Staying calm, staying present, and keeping your own reactions in check are the most important things you can do when someone near you is in the grip of an anxiety or panic attack. The episode is temporary, usually peaking within ten minutes, but to the person experiencing it, those minutes feel endless and terrifying. What you say and do during that window can either shorten the suffering or accidentally make it worse. The specific techniques that help are straightforward, but they work best when you understand what’s actually happening in the person’s body.
What Is Going on Inside Their Body
During an anxiety attack, the body’s fight-or-flight system floods the person with adrenaline, speeds up their heart rate, tenses their muscles, and shifts blood flow away from digestion and toward the limbs. Research on panic disorder shows that this amounts to a takeover by the sympathetic nervous system, with the calming parasympathetic system suppressed, which leaves the cardiovascular system less able to respond flexibly to what’s actually happening around the person.1JAMA Psychiatry. Somatic Symptoms and Physiologic Responses in Generalized Anxiety Disorder and Panic Disorder: An Ambulatory Monitor Study That’s why the person may feel like they’re having a heart attack, can’t breathe, or are about to faint. Their body is reacting as though there’s a physical threat, even when there isn’t one.
Knowing this matters for one practical reason: the person is not being dramatic or seeking attention. Their chest pain, tingling, dizziness, and sense of dread are physiologically real. You don’t need to fix the underlying cause in the moment. You just need to help their nervous system start winding down.
Recognizing an Anxiety Attack in Real Time
Anxiety attacks don’t always look the way they do in movies. Some people hyperventilate and clutch their chest. Others go very still and quiet, or become irritable and restless. Common signs to watch for include rapid or shallow breathing, visible trembling or shaking, sweating even when it’s not warm, a sudden need to leave a room or situation, and a glassy or distracted look as though the person has mentally checked out. Some people will tell you outright that they feel panicked; others won’t be able to articulate what’s happening.
The person may also report symptoms you can’t see: a racing heart, nausea, a feeling of unreality (as though the world has gone flat or dreamlike), or an overwhelming conviction that something terrible is about to happen. If someone you know has a history of panic attacks and suddenly excuses themselves, seems frozen, or starts breathing oddly, those are cues to step in gently rather than wait.
What to Say and How to Say It
Your voice matters more than your words. Speak slowly, in a low and steady tone. A calm voice is a signal to the person’s nervous system that the environment is safe. Rushed, high-pitched reassurance (“Oh my God, are you okay? What do I do?”) has the opposite effect and can escalate the episode.
Research into mental health first aid for panic attacks, conducted through expert consensus involving clinicians, people with lived experience, and caregivers, produced guidelines covering what bystanders should say and do when someone is mid-attack.2BMC Psychology. Redevelopment of mental health first aid guidelines for supporting someone experiencing a panic attack: a Delphi study A few principles from that work translate directly into everyday language:
- Name what’s happening: “This looks like it might be a panic attack. It’s going to pass.” Giving it a name takes away some of the terror of the unknown.
- Validate without dramatizing: “I know this feels awful right now, and I’m going to stay with you.” Avoid dismissive phrases like “just calm down” or “there’s nothing to worry about,” which tell the person their experience isn’t real.
- Ask before touching: Some people find a hand on the shoulder grounding; others feel trapped by physical contact during an attack. A quick “Is it okay if I put my hand on your back?” respects their autonomy.
- Keep your sentences short: The person’s ability to process complex information is limited. Short, concrete statements work better than explanations.
Avoid asking the person to explain what triggered the attack. Many panic attacks arrive without an obvious trigger, and pressing for a reason can make the person feel like they need to justify their distress.
Guiding Their Breathing
Helping someone slow their breathing is one of the most effective things a bystander can do, because rapid or shallow breathing during a panic attack creates a feedback loop: it lowers carbon dioxide in the blood, which causes tingling, dizziness, and a feeling of suffocation, which makes the person breathe even faster. A scoping review of breathwork interventions for people with clinically diagnosed anxiety disorders found that a range of structured breathing techniques produced significant improvements in anxiety symptoms.3PubMed Central. Breathwork Interventions for Adults with Clinically Diagnosed Anxiety Disorders: A Scoping Review
You don’t need to teach a complicated technique. The simplest approach: breathe with them. Say “breathe in with me” while visibly inhaling slowly through your nose for about four counts, then “now breathe out” while exhaling for about six counts. Making your own breathing audible and exaggerated gives the person something concrete to mirror. Many people who can’t follow verbal instructions mid-attack can still unconsciously match someone else’s breathing rhythm.
