The most important thing you can do when someone is having a panic attack is stay calm, stay present, and let them know the episode will pass. Panic attacks typically peak within 10 minutes and resolve within 5 to 20 minutes, though some last up to an hour. Your role isn’t to fix what’s happening. It’s to be a steady, reassuring presence while their body works through an intense but temporary surge of fight-or-flight activation.
What’s Happening in Their Body
During a panic attack, the brain’s threat-detection center essentially sounds a false alarm. It bypasses normal processing steps and floods the body with emergency signals, triggering a cascade of physical symptoms: racing heart, rapid breathing, sweating, chest tightness, tingling in the hands or face, dizziness, and sometimes nausea. These symptoms feel genuinely dangerous to the person experiencing them, and many people having their first panic attack believe they’re having a heart attack or dying.
Understanding this helps you respond with empathy rather than confusion. The person isn’t overreacting. Their nervous system has hijacked their body, and the physical sensations are real, even though there’s no actual medical emergency behind them.
Stay Calm and Ask What They Need
Your composure matters more than any specific technique. If you look panicked yourself, it reinforces the feeling that something is seriously wrong. Speak slowly, keep your voice low and steady, and position yourself where they can see you without feeling crowded. Some people want physical contact like a hand on their shoulder; others feel more overwhelmed by touch. Ask rather than assume.
Simple, direct phrases 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.”
- “I’m right here. I’m not going anywhere.”
Avoid anything that minimizes what they’re going through. Telling someone to “just relax” or “stop worrying” isn’t helpful because they can’t. Their body is running a program they didn’t choose to start. Phrases like “it’s all in your head” or “you’re fine” can make someone feel dismissed or ashamed, which tends to make the attack worse.
Guide Their Breathing
Hyperventilation is one of the most common features of a panic attack, and it directly fuels many of the scariest symptoms like dizziness, tingling, and feeling faint. Slowing their breathing down is one of the most effective things you can do together.
A straightforward approach from the NHS: breathe in gently while counting from 1 to 5, then breathe out slowly counting from 1 to 5 again. The person may not be able to reach 5 at first, and that’s fine. Even getting to 3 is progress. Keep doing this together for at least 5 minutes. Breathe with them visibly so they have a rhythm to follow. You can say something like “Breathe with me” and then count out loud or simply exaggerate your own breathing so they can mirror it.
Don’t push it if they can’t sync up right away. Sometimes just hearing you count in a calm, repetitive pattern gives them something to anchor to while the peak passes.
Use Grounding to Pull Them Into the Present
Panic attacks often come with a terrifying feeling of detachment from reality. Grounding techniques work by redirecting the brain’s attention away from the internal alarm system and toward concrete sensory information in the environment.
The most widely used method is the 5-4-3-2-1 technique. Walk them through it slowly:
- 5 things they can see. Point things out if they can’t focus. “Look at that blue mug on the table. What else do you see?”
- 4 things they can touch. The texture of their clothing, the chair beneath them, the ground under their feet.
- 3 things they can hear. Traffic outside, a fan humming, birds. Anything outside their own body.
- 2 things they can smell. If nothing is obvious, have them smell their sleeve, a piece of food, or step toward fresh air.
- 1 thing they can taste. Gum, coffee, the inside of their mouth.
You don’t need to follow this formula rigidly. The point is to engage their senses one at a time. Some people respond better to something more physical, like holding an ice cube, running cold water over their wrists, or pressing their feet firmly into the floor. Experiment with what works in the moment.
What Not to Do
Don’t tell them to “snap out of it” or suggest they’re being dramatic. Don’t bombard them with questions about why they’re panicking, because they often don’t know and being asked to explain in the middle of an attack adds pressure. Don’t take them to a louder or more crowded space. If you’re in a busy area, try to move somewhere quieter with fewer stimuli, but ask first rather than grabbing them or steering them physically.
Don’t leave them alone unless they specifically ask for space. Even then, stay nearby where they can find you. And resist the urge to talk a lot. Long explanations about how panic attacks work or reassuring monologues can become noise that competes with their ability to focus on breathing or grounding. Keep your words short, calm, and repeated as needed.
After the Attack Passes
Once the worst has subsided, the person will likely feel exhausted, embarrassed, or both. They may cry, feel shaky, or just want to sit quietly. Let them set the pace. Don’t immediately debrief or ask what triggered it unless they bring it up. A simple “I’m glad you’re feeling better” or “I’m proud of you for getting through that” can go a long way.
Offer water. Ask if they want to sit for a while or if they’d prefer to walk slowly. Some people recover faster with gentle movement; others need stillness. If this is someone you’re close to, it’s worth having a conversation later (not in the moment) about what helps them most during an attack. People who experience panic regularly often know their own patterns and preferences, and asking ahead of time means you’ll be better prepared next time.
When It Might Not Be a Panic Attack
Panic attacks and heart attacks share several symptoms, including chest pain, shortness of breath, and a sense of dread. There are differences worth knowing. Panic attacks start suddenly and peak within minutes. Heart attack symptoms tend to build gradually and intensify over time. Panic attack chest pain usually stays in the chest, while heart attack pain often radiates to the jaw, arm, back, or neck. Panic attack symptoms typically fade within 20 to 30 minutes. Heart attack symptoms don’t go away on their own.
If chest pain persists or worsens after several minutes despite calming techniques, or if the person has risk factors for heart disease, call 911. It is always better to have a panic attack evaluated in an emergency room than to dismiss a heart attack as anxiety. The two can look remarkably similar, and even experienced clinicians sometimes need an EKG to tell them apart.