Staying calm yourself, speaking in short and steady sentences, and guiding the person toward slow breathing are the most effective things you can do when someone near you is having a panic attack. A panic attack is a sudden surge of intense fear accompanied by physical symptoms like a racing heart, shortness of breath, and dizziness, and these symptoms typically peak within about ten minutes before gradually fading. The experience feels genuinely life-threatening to the person going through it, even though it is not physically dangerous. What you do in those minutes matters less than how you do it.
What Is Happening in Their Body
During a panic attack, the sympathetic nervous system fires hard. The body releases large bursts of norepinephrine and surges of epinephrine from the adrenal glands, producing a fight-or-flight response that is wildly out of proportion to any actual threat.1PubMed. Cardiac sympathetic nerve biology and brain monoamine turnover in panic disorder Heart rate spikes. Breathing quickens. Muscles tense. The person may feel chest pain, tingling in their face or hands, nausea, dizziness, or a terrifying sense that they are losing control or dying.2Springer Link. Panic Attack These symptoms feed on each other: the racing heart makes the person more afraid, which makes the heart race faster.
Understanding this loop helps you help them. You are not trying to fix a medical crisis. You are trying to interrupt a feedback cycle between fear and physical sensation long enough for the body’s own calming systems to catch up. Everything below works toward that goal.
Your Presence and Tone
Before you try any technique, recognize that your emotional state is contagious. Humans are wired to pick up on the emotional cues of people around them, and a calm, non-threatening presence can activate the social engagement circuits that help dampen defensive stress responses.3PubMed Central. The Covid-19 Pandemic is a Paradoxical Challenge to Our Nervous System: A Polyvagal Perspective In practical terms, this means your voice, posture, and facial expression do real physiological work. If you look panicked, they feel more panicked. If you look steady, their nervous system has something safe to latch onto.
Keep your voice low and even. Use short, concrete sentences: “I’m right here,” “You’re safe,” “This will pass.” Do not ask them to explain what is wrong or try to reason them out of it. Their prefrontal cortex is largely offline during a panic attack, so logic will not land. Avoid phrases like “Just relax” or “There’s nothing to be afraid of,” which inadvertently dismiss what their body is screaming at them. Instead, validate what they are experiencing without amplifying it: “I know this feels terrible. It’s going to end.”
Ask before you touch them. Some people find a hand on their shoulder grounding; others find unexpected contact overwhelming when their nervous system is already in overdrive. A quick “Can I put my hand on your back?” respects their autonomy and gives them a small sense of control, which itself is calming.
Guide Their Breathing, but Skip the Paper Bag
Slow, deep breathing is probably the single most effective in-the-moment intervention you can offer. When someone hyperventilates during a panic attack, they exhale too much carbon dioxide, which causes tingling, lightheadedness, and a feeling of suffocation that makes the panic worse. Guiding them to breathe more slowly helps reverse this.
The simplest approach is to breathe with them. Say “Breathe in with me” and inhale slowly through your nose for about four seconds, then exhale through your mouth for about six seconds. Do not just instruct from the sideline; actually breathe audibly so they can follow your rhythm. If they cannot manage a full four-count inhale, meet them where they are and gradually slow the pace. The emphasis should be on the exhale being longer than the inhale, because a prolonged exhale activates the parasympathetic nervous system, the body’s braking system for stress.
One thing to avoid: the old paper-bag trick. Rebreathing into a paper bag was once standard advice for hyperventilation, but it carries a real danger. If the cause of the person’s symptoms turns out to be something other than a panic attack, such as low oxygen from a heart or lung condition, rebreathing into a bag can worsen their oxygen levels. Case reports document deaths from this practice when it was applied to patients who were actually experiencing cardiac events.4PubMed. Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients Guided slow breathing accomplishes the same carbon dioxide correction without the risk.