One note of caution: paper bags are an outdated approach. Rebreathing into a bag does raise carbon dioxide levels, but it also reduces oxygen intake, and if the person’s symptoms are caused by something other than hyperventilation, a paper bag can make things worse. Respiratory feedback research shows that helping a person gain voluntary control over their breathing rate is effective, but the mechanism works best when the person is actually slowing down, not restricting airflow.4Journal of Clinical Psychology. Respiratory feedback for treating panic disorder
The Cold Water Trick
If the person is open to it, cold water applied to the face can produce a surprisingly fast reduction in panic symptoms. This works by activating the mammalian diving response, a reflex that lowers heart rate and redirects blood flow when cold water contacts the face, especially around the forehead, eyes, and cheeks. A clinical study testing cold facial immersion in people with panic symptoms found that the technique significantly reduced heart rate and lessened self-reported anxiety and panic.5PubMed Central. The Implications of the Diving Response in Reducing Panic Symptoms
In practice, you don’t need a bowl of ice water. A cold wet cloth held against the person’s forehead or cheeks works. So does splashing cold water on the face at a sink or holding a cold bottle or ice pack against the neck. The key is cold contact with facial skin. It’s a quick, physical intervention that bypasses the need for the person to think or follow instructions, which makes it useful when someone is too overwhelmed to engage with breathing exercises.
Adjusting the Surroundings
Sensory overload makes panic worse. If the attack is happening in a crowded, loud, or brightly lit space, moving the person to somewhere quieter helps. Research on reduced environmental stimulation found that lowering sensory input led to meaningful drops in self-reported anxiety, with effects lasting up to 48 hours after the intervention.6PubMed Central. Reduced Environmental Stimulation Therapy (REST) in anxiety and depression: An experience sampling study You’re not going to replicate a clinical setting during someone’s panic attack on a sidewalk, but the principle translates: fewer competing stimuli means less for the nervous system to process.
If you can’t move the person, you can still reduce their sensory load. Ask bystanders to give space. Turn down music. Dim lights if you have control over them. Position yourself between the person and the crowd so they have a visual anchor instead of a sea of faces. Some people find it helpful to focus on a single object, hold something with an interesting texture, or press their feet firmly into the ground. These grounding techniques work by giving the brain something concrete and non-threatening to attend to.
When You Are Not Sure It Is Anxiety
Panic attacks can look remarkably like cardiac events. Chest pain, shortness of breath, arm tingling, and a feeling of impending doom are symptoms of both. Research has documented that a substantial subset of people experiencing panic attacks present with symptoms closely mimicking cardiac emergencies, differing primarily in the intensity of physical complaints rather than the overall pattern of symptoms.7Europe PMC. The cardiac anxiety syndrome–a subtype of panic attacks If you are unsure whether the person is having a panic attack or a medical emergency, err on the side of calling for help. This is especially true if the person has no history of panic attacks, is over 40, has known heart conditions, or if their symptoms include sudden severe chest pressure radiating to the jaw or left arm.
You can still use calming techniques while waiting for medical assistance. Helping someone breathe slowly and speaking in a reassuring voice won’t interfere with cardiac care if it turns out to be a heart issue, and it will help if it’s panic. The worst-case scenario of treating a panic attack as a possible cardiac event is an unnecessary trip to the emergency room. The worst-case scenario of assuming a cardiac event is “just anxiety” is far more serious.
After the Attack Passes
Once the acute symptoms subside, the person is often left feeling drained, embarrassed, and shaky. This is normal. The flood of stress hormones takes time to clear, and many people feel physically exhausted or emotionally fragile for hours afterward. Resist the urge to immediately debrief or analyze what happened. “You’re doing great, take your time” is usually more helpful than “So what triggered that?”
