Stay with the person, speak calmly, and help them slow their breathing. That is the core of what you can do when someone near you is having a panic attack. The experience is terrifying for the person going through it, but attacks are not physically dangerous and almost always pass within ten to twenty minutes. Your role is not to fix what is happening but to be a steady, reassuring presence while their body’s alarm system winds itself down. The specifics of how you do that matter more than you might expect.
What Is Happening Inside Their Body
Understanding the basics of what a panic attack does physically helps you respond without adding to the person’s fear. During an attack, the body floods with stress hormones. There are large bursts of sympathetic nervous system activity, sharp increases in cardiac stress hormones, and surges of adrenaline from the adrenal glands.1PubMed. Cardiac sympathetic nerve biology and brain monoamine turnover in panic disorder This is the same fight-or-flight cascade that would kick in if a bear walked into the room, except there is no bear. The heart races, muscles tense, breathing becomes fast and shallow, and the person may feel chest pain, dizziness, tingling in their hands, or a sense that they are dying or losing control.
These symptoms are real. The chest pain is real. The dizziness is real. They are not imagining it. Knowing this helps you avoid the single most counterproductive thing a helper can say, which is “it’s all in your head.” The sensations are produced by a genuine physiological event. They just aren’t dangerous, even though every signal in the person’s body is screaming otherwise.
Your First Move Is Communication, Not a Technique
Before you try any breathing exercise or grounding trick, the person needs to know you are there and that you are calm. Speak in short, simple sentences. Use a low, steady voice. Introduce yourself if they don’t know you. Tell them what you see: “It looks like you’re having a panic attack. I’m going to stay with you. You’re safe.” This matters because during peak panic, the brain’s ability to process complex information drops dramatically.
A consensus statement from emergency psychiatry professionals outlines a straightforward approach: engage the person verbally, build a brief collaborative relationship, and then guide them out of the acute state.2PubMed Central. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup In practice this means you ask before you act. “Can I sit next to you?” is better than sitting down uninvited. “Would it help if we tried breathing together?” is better than barking “Breathe!” at someone who already feels out of control. You are giving them small choices, which counteracts the helplessness that fuels panic.
Avoid asking them to explain what triggered the attack. Many panic attacks have no identifiable trigger, and being pressed to find one can intensify the distress. If they volunteer information, listen. If they don’t, let it go.
Guided Breathing That Actually Helps
Hyperventilation is one of the most common features of a panic attack, and it is also the one you can most directly help with. When someone breathes too fast, they blow off too much carbon dioxide, which causes tingling, lightheadedness, and more panic, which causes more fast breathing. Breaking this cycle is one of the most effective things you can do.
The old advice was to have the person breathe into a paper bag. Do not do this. A case report in emergency medicine documented deaths when paper-bag rebreathing was used on people whose hyperventilation was actually caused by heart problems or low oxygen rather than anxiety.3PubMed. Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients Since you usually cannot tell the difference in the moment, the paper bag is not worth the risk. On top of that, research on how rebreathing actually works found that a large portion of the benefit may come from expectation and suggestion rather than any direct correction of blood chemistry.4PubMed. Rebreathing to cope with hyperventilation: experimental tests of the paper bag method
What works better is guided slow breathing without any device. Sit or stand facing them, and breathe with them. Inhale through your nose for a count of four, hold briefly, exhale slowly through your mouth for a count of six or so. Exaggerate the exhale slightly so they can see and hear what you’re doing. Say “breathe with me” and count out loud. The exhale being longer than the inhale is what matters, because a longer out-breath activates the parasympathetic nervous system, which is the body’s built-in brake on the fight-or-flight response. You don’t need to be precise about the counts. The rhythm matters more than the numbers.
Grounding Techniques You Can Walk Someone Through
If the person is too panicked to focus on breathing, grounding exercises give their brain something concrete to latch onto. The most widely used is the 5-4-3-2-1 technique, which works by pulling attention out of anxious thoughts and back into the immediate physical environment.5SciTechnol. Combat Against Stress Anxiety and Panic Attacks 5-4-3-2-1 Coping Technique You guide them through it like this:
- Five things you can see: “Tell me five things you can see right now.” Point to objects if they can’t start on their own.
- Four things you can touch: “Can you feel the chair under you? The fabric of your shirt?”
- Three things you can hear: “What sounds can you pick up? Traffic outside? The air conditioner?”
