Staying calm yourself is the single most useful thing 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, chest tightness, dizziness, and a feeling of losing control. The episode typically peaks within about ten minutes and passes on its own, but for the person living through it, those minutes can feel like a genuine medical emergency. Your role is not to fix what is happening but to create a steady, grounding presence that helps the person ride it out safely.
Recognize What You Are Seeing
Panic attacks look different from person to person, but they share a recognizable cluster of signs. The person may clutch their chest, breathe rapidly or gasp for air, tremble, sweat, or say they feel like they are dying. Some people freeze in place; others pace or try to flee. Occasionally the person goes quiet and pale, dissociating rather than visibly panicking. If you know the person has a history of panic attacks, that context helps you respond with confidence rather than alarm. Panic disorder affects roughly four percent of the general population, so encountering someone in the middle of an episode is not unusual.
1Europe PMC. Brain Mechanisms Underlying Panic Attack and Panic DisorderThe person is not in physical danger from the panic attack itself. The heart racing, the tingling, the sensation of not being able to breathe are all products of the body’s fight-or-flight system firing without a real threat. Knowing this keeps you from escalating the situation with your own fear. Your composure is the anchor.
What to Do in the Moment
The first step is to approach the person gently and identify yourself if they do not know you well. Ask a simple question: “Are you having a panic attack?” or “Do you need some help?” Let their answer guide what comes next. If they say yes or nod, you can proceed with supportive steps. If they wave you off, give them space but stay nearby.
Once you have their attention, speak in short, slow sentences. Your voice sets the tempo. A calm, slightly quieter-than-normal tone signals safety in a way that long reassurances do not. Avoid saying “calm down” or “there’s nothing to worry about,” because those phrases dismiss what the person is experiencing. Instead, try something concrete: “I’m right here. You’re safe. This will pass.” The goal is to provide a simple, repeatable anchor they can hold onto while the wave of adrenaline works through their body.
If possible, guide the person to a less stimulating environment. Moving to a quieter room, stepping outside, or even turning away from a crowd can reduce the sensory overload that feeds the attack. Lowering lights, turning off loud music, or creating physical space around the person all help.
Breathing Together
Hyperventilation is one of the most common features of a panic attack. Rapid, shallow breathing drops carbon dioxide levels in the blood, which causes tingling in the hands and face, dizziness, and a tightening feeling in the chest. Those symptoms then convince the person something is seriously wrong, which drives more panic breathing. Breaking this cycle is one of the most effective things a bystander can do.
Rather than simply telling the person to “take deep breaths,” breathe with them. Hold up your hand and breathe in slowly through your nose for a count of four, then exhale through your mouth for a count of six, making your exhale visible and audible. Ask them to follow along. Matching your breathing to theirs first, then gradually slowing it down, is more effective than starting at a pace they cannot reach. Research on respiratory biofeedback has shown that voluntary control of breathing rate can reduce panic symptoms, confirming that this is not just folk wisdom.
2PubMed. Respiratory feedback for treating panic disorderIf the person is too overwhelmed to follow a breathing pattern, try asking them to blow out as if they are slowly extinguishing a candle. This naturally lengthens the exhale, which activates the parasympathetic nervous system and begins to counteract the adrenaline surge. Even partial slowing of the breath can help.
Why You Should Never Use a Paper Bag
The paper bag trick is one of the most persistent myths in first aid. The idea is that rebreathing exhaled air raises carbon dioxide levels and corrects hyperventilation. In reality, this practice is dangerous. A case series published in the Annals of Emergency Medicine documented deaths that occurred when paper bag rebreathing was applied to patients who turned out to be hypoxemic or having a heart attack rather than a panic attack.
3PubMed. Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patientsThe core problem is that you cannot diagnose the cause of someone’s rapid breathing on the spot. Asthma attacks, pulmonary embolism, diabetic ketoacidosis, and cardiac events can all look like a panic attack from the outside. Covering someone’s mouth and nose with a bag while they are already struggling to oxygenate their blood can push them into a medical crisis. The slow-breathing technique described above achieves the same carbon dioxide correction without any risk of oxygen deprivation. If you see someone reach for a paper bag during a panic attack, gently redirect them to breathing with you instead.
The Cold Water Trick
One technique that has gained attention in recent years involves applying cold to the face, specifically the forehead, cheeks, and area around the eyes. This triggers what is called the dive reflex, a set of automatic responses the body uses when submerging in cold water. The reflex slows the heart rate and redirects blood flow, activating the vagus nerve and essentially putting the brakes on the fight-or-flight response.