The mental health first aid guidelines that emerged from expert consensus included specific recommendations for what a supporter should do once a panic attack ends, recognizing that the post-attack period is its own phase that needs care.2BMC Psychology. Redevelopment of mental health first aid guidelines for supporting someone experiencing a panic attack: a Delphi study Practical post-attack support includes offering water, suggesting the person sit somewhere comfortable for a few minutes, and letting them decide the pace at which they re-engage with whatever they were doing. If they want to talk about it, listen. If they don’t, let them know you’re available whenever they’re ready.
If the person has never had a panic attack before, gently encourage them to see a doctor. A first panic attack deserves medical evaluation to rule out other conditions and to discuss whether treatment might help prevent recurrence. If they already have a treatment plan or medication, ask if there’s anything specific they usually do after an episode and help facilitate that.
Helping a Child or Teenager
Panic attacks in young people are more common than many adults realize, and the experience can be even more frightening for someone who doesn’t have the life experience to recognize what’s happening. A child may not be able to say “I’m having a panic attack.” Instead, they might cry, refuse to go to school, complain of stomach pain, or become suddenly clingy or aggressive.
The same techniques that help adults also work for kids, but with adjustments. Children respond well to guided breathing that feels like a game: blowing out birthday candles, blowing up an imaginary balloon, or breathing along with a slow hand movement you make in front of them. Physical grounding techniques also land well, like asking them to name five things they can see, four things they can touch, or three things they can hear.
Research on adolescent panic treatment has highlighted the value of involving parents and caregivers as coaches rather than passive observers. In intensive treatment programs for teens with panic disorder, therapists trained parents to support their child’s coping strategies outside of sessions, effectively extending the therapeutic support into everyday life.8Cognitive and Behavioral Practice. Implementation of an Intensive Treatment Protocol for Adolescents With Panic Disorder and Agoraphobia The implication for a parent helping during an attack is that your role isn’t to make the panic disappear but to model calm, validate the child’s experience, and reinforce the idea that the feelings will pass without causing harm.
Taking Care of Yourself as the Helper
If you regularly support someone who has panic attacks, your own wellbeing deserves attention. Supporting a loved one through repeated episodes of intense distress takes a toll, and research confirms this isn’t just a feeling. A study of caregivers of people with panic disorder and agoraphobia found that more than a third of caregivers met criteria for common mental disorder themselves, and higher caregiver burden was consistently associated with greater personal distress.9The Journal of Nervous and Mental Disease. Burden and Distress in Caregivers of Patients With Panic Disorder and Agoraphobia The severity of the patient’s avoidance behavior and panic attacks predicted the caregiver’s level of worry.
This isn’t a reason to pull back from supporting someone, but it is a reason to build in your own supports. That might mean talking to a therapist, setting boundaries around how much crisis support you can provide in a given week, or connecting with others who are in similar caregiving situations. You can’t pour from an empty cup, and guilt about setting limits doesn’t make anyone healthier. If you notice yourself becoming anxious, resentful, or chronically exhausted, those are signals to invest in your own care rather than evidence that you’re failing the other person.
Digital Tools and Longer-Term Support
For someone who experiences panic attacks regularly, smartphone apps designed for panic management can serve as a bridge between professional treatment sessions and daily life. A three-year study found that people with panic disorder who used a mobile case management app alongside standard therapy showed greater improvement on panic severity measures than those receiving standard therapy alone, with meaningful differences persisting at both six and twelve months.10PubMed Central. Enhancing panic disorder treatment with mobile-aided case management: an exploratory study based on a 3-year cohort analysis The app allowed patients to track symptoms in real time, set goals, and practice stress management skills learned in therapy.
As a supporter, you can help by encouraging the person to explore these tools during a calm period rather than in the middle of an attack. Downloading and learning a breathing app or guided relaxation tool ahead of time means it’s ready when needed. Some couples and close friends develop a shared plan: the person with panic attacks identifies what helps them most, writes it down, and shares it with their support person. That way, when an attack hits and the person can’t think clearly, you already know whether they prefer silence or conversation, cold water or a dark room, a hand on the shoulder or space. Having that plan removes guesswork from an already stressful moment and makes your help feel less like fumbling and more like partnership.