- Two things you can smell: This one often requires creativity. Hand them something with a scent if possible.
- One thing you can taste: A sip of water or a piece of gum works.
The technique forces the brain to engage with sensory input from the present moment instead of spiraling through catastrophic predictions. You don’t have to be rigid about it. If the person can only manage three senses instead of five, that’s fine. The point is redirection, not perfection.
The Cold Water Trick
One surprisingly effective physical intervention involves cold. Applying cold water or a cold object to the face, particularly around the forehead and cheeks, triggers what is called the mammalian diving reflex, an automatic response that slows heart rate and lowers sympathetic arousal. A clinical study tested this by having people with panic symptoms hold a cold stimulus to their face and found that it significantly reduced heart rate and lessened self-reported anxiety and panic symptoms.6PubMed Central. The Implications of the Diving Response in Reducing Panic Symptoms
In a practical setting, this can be as simple as handing the person a cold water bottle to press against their face, getting them a damp cold cloth, or running cold water over their wrists. It is not a magic fix, but it can interrupt the escalation of symptoms enough for other strategies to start working. If you’re in a place with access to ice or cold water, it’s worth trying early.
What Not to Do
Some well-meaning responses make things worse. Knowing what to avoid is just as important as knowing what to try.
- Don’t minimize: “Calm down,” “You’re overreacting,” or “There’s nothing to worry about” all tell the person their experience isn’t real. They know intellectually that they probably aren’t dying, but their body is giving them every signal that they are. Dismissal deepens the isolation.
- Don’t crowd them: If you’re in public, try to give the person some space from onlookers. A ring of concerned strangers staring can amplify the panic.
- Don’t grab or restrain: Physical contact should only happen if the person wants it. Ask first. Some people find a hand on the shoulder calming; others find unexpected touch terrifying during an attack.
- Don’t demand deep breaths: “Take a deep breath!” said urgently or loudly can feel like another demand on a system that is already overwhelmed. Model the breathing and invite them to join you. The difference in tone matters enormously.
When It Might Not Be a Panic Attack
One of the difficult realities for bystanders is that panic attacks and heart attacks share several symptoms: chest pain, shortness of breath, sweating, dizziness, nausea. Research on patients arriving at emergency departments with chest pain has found that there are no reliable signs or symptoms collected during a standard chest-pain workup that can clearly distinguish panic disorder from cardiac problems.7Heart, Lung and Circulation. Panic Disorder in Patients Presenting to the Emergency Department With Chest Pain: Prevalence and Presenting Symptoms Physicians themselves have noted the difficulty of reliably separating the two conditions.8International Journal of Clinical Practice. CHEST PAIN: PANIC ATTACK OR HEART ATTACK?
So what should you do? If the person has a known history of panic attacks and recognizes what is happening, you can generally trust their self-assessment. If they have never had a panic attack before, if the chest pain is severe or radiating to the arm or jaw, if they are over 40 with cardiac risk factors, or if they lose consciousness, call emergency services. It is far better to end up in an emergency department for a panic attack than to assume a heart attack is “just anxiety.” Let the professionals sort it out.
Helping Someone Who Wakes Up in Panic
Panic attacks that happen during sleep are disorienting for everyone involved. The person wakes abruptly in a state of full-blown panic with no dream or nightmare to explain it. Nocturnal panic is surprisingly common among people with panic disorder, with studies estimating that somewhere between 44% and 71% of people with the condition have experienced at least one attack during sleep. These episodes happen during non-REM sleep, meaning they are not triggered by nightmares.9PubMed. Assessment and treatment of nocturnal panic attacks
If you share a home with someone who experiences these, the approach is the same as during the day but with a few adjustments. Turn on a soft light so they can orient to where they are. Speak gently and identify yourself, because waking in a dark room mid-panic can include confusion about what is real. Don’t try to physically shake them awake more, as they are already awake; the disorientation is part of the attack, not sleep. Once they are oriented, the same strategies apply: guided breathing, grounding, cold water if it helps. Some people find it useful to get out of bed and move to a different room, because staying in bed can become associated with the panic itself over time.