A study testing this cold face technique during acute psychosocial stress found that applying a facial cooling mask produced significant heart rate slowing, with peak reductions in the range of twenty to twenty-seven percent compared to baseline. Even more striking, cortisol responses were nearly flat in the cooling group, while the control group showed cortisol increases averaging over seventy percent.
4Nature / Scientific Reports. Vagus activation by Cold Face Test reduces acute psychosocial stress responsesIn practice, you do not need a laboratory cooling mask. A cold wet cloth draped across the person’s forehead and cheeks, a bag of ice wrapped in a towel, or even splashing cold water on the face can produce a similar vagal response. Offering this to someone mid-attack gives them a physical sensation to focus on, which also serves as a grounding tool. Ask first: “Would it help if I got you something cold for your face?” Autonomy matters during a panic attack, because the person already feels out of control.
Grounding Techniques You Can Guide
Grounding exercises work by pulling the person’s attention out of the internal storm and anchoring it to the present environment. The most widely known is the 5-4-3-2-1 method: ask the person to name five things they can see, four they can touch, three they can hear, two they can smell, and one they can taste. This is not a magic formula, but it occupies the brain’s attentional resources with concrete sensory input, which competes with the catastrophic thoughts driving the panic.
If the person is too panicked for a structured exercise, try something simpler. Place a textured object in their hand, such as an ice cube, a set of keys, or a piece of rough fabric, and ask them to describe what it feels like. Engaging the sense of touch can be effective at redirecting attention. Research on deep pressure therapy, such as weighted vests and firm, steady pressure, has found that people who are comfortable with touch experience meaningful reductions in anxiety from that kind of input.
5PubMed Central. Deep Pressure Therapy: A Promising Anxiety Treatment for Individuals With High Touch Comfort?That caveat about touch comfort is worth taking seriously. Some people find physical contact calming during a panic attack; others find it suffocating and invasive. Always ask before touching someone. A hand on the shoulder or a firm hug might help one person and worsen another’s panic. “Can I put my hand on your back?” is a better approach than just reaching out.
When to Call for Medical Help
Most panic attacks resolve within ten to twenty minutes without medical intervention. But there are situations where calling emergency services is the right move. If the person has never had a panic attack before and does not know what is happening, the symptoms could represent something else entirely. Chest pain during panic and chest pain during a cardiac event overlap enough that even emergency physicians have to work to distinguish them.
6International Journal of Clinical Practice. CHEST PAIN: PANIC ATTACK OR HEART ATTACK?Research on the thought patterns people have during chest pain episodes suggests that frightening cognitions, like “I’m going to die” or “I’m going crazy,” are more characteristic of panic disorder than of cardiac events. But that is a statistical tendency, not a diagnostic tool you can use in the moment.
7Depression and Anxiety. Differences in cognitions during chest pain of patients with panic disorder and ischemic heart diseaseCall for help if:
- Chest pain persists: If chest pressure or pain does not ease as the panic subsides, or if it radiates to the arm, jaw, or back, treat it as a possible cardiac event.
- The person loses consciousness: Fainting during a panic attack is uncommon. If someone passes out, something else may be going on.
- They have a known heart condition: Panic-like symptoms in someone with cardiac history warrant medical evaluation. Research has identified a cardiac subtype of panic attack that is associated with existing heart disease.
- Symptoms last longer than thirty minutes: A true panic attack peaks and then fades. Extended or worsening symptoms need medical assessment.
What Not to Do
Some well-meaning responses can make things worse. Here are the most common mistakes bystanders make:
- Minimizing the experience: “It’s all in your head” or “Just relax” tells the person their fear is not real. The fear is real. The danger is not, but the physical and emotional experience is genuine and intense.
- Asking too many questions: “What happened? What triggered this? Were you stressed?” feels like an interrogation. Save the detective work for later. During the attack, keep questions to the bare minimum needed to help.
- Crowding the person: Gathering a group of onlookers or hovering too closely increases the sense of being trapped. If you are in public, quietly ask other people to give the person space.
- Forcing them to move or eat: “Walk it off” or “Drink some water” can feel controlling. Offer, do not insist. The person needs to feel they have choices.
Equally important is resisting the urge to rationalize away what is happening. Explaining the neuroscience of panic attacks mid-episode does not help. The prefrontal cortex, the part of the brain responsible for logical reasoning, is largely offline during a panic attack. Facts bounce off. Simple, repetitive, grounding statements are what get through.
