The most important thing you can do for someone having an anxiety attack is stay calm yourself, because your composure becomes their anchor. Most panic attacks peak within 10 to 20 minutes, though some symptoms can linger for an hour or more. That window feels eternal to the person experiencing it, but knowing it will pass helps you stay steady and guide them through.
What to Say (and How to Say It)
Your words matter more than you might think. Speak slowly, keep your voice low and even, and use short, clear sentences. Phrases that acknowledge what they’re feeling without reinforcing the fear work best:
- “You can get through this.”
- “What you’re feeling is scary, but it’s not dangerous.”
- “Tell me what you need right now.”
- “Concentrate on your breathing. Stay in the present.”
Avoid minimizing what they’re going through. Saying “just relax” or “there’s nothing to worry about” can feel dismissive, even if you mean well. The person knows logically that they’re not in danger. The problem is their body isn’t listening to logic right now. Validate the experience without feeding it. “I’m right here with you” goes a long way.
Guide Their Breathing
During an anxiety attack, breathing tends to become fast and shallow, which floods the body with oxygen and drops carbon dioxide levels. That imbalance is what causes tingling in the hands, dizziness, and the terrifying feeling of not being able to get a full breath. Slowing the breath down reverses this cycle.
Ask the person to breathe with you. Inhale slowly through the nose for about four counts, then exhale through pursed lips (as if blowing through a straw) for six to eight counts. The longer exhale is key: it activates the body’s calming response and gradually brings heart rate down. Don’t just tell them to do it. Do it visibly alongside them so they have a rhythm to follow. If counting feels like too much, simply say “in” and “out” with each breath.
Use the 5-4-3-2-1 Grounding Technique
If the person is spiraling into panicked thoughts, grounding pulls their attention back to the physical world around them. The 5-4-3-2-1 method works well because it gives the mind something specific to do. Walk them through each step one at a time:
- 5 things they can see. Point things out if they’re struggling. A clock on the wall, a tree outside, a pen on the table.
- 4 things they can touch. The texture of their shirt, the floor under their feet, a cool wall, their own hair.
- 3 things they can hear. Traffic outside, a fan humming, birds.
- 2 things they can smell. This one often requires moving closer to something. Hand them a jacket, a cup of coffee, or step outside for fresh air.
- 1 thing they can taste. Gum, water, or even just the taste already in their mouth.
You don’t need to announce that you’re using a technique. Just start asking: “Tell me five things you can see right now.” Keep your tone conversational, not clinical. The goal is to gently redirect their focus from internal panic to external reality.
Reduce the Environment
Sensory overload makes everything worse. If you’re in a crowded or noisy space, try to move the person somewhere quieter. Ask if they’d like to step outside, sit down, or move to a different room. Give them physical space, too. Don’t crowd them or touch them without asking first. Some people find a hand on their shoulder comforting; others feel more trapped by it.
If you can’t change the location, you can still reduce stimulation. Lower your voice. Turn off music or a TV if one is nearby. Position yourself so you’re at their eye level rather than standing over them. Small adjustments to the environment signal safety to a nervous system that currently perceives threat everywhere.
What Not to Do
Don’t ask them to explain what’s wrong. Anxiety attacks often have no clear trigger, and being pressed for a reason can increase frustration and shame. Don’t tell them to “snap out of it” or suggest they’re overreacting. And don’t leave abruptly unless they ask for space. Even if you’re not saying anything, your calm presence is doing more than you realize.
Avoid giving them too many choices or instructions at once. A panicking brain can’t process “Do you want water, or should we go outside, or do you want to sit down, or should I call someone?” Pick one option and offer it simply: “Let’s sit down right here.” If they say no, offer one alternative.
After the Attack Passes
Once the worst is over, the person will likely feel exhausted, embarrassed, or both. Anxiety attacks trigger a massive adrenaline surge, and coming down from that leaves the body drained. Offer water. Suggest sitting somewhere comfortable for a few minutes before jumping back into whatever they were doing. Don’t rush them.
Resist the urge to immediately debrief or analyze what happened. Follow their lead. Some people want to talk about it; others want to pretend it didn’t happen. Either response is fine. If they do want to talk, listen without trying to problem-solve. In the days that follow, avoiding alcohol, caffeine, and nicotine can help prevent the nervous system from being retriggered. Exercise, even a short walk, helps burn off residual stress hormones.
When It Might Not Be an Anxiety Attack
Panic attacks and heart attacks share symptoms like chest pain, shortness of breath, and nausea. The key differences are in the onset pattern and the type of chest sensation. Panic attacks come on quickly and generally hit peak intensity within about 10 minutes. Heart attacks more often start slowly, with mild discomfort that builds gradually and may come and go before the event itself. Heart attack pain also tends to radiate to the jaw, back, or arm, particularly in women who may experience nausea and back pain more prominently than chest pain.
If the person has never had a panic attack before, if the chest pain feels like pressure or squeezing rather than sharp stabbing, or if symptoms keep getting worse after 20 minutes instead of improving, treat it as a potential cardiac event and call emergency services. It’s always better to be wrong about a heart attack than to miss one.
Supporting Someone With Recurring Attacks
If this person experiences anxiety attacks regularly, the most helpful thing you can do between episodes is ask them what works for them. Everyone’s panic response is slightly different, and someone who has been through multiple attacks usually knows what helps. Maybe they have a breathing pattern they prefer, or a specific person they want called, or a phrase that grounds them. Having that conversation when they’re calm means you’re not guessing in the moment.
Recurring panic attacks that interfere with work, relationships, or daily routines point toward panic disorder or generalized anxiety, both of which respond well to professional treatment. You can’t fix this for someone, but you can normalize the idea of getting help by treating it the same way you’d treat any other health condition. People who feel supported are more likely to seek treatment than people who feel judged.