The most important thing you can do for someone having an anxiety attack is stay calm yourself, stay physically present, and avoid trying to rationalize them out of it. An anxiety attack typically peaks within about 10 minutes and passes on its own, but those minutes can feel terrifying for the person experiencing one. Your role isn’t to fix what’s happening. It’s to be a steady, reassuring presence while their body works through the surge of adrenaline.
What You’re Seeing
An anxiety attack (often used interchangeably with panic attack) can look dramatic from the outside. The person may be breathing rapidly, shaking, clutching their chest, or saying they feel like they’re dying. They might be sweating, dizzy, nauseated, or feel tingling in their hands and face. Some people freeze and go quiet; others pace or cry. None of these responses are exaggerated or voluntary. Their nervous system has activated a full fight-or-flight response, flooding the body with stress hormones even though there’s no physical danger.
One thing worth knowing: the person may genuinely believe they’re having a heart attack. The chest tightness and shortness of breath overlap significantly. A key difference is that heart attacks usually build slowly, with pain that worsens over several minutes and may radiate to the arm, jaw, or back. Anxiety attacks come on fast and hit peak intensity quickly. If this is someone’s first episode, if they have heart disease risk factors, or if the chest pain feels crushing and radiates, treat it as a potential cardiac event and call emergency services.
What to Say (and What Not To)
Your words matter more than you might think, and the wrong ones can make the attack worse. Avoid these common responses:
- “Calm down.” This implies the person has a switch they could flip if they just tried harder. They can’t. Hearing this often makes them more self-conscious about their symptoms.
- “You have no reason to be nervous.” Pointing out that nothing is actually wrong doesn’t help, because the fear isn’t rational in that moment. It can actually increase anxiety by making the person feel misunderstood.
- “You’re overreacting” or “You’re embarrassing yourself.” Both minimize what the person is going through and add shame on top of an already overwhelming experience.
Instead, keep your language simple and affirming. Say things like “I’m right here with you,” “You’re doing a great job,” or “This will pass, and I’ll stay with you until it does.” You don’t need to say much. A calm, quiet tone communicates more than the specific words.
How to Guide Their Breathing
Rapid, shallow breathing is one of the main drivers of panic symptoms. It drops carbon dioxide levels in the blood, which causes tingling, dizziness, and a feeling of suffocation, all of which convince the person something is seriously wrong. Slowing their breathing down can interrupt this cycle.
The simplest approach: breathe with them. Say “breathe with me” and then visibly, audibly inhale slowly through your nose and exhale through your mouth. Let them mirror you. Don’t count out loud unless they seem receptive to instruction.
If the person is open to a more structured technique, try the 4-7-8 method. Inhale through the nose for four counts, hold for seven counts, then exhale slowly through the mouth for eight counts. The extended exhale is the key part. It activates the body’s parasympathetic nervous system, which is the counterbalance to the fight-or-flight response. Repeat this cycle three or four times. Even if they can’t hit the exact counts, the act of slowing down and lengthening the exhale helps.
Grounding Techniques That Work
During an anxiety attack, the person’s attention is locked on internal sensations: the pounding heart, the tight chest, the racing thoughts. Grounding techniques work by pulling their focus outward, back into the physical environment. The most widely used is the 5-4-3-2-1 method. Walk them through it gently:
- 5 things they can see. Ask them to name five objects around them. A pen, a light fixture, a crack in the wall, anything.
- 4 things they can touch. Have them feel the texture of their clothing, press their feet into the floor, or run their hand along a surface.
- 3 things they can hear. External sounds only. Traffic, a fan humming, birds outside.
- 2 things they can smell. If nothing is obvious, hand them something with a scent, like a cup of coffee or a bar of soap.
- 1 thing they can taste. Even the taste already in their mouth counts.
This exercise forces the brain to process sensory information that has nothing to do with the panic. It’s surprisingly effective, even when the person feels skeptical about trying it. Don’t force it, though. If they’re too overwhelmed to engage, just stay close and keep breathing slowly where they can see and hear you.
Quick Physical Resets
A few physical interventions can help the body shift out of panic mode by stimulating the vagus nerve, which runs from the brain to the abdomen and plays a central role in calming the nervous system.
Cold water is one of the fastest options. Splash cold water on the person’s face, offer them a cold wet cloth, or place a cold pack against their neck. The cold triggers a reflex that slows heart rate almost immediately. If you’re at home, even holding ice cubes in their hands can work.
Humming or sustained vocalization also helps. The vibration stimulates the vagus nerve through the throat. You can hum together, which doubles as a distraction and a social connection. It doesn’t need to be a specific song or sound.
Gentle movement is another option if the person is willing. A slow walk, even just around the room, can help discharge some of the restless energy that builds during an attack. Yoga-style stretching or simply rolling the shoulders and neck can restore a sense of control over the body.
What Helps After the Attack Passes
When the acute symptoms fade, the person isn’t necessarily fine. Many people experience what’s sometimes called a “panic hangover,” a period of deep fatigue, brain fog, headache, or emotional numbness that can last hours. The body just burned through a massive surge of adrenaline and cortisol, and it needs time to recover.
If possible, help them move to a quieter, more comfortable space. The environment that triggered the attack, or simply the place where it happened, can keep their anxiety simmering. A change of scenery signals to the brain that the threat is over.
Offer a light snack. Something like nuts or fruit can help restore blood sugar, which often drops after a prolonged stress response. A short nap can also help if the setting allows it, though keeping it under 30 minutes avoids disrupting nighttime sleep.
Once they’re ready, talking through the experience can be valuable. Not analyzing or problem-solving, just listening. Let them describe what it felt like. Sometimes processing the episode out loud helps a person identify what triggered it, which is useful for preventing future attacks. Follow their lead here. Some people want to talk immediately, others need space first.
When It Needs Medical Attention
Most anxiety attacks resolve on their own and don’t require emergency care. But there are situations where you should call for help. If this is the person’s very first episode and they’ve never been diagnosed with anxiety or panic disorder, it’s worth getting checked out. Symptoms that look like a panic attack can sometimes be caused by other medical conditions, including blood clots in the lungs, which produce sudden anxiety, shortness of breath, and a feeling of impending doom.
You should also seek immediate help if the person expresses thoughts of self-harm or suicide during or after the episode, if their symptoms don’t improve after 20 to 30 minutes, or if they lose consciousness. When in doubt, especially with someone who has no history of panic attacks, it’s better to get medical evaluation and find out it was anxiety than to assume and be wrong.