equation.
- Tell someone who will not hand the alarm back to you. Not so they calm you down, but so the episode stops being a secret. What is kept hidden grows.
- Write three facts, no more. Where you were, what you felt first, what you thought. Three lines, whenever you can.
- Return to what you were doing as soon as you can, even halfway. This is the most important one and the hardest, and it is the one that shapes the outcome.
People who manage to resume part of their day on the day of the episode. You do not have to perform: you have to avoid wrapping the whole day around the fear.
7. The days after: the safety inventory
There is a part of this picture that is invisible in the moment and decides whether the fear settles in: safety behaviours. They are the small things you do “just in case”, which in reality confirm that without them you could not cope.
- Always carrying the pill “just in case”.
- Sitting near the door or at the end of the row.
- Going accompanied to places you used to go alone.
- Checking the route before leaving.
- Drinking water or eating something before every feared situation.
- Keeping the phone ready to call if it happens.
None of these is silly and none is dropped at once. What matters is seeing them written down, because an inventory does something memory does not: it turns them into a list. And lists can be shortened, step by step.
| Safety behaviour | What it relieves today | What it confirms tomorrow |
|---|---|---|
| Checking the route | The feeling of being prepared | That leaving without checking is dangerous |
| Going accompanied | Calm during the trip | That alone you could not manage |
| The pill “just in case” | The certainty of an exit | That the exit lives in the pill |
| Sitting near the door | Less pressure in the chest | That the place was a trap |
So should I stop carrying the medication I was prescribed?
No. Medication prescribed by a doctor is not a safety behaviour to be withdrawn on your own, and this article does not adjust anyone’s treatment. What therapy works on is the “just in case” ritual as a control gesture — and that is always decided with the professional who prescribed it. Nothing you read here replaces that conversation.
8. What the evidence does support
It is worth going to what is concrete, because this topic is full of cheap promises.
Episodes are common; the disorder is less so. In the most cited population survey, around 22.7% of people report having had an isolated panic attack at some point in their lives, while panic disorder — the pattern with anticipatory fear and avoidance — sits around 3-4% (Kessler et al., 2006; DOI: 10.1001/archpsyc.63.4.415). That figure reads as a population estimate, never as an individual probability or a diagnosis.
Treatment is well evidenced. Cognitive behavioural therapy for panic, including exposure to bodily sensations, showed solid results in controlled trials: Clark et al. (1994; DOI: 10.1192/bjp.164.6.759) found cognitive therapy outperformed applied relaxation and the medication compared in their study, and Barlow et al. (2000; DOI: 10.1001/jama.283.19.2529) reported marked improvement with therapy alone or combined. The honest wording is “effective, well-studied treatment”, not “cured”.
What the evidence does not allow. It does not allow anyone to promise that another single episode will never happen, to say your case will behave like a study average, or to give you a date. And it does not allow me to tell you, from an article, whether you have panic disorder: that is an interview, with a professional, in a consulting room.
Approximate share of people who gain clear improvement from cognitive behavioural therapy for panic in controlled trials. It is not a promise for one person: it is the reason the work is worth doing.
9. Today’s exercise: your twenty-second protocol
This one is done today and does not require an episode this week. It has one purpose: making sure that at the peak you have nothing to decide, because the decision is already written down.
- Write your naming sentence. One line, in your own words: “this is an alarm discharge, I know this one”. It has to be sayable quietly and without irony.
- Write your breathing anchor. “I inhale to a count of 3, I exhale to a count of 5, three times.” Without forcing the air in.
- Write your three sensory anchors. Three concrete things you can see in the places where it usually happens: the bus, the office, your home. Different ones for each place.
- Write your return behaviour. What you will do as soon as it drops: “I stay on until my stop”, “I go back into the meeting”, “I finish the shopping”. Concrete and small.
- Write what you will NOT do. “I will not check my pulse, I will not run out, I will not call someone to calm me down.” As important as everything else.
- Rehearse it out loud once. Not while you are struggling: today, sitting down, calm. Cold rehearsal is what makes it come out hot.
- Keep the five lines on your phone, in a note that opens fast. Not in a file you have to search for: on the home screen.
An honest warning: this protocol does not cut the peak dead, and it should never promise to. What it does is remove the worst part of the moment — not knowing what to do while your body is shouting — and that, repeated, changes the direction of the cycle.
People who have their plan written before the episode rather than improvised inside it. That is the difference between executing a decision and making one with the alarm switched on.
What if it happens while I am asleep and I miss all of it?
Nocturnal panic usually wakes people in the first half of the night, with a racing heart and a sense of suffocation. Since there is no clear waking moment, the protocol shifts to the following morning: soft light, water, and writing the three facts before starting the day. One important thing: if awakenings with breathlessness are frequent, mention them in a consultation to rule out other sleep-related causes. Not every night-time awakening is panic.
10. When this needs professional help
Panic has one of the best problem-to-solution ratios in mental health: there is effective, well-studied treatment. So the useful question is not “is it serious?” but “what is it costing me?”.
Look for professional support in the coming days if: episodes are repeating; anticipatory fear of the next one has appeared; you are starting to avoid places, transport or situations; sleep or work is being affected; or you need to be accompanied all the time to feel calm. You do not need to be in crisis to start: starting earlier is when it pays off most.
The list that sends you to a medical professional before you reach for a breathing exercise looks like this: chest pain that has not shown up in your pattern before; pain that does not soften as you slow your breath, walk, or change position; pain that travels down one arm, up to the jaw, or across the back; a brief loss of consciousness; lips or fingertips going blue; or a new neurological sign arriving out of the blue — weakness on one side, slurred speech, vision that blurs in an instant. Any one of those belongs in an emergency department, not in a notebook.
And the one thing this article can tell you with real confidence: a panic attack in the moment does not injure the heart muscle. The body is sending alarm, not breaking down — which is exactly why an actual medical check, done once with a clear description of what happens, is what opens the door to working on the panic side afterwards. Panic disorder as a recurring pattern does carry a longer cardiovascular cost, and that is one more reason to look after general heart health over the years — not an argument for staying away from the doctor when tonight’s symptoms are the ones you already recognise.
11. Crisis box — if you are in crisis NOW
If you are in crisis right now, with thoughts of harming yourself or that nothing matters, stop reading. Call now.
- Colombia: Line 123 (national emergency) · Line 106 (mental health)
- United States: 988 (Suicide & Crisis Lifeline)
- United Kingdom: 116 123 (Samaritans)
If you can, stay with someone while you call. These lines also help outside emergencies: there are nights when all you need is a voice that will not panic back at you.
12. Today’s minimum step
Today is not the day to walk into the hardest room or to set aside the safety net. That step has its own pace: surviving the episode is one thing, learning not to flee it is another, and the body does not need both on the same day.
Today’s step takes less than five minutes and it is one thing: write the five lines of the protocol and keep them two taps away. Do not polish them, do not worry about wording. Five lines: your sentence, your breathing, your three anchors, your return behaviour, your list of no.
That is the whole step. If you want to keep going afterwards, the panic hub holds the full map of the four faces of the cycle, and the hub tools build the three-anchor plan for you and give you the inventory of what fear took away, with steps to walk it back. And if you feel this is shrinking your life, therapy through rdkterapia is a possible door: not a promise of results, but a place where this work is done with someone beside you.