The Cold Water Trick
If slow breathing is not getting through or the person is too overwhelmed to follow along, a cold stimulus applied to the face can help. Cold water on the forehead, cheeks, and around the eyes triggers what is known as the diving reflex, an involuntary response that slows the heart rate and redirects blood flow.5Clinical Science. The cold face test (diving reflex) in clinical autonomic assessment: methodological considerations and repeatability of responses In research on people with panic symptoms, a cold facial immersion task significantly reduced heart rate and lessened self-reported anxiety and panic.6PubMed Central. The Implications of the Diving Response in Reducing Panic Symptoms
You do not need a bowl of ice water to make this work. A wet paper towel from a bathroom, a cold water bottle pressed against their cheeks, or even cupping cold water from a tap and splashing it on their face will do. The key area is the forehead and the skin around the eyes, where the trigeminal nerve runs close to the surface. This trick is especially useful because it does not require the person to follow instructions or engage cognitively. The reflex is automatic.
Grounding With the Senses
Grounding techniques work by pulling the person’s attention out of the internal storm and anchoring it in the physical environment. The most well-known version is the “5-4-3-2-1” method: name five things you can see, four you can touch, three you can hear, two you can smell, and one you can taste. You can walk them through this out loud, slowly, pointing things out if needed.
Research on the five-senses technique in people experiencing acute anxiety found that it produced a meaningful drop in anxiety scores after a single use.7Teaching and Learning in Nursing. Ground yourself: Using five senses technique to cope with test anxiety among nursing students The mechanism is straightforward: sensory focus competes with the catastrophic thoughts feeding the panic cycle. When the brain is busy processing the texture of a chair fabric or the hum of an air conditioner, there is less bandwidth left for “I’m dying.”
Other grounding options include having the person hold a piece of ice, press their feet firmly into the floor, or describe an object in the room in exaggerated detail. The specific technique matters less than the principle: redirect attention from internal sensation to external, concrete, neutral stimuli.
How Long It Lasts
Most panic attacks peak within about ten minutes and rarely last longer than twenty to thirty minutes in total.2Springer Link. Panic Attack This is important for you to know, because it means the worst is almost always over faster than it feels. Telling the person “This usually peaks in about ten minutes and then eases up” can be genuinely reassuring, especially if it is their first attack and they have no frame of reference for how long the terror will continue.
After the peak subsides, the person will often feel exhausted, shaky, and emotionally wrung out. Some people cry. Some feel embarrassed. Some want to talk about what happened; others want to be left alone. Do not push a debrief. Let them set the pace for the next hour. Offer water, a quiet space, and the reassurance that what they just went through was not dangerous, even though it felt that way.
When It Might Not Be a Panic Attack
Panic attacks share several symptoms with genuine cardiac emergencies: chest pain, shortness of breath, sweating, dizziness. Even clinicians find it difficult to distinguish the two based on symptoms alone, and research has shown that panic disorder frequently goes undiagnosed in emergency settings because biomedical assessments alone do not reliably catch it.8PubMed. Cardiac pain or panic disorder? Managing uncertainty in the emergency department The overlap is significant enough that physicians consider it important to differentiate between the two to avoid both missed diagnoses and unnecessary medical workups.9International Journal of Clinical Practice. Chest Pain: Panic Attack or Heart Attack?
As a bystander, you are not expected to make that call. But there are some red flags that should prompt a 911 call rather than at-home calming techniques:
- Crushing chest pressure: Panic attacks often produce sharp, localized chest pain, while cardiac pain tends to feel like heavy pressure spreading across the chest or into the arm, jaw, or back.
- Risk factors: If the person is over 50, has a history of heart disease, smokes, or has diabetes, lean toward calling for help.
- Duration beyond 20 minutes: If the symptoms are not easing at all after 20 minutes, or are getting worse, that is unusual for a panic attack.
- Loss of consciousness: People having panic attacks feel like they might faint but rarely do. Actual fainting warrants medical attention.
When in doubt, err on the side of calling emergency services. An unnecessary ER visit is always better than a missed heart attack. You can still use the calming techniques above while waiting for help to arrive.