Panic Attacks Can Look Different Across People
Not everyone experiences or expresses panic the same way. Research comparing panic symptoms across racial and ethnic groups in a large student sample found that while overall rates of symptom endorsement were similar, the specific symptoms people reported varied. Participants who identified as Asian more frequently reported dizziness, unsteadiness, choking, and feeling terrified compared to white participants, while African American participants reported feeling less nervous than white participants despite similar overall severity.10PubMed Central. The experience of panic symptoms across racial groups in a student sample This means you should not expect a single “look” for a panic attack. Someone might appear more physically symptomatic than emotionally distressed, or vice versa.
People with higher levels of autistic traits may also experience panic differently. Research has found that autistic traits are linked to greater sensory sensitivity, which in turn is linked to more catastrophic thinking and more severe panic episodes.11Cambridge University Press / European Psychiatry. Associations Between Autistic Traits, Catastrophizing, Sensory Sensitivity, and Panic Attack Severity in Patients With Panic Disorder For these individuals, the sensory overload of the panic itself, along with the noise and light of a busy environment, can compound the distress. Reducing environmental stimulation (dimming lights, moving to a quieter space) may be especially important.
Helping a Teenager Through a Panic Attack
Adolescents are often less equipped to identify what is happening to them during a first panic attack. They may believe they are having a medical emergency, going crazy, or dying. The same in-the-moment strategies work for teens, but the emotional reassurance piece carries more weight. Telling a fourteen-year-old “this is a panic attack and it will pass” can be genuinely revelatory to someone who has no framework for the experience.
If a teenager in your life has recurring panic attacks, the evidence points toward getting professional help sooner rather than later. A randomized controlled trial of cognitive-behavioral therapy adapted for adolescents found significant reductions in panic severity, anxiety, and depression compared to a control group, and those gains held at six-month follow-up.12PubMed. Cognitive-behavioral treatment of panic disorder in adolescence Panic disorder in young people tends to worsen without intervention, so treating it early can prevent years of escalation.
After the Attack Passes
Once the acute symptoms subside, the person will often feel exhausted, shaky, and embarrassed. Give them time. Offer water. Don’t immediately launch into problem-solving or suggest they see a therapist. Right after an attack is not the moment for that conversation. Instead, simply check in: “How are you doing now? Do you need anything?”
At a later time, if the person is open to it, you might gently raise the topic of professional support. The gold-standard treatment for panic disorder is cognitive-behavioral therapy, and one of the most effective components involves something called interoceptive exposure, where the person deliberately and repeatedly practices triggering the physical sensations of panic in a safe setting. Studies have found that this approach reduces both the frequency and severity of panic attacks, with gains maintained well after treatment ends.13PubMed. Interoceptive exposure versus breathing retraining within cognitive-behavioural therapy for panic disorder with agoraphobia The exercises used most often in therapy include hyperventilation, breathing through a straw, breath-holding, and spinning, all designed to teach the brain that those physical sensations are uncomfortable but not dangerous.14Cognitive and Behavioral Practice. Interoceptive assessment and exposure in panic disorder: A descriptive study
There are also app-based tools being developed that incorporate these therapeutic exercises for use between therapy sessions or on the go. Early feasibility research has found that users report high satisfaction and reduced clinical symptoms after using such apps, though in-vivo exposure components were perceived as more difficult to use independently.15ScienceDirect (Elsevier). A mobile application for panic disorder and agoraphobia: Insights from a multi-methods feasibility study These tools are not substitutes for therapy but can be helpful supplements.
Taking Care of Yourself as a Supporter
If you regularly support someone with panic disorder, your own mental health deserves attention. A study of caregivers of people with panic disorder and agoraphobia found that over a third of caregivers met criteria for common mental distress, and that distress was strongly associated with the burden of caregiving.16The Journal of Nervous and Mental Disease. Burden and Distress in Caregivers of Patients With Panic Disorder and Agoraphobia Separate research found that the severity of the affected person’s symptoms directly predicted how much burden family members felt, with children of the affected person reporting particularly high levels.17PubMed. Family burden and family environment: comparison between patients with panic disorder and with clinical diseases
This is not a footnote. Watching someone you love go through repeated panic attacks is its own form of stress. You may start anticipating attacks, scanning for triggers, reshaping your own behavior to avoid upsetting them. Over time, that hypervigilance wears you down. Setting boundaries, maintaining your own routines, and talking to someone about how the experience affects you are not selfish acts. You cannot pour from an empty cup, as the saying goes, and the research backs that up: caregivers who are more distressed provide less effective support. Taking care of yourself is part of taking care of them.