Anxiety

Panic Attack: What to Do in the Moment

Your heart is pounding, you can't get enough air, and it feels like something terrible is happening. Here's what's going on in your body, what helps in the moment — and when to get medical help.

Updated September 23, 2026 · 8 min read

A panic attack is a sudden wave of intense fear that peaks within minutes and comes with strong physical sensations: a racing or pounding heart, shortness of breath, chest tightness, sweating, trembling, dizziness, nausea, tingling hands, and sometimes a sense that the world isn't quite real. Alongside them comes a frightening thought: I'm going crazy, I'm losing control, I'm going to die.

Two things are worth knowing in advance. First, a panic attack is extremely frightening but not dangerous in itself — according to the NHS, most last between 5 and 20 minutes, and the body settles on its own even if you do nothing. Second, some of the symptoms overlap with heart problems and other medical conditions. So the first time, or whenever something feels different from usual, it's always better to get checked.

What's happening in your body

A panic attack is the body's alarm system — the fight-or-flight response — going off without a fire. Adrenaline speeds up the heart, breathing becomes fast and shallow, blood is sent to the large muscles. The fast breathing itself lowers the level of carbon dioxide in the blood, which causes many of the scariest sensations: dizziness, tingling, the feeling of not getting enough air.

The cognitive model of panic (David Clark, 1986) explains why an attack feeds itself: you notice a body sensation ("my heart is racing"), interpret it as a catastrophe ("this is a heart attack"), the fear amplifies the sensations, and the sensations "prove" the fear. Every technique below is designed to break that loop — by calming the body and by changing the interpretation.

What to do in the moment: 6 steps

1. Name it

Tell yourself, out loud if you can: "This is a panic attack. It's frightening, but it isn't dangerous. It will peak and pass." If this isn't your first one and you've already been checked, remind yourself that you've been through it before. Naming the experience moves you from inside the fear to the position of an observer.

2. Slow down your out-breath

You don't need to "breathe deeply" — big, fast breaths can make things worse. The aim is a long, slow exhale. Try breathing in through your nose for a count of 4 and out slowly through your mouth, as if through a straw, for a count of 6. Keep going for a few minutes. If counting stresses you, simply make the out-breath as long as feels comfortable. More options are in 3 Breathing Exercises for Anxiety.

What about a paper bag? Not recommended. If the symptoms are actually caused by a medical problem, breathing into a bag can be harmful — and slow breathing achieves the same goal safely.

3. Ground yourself in the here and now

When your mind is racing through scenarios, your senses can bring you back to the present. Try 5-4-3-2-1: find 5 things you can see, 4 you can touch, 3 you can hear, 2 you can smell and 1 you can taste. Or simply press your feet into the floor and quietly describe the room to yourself, detail by detail. Some people find cold water on the face or wrists helps them reset.

4. Don't flee, if you can help it

This is the least intuitive step. The urge is to escape — leave the supermarket, get off the bus. But escaping teaches your brain that the "danger" was real and that only escape saved you, so the place becomes scarier next time. If you're somewhere safe, try to stay, sit down, and let the wave rise and fall. If you have to leave, that's okay; try to return to the same place later, when you're calmer.

5. Loosen your body instead of fighting it

Fighting the sensations ("stop it already!") adds tension. Drop your shoulders, unclench your jaw, open your hands. You might say to yourself, "I'm letting this feeling be here; it will pass." Acceptance rather than struggle is also a central idea in acceptance and commitment therapy (ACT).

6. Afterwards

Don't rush to analyze every body sensation or search your symptoms online — that tends to set the alarm off again. Drink some water, take a few minutes and, if possible, return to what you were doing. Later that day, jot down briefly what happened before the attack, what you were thinking at the peak and what helped. Over time this reveals triggers and patterns.

Panic attacks at night

Some people wake from deep sleep with a racing heart, sweating and intense fear — with no nightmare and no obvious cause. This is called a nocturnal panic attack, and it's especially confusing because there's no trigger to point to. The same steps work here: name it, lengthen the out-breath, switch on a dim light and sit on the edge of the bed with your feet on the floor. If you haven't fallen back asleep after about 20 minutes, get up and sit somewhere quiet until you feel sleepy again. If it happens often, or if you snore heavily or stop breathing in your sleep, mention it to your doctor, as there can also be physical causes worth checking. More night-time techniques are in Racing Thoughts at Night.

Panic attack or "just" anxiety?

In everyday language, "anxiety attack" covers many things: stress before an exam, worry that builds over hours, or a sudden wave of fear with strong physical symptoms. Clinically, only the last one is a panic attack — it comes on suddenly, peaks within minutes and fades. Ongoing anxiety looks different: it builds slowly, lasts hours or days, and mostly involves worry, muscle tension and difficulty relaxing. There are effective tools for both, but the distinction helps you understand what's happening and choose the right one.

What not to do

• Check your pulse over and over. Each check pulls attention back to your body and feeds the loop.
• Start avoiding places. Avoidance brings short-term relief but narrows your life over time and can develop into agoraphobia.
• Calm yourself with alcohol. It helps briefly and increases anxiety the next day.
• Fight the attack or try to force it to stop. Allowing it to pass is what actually shortens it.

When to get urgent medical help

A panic attack is not dangerous in itself, but you can't always tell from the inside that this is what's happening. Call your local emergency number if:

• this is the first time you've had symptoms like these and you haven't been checked;
• you have crushing chest pain, or pain spreading to your arm, jaw or back — especially if you have heart disease or risk factors;
• you have difficulty breathing that isn't improving, you faint or you feel confused;
• the symptoms are different from your usual attacks, or haven't settled after about half an hour;
• you're having thoughts of harming yourself — you can also contact a crisis line (US 988, UK Samaritans 116 123, Israel ERAN 1201).

There is no shame in going to the emergency room and finding out it was "only" anxiety. When you're not sure, that is exactly the right decision.

How to help someone else during an attack

Stay with them and speak calmly, in short sentences. Don't say "calm down" — ask what helps. Offer to breathe together slowly, with a long out-breath. Help them sit somewhere quieter. If there is chest pain or fainting, or you're not sure, call emergency services.

What helps in the long run

A single attack after a stressful period is common. But if attacks keep coming and you begin to fear the next one and avoid places, it may be panic disorder — a condition that responds very well to treatment. UK clinical guidelines (NICE) recommend CBT as a first-line treatment, and research reviews show it is among the most effective options for panic disorder. It usually involves understanding the panic cycle, working on catastrophic interpretations, and gradual, planned exposure to the sensations and places you've been avoiding. Medication is also an option to discuss with a doctor.

The first step is usually your family doctor: a conversation, a check to rule out physical causes, and a referral. In the meantime, practicing slow breathing daily while you're calm makes it much easier to use when you need it.