A panic attack peaks within about 10 minutes, but those 10 minutes can feel endless. The good news: there are concrete techniques that work in real time to slow the cascade of symptoms, and longer-term strategies that can reduce how often attacks happen in the first place. Here’s what actually helps, both in the moment and over time.
What’s Happening in Your Body
Understanding the mechanics can take some of the fear out of a panic attack. It starts in the amygdala, the brain’s emotional alarm system. When it perceives a threat (real or not), it fires a distress signal to the hypothalamus, which acts as a command center for involuntary functions like heart rate, breathing, and blood pressure. The hypothalamus activates your sympathetic nervous system, telling your adrenal glands to flood your bloodstream with adrenaline.
That’s why a panic attack feels so physical. Your heart pounds, your breathing speeds up, your muscles tense, and your palms sweat. If the stress response continues, a second wave kicks in through what’s called the HPA axis, releasing cortisol to keep your body on high alert. None of this is dangerous. Your body is running its emergency protocol in the absence of an actual emergency. The symptoms are deeply uncomfortable, but they cannot hurt you.
How to Get Through One in the Moment
Slow Your Breathing First
Breathing is the fastest lever you have. Belly breathing (also called diaphragmatic breathing) stimulates the vagus nerve, which runs from your head through your chest and down to your colon. Activating it flips your body from fight-or-flight mode into its relaxation response, lowering your heart rate and blood pressure.
If you’ve never practiced belly breathing, try this: sit in a chair, lean forward, and rest your elbows on your knees. Breathe naturally. This position forces you to breathe from your belly rather than your chest, so you learn what the sensation feels like. During a panic attack, you don’t need a complicated pattern. Just take three slow, controlled deep breaths into your belly. That alone interrupts the fight-or-flight response and puts it on pause. Repeat as many times as you need.
Use the 5-4-3-2-1 Grounding Technique
Once you’ve taken a few breaths, grounding pulls your attention out of the spiral and into the present moment. The 5-4-3-2-1 method works through your senses, one by one:
- 5: Name five things you can see. A crack in the ceiling, a pen on the desk, anything around you.
- 4: Notice four things you can physically touch. The fabric of your shirt, the chair beneath you, the ground under your feet.
- 3: Listen for three things you can hear. Traffic outside, a fan humming, your own breathing.
- 2: Identify two things you can smell. If nothing is obvious, walk to a bathroom and smell the soap, or step outside.
- 1: Notice one thing you can taste. Gum, coffee, the lingering flavor of your last meal.
This exercise works because it forces your brain to process concrete sensory information, which competes with the anxious thoughts driving the attack. It sounds simple, and it is. That’s the point.
Remind Yourself of the Timeline
Panic attacks begin suddenly and peak within about 10 minutes. Most are over in 20 to 30 minutes. Sometimes multiple waves of varying intensity roll through over a longer stretch, which can feel like one continuous attack, but each individual wave still follows the same arc: fast rise, peak, gradual fade. Knowing this gives you something to hold onto. You are not stuck in this state. It will pass.
Panic Attack or Heart Attack?
Chest pain during a panic attack is common, and it’s the symptom that sends many people to the emergency room convinced they’re having a heart attack. There are some differences. Heart attacks often start slowly, with mild discomfort that worsens over several minutes, and these episodes can come and go in the days before the actual event. Chest pain from a heart attack may radiate to the jaw, back, or arm. Women are more likely to experience shortness of breath, nausea, and back or jaw pain as primary symptoms.
Panic attacks, by contrast, come on quickly and hit peak intensity within about 10 minutes. The chest pain tends to stay localized and doesn’t radiate. That said, if you’re unsure whether you’re having a panic attack or a heart attack, especially if you’ve never had a panic attack before, err on the side of getting medical help. You can sort it out after the fact.
Reducing Attacks Over Time
Interoceptive Exposure
One of the most effective long-term approaches is a technique called interoceptive exposure, used in cognitive behavioral therapy. The idea is counterintuitive: you deliberately recreate the physical sensations of panic (rapid heartbeat, dizziness, breathlessness) in a controlled setting so your brain learns they aren’t dangerous.
This might mean spinning in a chair to produce dizziness, breathing through a straw to mimic breathlessness, or running in place to raise your heart rate. You repeat each exercise until the anxiety it produces drops significantly. Then you increase the difficulty: longer durations, standing instead of sitting, practicing in unfamiliar locations. Over time, your brain stops treating those body sensations as evidence that something catastrophic is happening. This breaks the cycle where noticing a fast heartbeat triggers fear, which makes your heart beat faster, which triggers more fear.
This kind of work is best done with a therapist who can guide the process and help you challenge the catastrophic thoughts that come up during the exercises.
Medication Options
For people with recurring panic attacks, medication can help reduce their frequency and severity. SSRIs (a class of antidepressant) are the standard first-line treatment. They take a few weeks to reach full effect, but they have a generally low risk of serious side effects. Certain SNRIs, a related class of antidepressant, are also approved for panic disorder.
Benzodiazepines work much faster and can stop a panic attack in progress, but they’re typically prescribed only for short-term use. They can be habit-forming and carry risks of dependence, especially for anyone with a history of substance use. They’re a tool for acute situations, not a long-term solution on their own.
How to Help Someone Else Through One
If someone near you is having a panic attack, the most important thing you can do is stay calm and stay present. Move them to a quieter spot if possible. Speak in short, simple sentences. Avoid surprises or sudden movements.
Ask what they need rather than assuming. Some people want physical contact, others don’t. You can help slow their breathing by breathing alongside them or counting slowly to 10. Giving them a simple physical task, like raising their arms over their head repeatedly, can also help redirect their focus.
What you say matters. Phrases like “You can get through this,” “What you’re feeling is scary, but it’s not dangerous,” and “Concentrate on your breathing, stay in the present” are genuinely helpful. Avoid telling them to “just relax” or asking them what’s wrong, which can increase the sense that something is deeply broken. Be patient. Accept where they are in that moment instead of trying to rush them out of it.