What Not to Do
Some instincts that feel helpful actually make things worse. Avoid bombarding the person with questions: “What happened? What triggered this? Are you okay? What can I do?” Rapid-fire questions increase the cognitive load on someone whose brain is already overwhelmed. One calm question at a time, with space for a response, is better.
Do not physically restrain them or prevent them from moving unless they are in immediate physical danger. Some people pace or rock during a panic attack, and that movement can actually help discharge some of the adrenaline flooding their system. Let them move if they want to.
Avoid making it about you. Comments like “You’re scaring me” or “I don’t know what to do” transfer your anxiety onto them, adding guilt to an already awful experience. If you feel out of your depth, that is fine, but keep it to yourself in the moment and process it later.
Do not offer alcohol. It might seem like a quick sedative, but alcohol is a poor anxiolytic that rebounds into worse anxiety as it wears off and can interact dangerously with medications the person might be taking.
If They Already Take Medication
Some people who experience recurrent panic attacks carry a prescription benzodiazepine for acute episodes. These medications work quickly, often within fifteen to thirty minutes, but they come with risks of tolerance and dependence with repeated use.10Taylor & Francis Online (Expert Opinion on Drug Safety). Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines If the person tells you they have a prescribed as-needed medication and asks you to help them find it in their bag or get them water to take it, help them. If they do not mention it, do not suggest it. You do not know their medication situation, and suggesting they take a pill can feel presumptuous or panicking in itself.
For people on daily medication for panic disorder, such as SSRIs, those drugs do not help in an acute attack. They work over weeks to reduce the overall frequency and severity of attacks, and they can sometimes increase anxiety in the first few weeks of treatment.10Taylor & Francis Online (Expert Opinion on Drug Safety). Risks and benefits of medications for panic disorder: a comparison of SSRIs and benzodiazepines Knowing this prevents you from asking unhelpful questions like “Did you take your medication today?” during an attack. The daily medication is doing background work; it is not a switch that prevents individual episodes.
After the Attack Passes
What you do in the hours and days after a panic attack can matter almost as much as what you do during one. Many people who have their first panic attack become terrified of having another, and that anticipatory anxiety can itself become a trigger. If you are close to the person, checking in the next day with a simple “How are you feeling today?” signals that you are not uncomfortable or scared off by what happened.
If the person has never had a panic attack before, gently encourage them to see a doctor. A first-time panic attack warrants a medical evaluation to rule out thyroid problems, cardiac arrhythmias, and other conditions that can mimic panic. If they have a known panic disorder and attacks are becoming more frequent, that is worth mentioning too, because treatment adjustments can help.
Avoid repeatedly bringing up the episode in conversation unless they do. Some people process by talking; others process by not talking. Let them lead. The most helpful thing you can communicate, whether during the attack or after it, is the same: “I’m here, I’m not rattled, and this does not change how I see you.”
Helping Someone You Live With
If you live with someone who has recurrent panic attacks, it is worth having a conversation during a calm period about what helps them specifically. People who have been through multiple attacks usually know their own patterns: one person might want you to count breaths with them, another might want you to leave the room and come back in fifteen minutes. Having that plan in place ahead of time removes the guesswork during a crisis and gives you both a sense of agency.
It also helps to learn your own limits. Witnessing repeated panic attacks in a partner, child, or roommate is emotionally draining, and caretaker fatigue is real. You are allowed to feel frustrated, scared, or exhausted by the experience, and addressing those feelings with your own support system or therapist keeps you from unconsciously resenting the person you are trying to help. The goal is sustainable support, not heroic self-sacrifice that quietly builds resentment over months.
Keep a small kit accessible if attacks happen at home: a reusable cold pack in the freezer, a glass of water within reach, and a list of grounding prompts on the fridge or a phone. These small preparations mean you spend less time scrambling and more time being present, which is ultimately the thing that helps most.