After the Attack Passes
Once the acute phase ends, the person will often feel exhausted, embarrassed, or shaky. This is a normal aftermath. Let them set the pace for what happens next. Some people want to talk about what just happened; others want to sit in silence for a while. Do not pressure them either way.
If the person has recurrent panic attacks, this is a good time, not during the attack, to gently bring up the idea of professional support. Cognitive behavioral therapy has strong evidence for panic disorder, and part of that treatment involves gradually exposing patients to the physical sensations of panic in a controlled setting so that the brain learns those sensations are not dangerous. Studies on this approach, called interoceptive exposure, have shown significant reductions in fear of bodily sensations like dizziness, breathlessness, and racing heart.
9PubMed Central. Interoceptive hypersensitivity and interoceptive exposure in patients with panic disorder: specificity and effectivenessYou can also help by collaborating on a simple plan for future episodes. What helped this time? What made things worse? Does the person want you to guide their breathing, offer cold water, or just sit quietly? Having a loose script reduces the chaos the next time around and gives the person a sense of control over something that otherwise feels completely random. A Delphi study that developed mental health first aid guidelines for panic attacks arrived at a consensus set of supportive actions through input from both clinicians and people with lived experience, reinforcing that practical, simple strategies are what the evidence supports.
10BMC Psychiatry. Development of mental health first aid guidelines for panic attacks: a Delphi studyLooking After Yourself as the Supporter
Helping someone through repeated panic attacks takes a toll that often goes unacknowledged. A study of caregivers of people with panic disorder and agoraphobia found that over a third, roughly 37.5 percent, met criteria for a common mental health condition themselves, and higher burden was closely tied to that distress.
11The Journal of Nervous and Mental Disease. Burden and Distress in Caregivers of Patients With Panic Disorder and AgoraphobiaIf you are regularly supporting someone with panic attacks, whether a partner, family member, friend, or coworker, your own mental health deserves attention. The hypervigilance that develops, constantly scanning for signs that an attack is coming, learning to avoid triggers, adjusting plans around the other person’s anxiety, can quietly reshape your life. It is worth checking in with yourself about whether you are sleeping well, maintaining your own social connections, and feeling resentment or exhaustion.
Setting boundaries is not selfish. Telling someone, “I want to help you, and I also need to take care of myself,” is honest and sustainable. Encouraging them toward professional treatment is one of the most supportive things you can do, because it ensures they have tools and resources beyond just you. Therapy for panic disorder works well for most people. Helping someone get connected to it may be the most lasting form of help you can provide.
Panic Attacks in Public and at Work
The dynamics shift when the panic attack happens somewhere public. The person may feel intense shame on top of the panic itself, and the presence of strangers staring can make everything worse. If you are with someone who starts panicking in a store, at a restaurant, or on public transit, your first job is to create a bubble of privacy. Step between them and the crowd. If possible, move to a quieter spot. Speak quietly so others cannot easily overhear.
At work, the challenge is slightly different. Colleagues may not know the person has panic disorder, and the person may be terrified of being seen as unstable. If you notice a coworker in distress, a low-key approach works best: “Let’s step outside for a minute” or “Want to grab some air?” gives them an exit without drawing attention. Once you are somewhere private, the same techniques apply: slow breathing, grounding, calm presence.
For people who have panic attacks regularly in public or at work, carrying a small kit can help. A cold pack, a scented object like a peppermint, earbuds for calming audio, and a card with a simple breathing reminder are all low-profile tools that can be used discreetly. If you are the person’s regular support, helping them assemble something like this is a practical contribution that pays off in moments when you might not be there.
Children and Panic Attacks
Children can and do have panic attacks, though their ability to articulate what is happening is limited. A child in a panic attack may complain of a stomachache or say their heart hurts. They may cry, cling, or go rigid. Because children are less able to distinguish between “my body feels scary” and “something is actually wrong,” their fear can be especially intense.
The principles are the same as for adults, just simplified. Get down to their eye level. Use short, concrete language: “You are safe. I am right here. Let’s breathe like this.” Counting breaths together or blowing bubbles, which naturally extends the exhale, can work well with younger children. Avoid expressing your own worry on your face; kids read adult emotions closely, and your alarm will feed theirs.
After the episode, resist the temptation to avoid whatever situation seemed to trigger it. Avoidance teaches the child’s brain that the situation really was dangerous, which makes the next panic attack more likely. Instead, help the child return to the situation gradually when they are ready, and consult a pediatric mental health professional if the attacks recur. Early intervention for childhood panic tends to have good outcomes.