Stay with them, speak calmly, and help them slow their breathing. Most panic attacks peak within 10 minutes and resolve within 20, so your main job is to be a steady, reassuring presence while their body’s alarm system winds down. Knowing a few simple techniques can make that window far less frightening for both of you.
What’s Happening in Their Body
A panic attack is a sudden surge of intense fear that triggers a powerful physical reaction. The brain’s threat-detection center fires a distress signal before the rational parts of the brain even have a chance to process what’s going on. That signal floods the body with stress hormones, activating the same fight-or-flight system that would kick in if a car were speeding toward you. Heart rate spikes, breathing gets fast and shallow, muscles tense, and the person may feel dizzy, numb, or nauseous.
This is important to understand because it means the person isn’t choosing to overreact. Their nervous system has essentially slammed the gas pedal without permission. The “brake” system, which restores calm, takes time to catch up. Everything you do as a helper is aimed at gently engaging that brake.
What to Say and What to Avoid
Keep your voice low and steady. Short, simple phrases work best: “I’m here with you,” “You’re doing a great job,” or “This will pass.” You’re not trying to fix the panic. You’re trying to be an anchor so the person doesn’t feel alone in what their body is doing.
Avoid telling them to “just calm down.” It sounds logical, but it often makes people feel more self-conscious and less in control. Don’t say “you have no reason to be nervous,” either. Their mind and body are reacting to a perceived danger, and pointing out that the danger isn’t real doesn’t override the physical response. Phrases like “you’re overreacting” or “you’re embarrassing yourself” can make everything worse. If you feel the urge to be directive, redirect that energy into guiding them through a breathing exercise instead.
Guide Their Breathing
Hyperventilation, breathing too fast and too shallow, is one of the most distressing parts of a panic attack. It drops carbon dioxide levels in the blood, which causes tingling, dizziness, and a feeling of not getting enough air. Slowing the breath reverses this quickly.
The simplest approach is pursed-lip breathing. Ask the person to pucker their lips as if they’re blowing out a candle and exhale slowly through their mouth. Breathing out through pursed lips naturally slows the exhale and prevents the rapid gasping that fuels hyperventilation. You can do it alongside them so they have a rhythm to follow.
If they’re able to follow more structured instructions, try the 4-7-8 technique. Have them breathe in through the nose for a count of four, hold gently for seven, then exhale slowly through the mouth for eight. Starting with an exhale helps, since emptying the lungs first makes the inhale deeper and more natural. Even two or three cycles can begin to shift the nervous system toward calm. Don’t worry about getting the counts perfect. The goal is simply to make the exhale longer than the inhale.
Try the 5-4-3-2-1 Grounding Technique
If breathing alone isn’t cutting through, grounding can help pull their attention out of the panic spiral and back into the room. The 5-4-3-2-1 method works through the senses, one at a time:
- 5 things they can see. Ask them to name five objects around them: a clock, a chair, a crack in the ceiling, anything at all.
- 4 things they can touch. Have them feel the texture of their shirt, the cool surface of a table, the ground under their feet.
- 3 things they can hear. Traffic outside, a fan humming, their own breathing all count.
- 2 things they can smell. If nothing is obvious, suggest they smell their sleeve, a bar of soap, or walk near an open window.
- 1 thing they can taste. A sip of water or even just noticing the taste already in their mouth.
Walk them through it out loud. The exercise works because the brain struggles to maintain a full-blown panic response while simultaneously cataloging sensory details. It redirects mental energy from the internal alarm to the external world.
What Not to Do
Don’t grab or restrain them unless they’re in physical danger. Some people find a hand on the shoulder comforting, but others feel more trapped by touch during a panic attack. Ask first: “Is it okay if I put my hand on your back?” Let them decide.
Don’t hand them a paper bag to breathe into. This used to be common advice, but it can actually make things worse by restricting oxygen intake too much, especially if the symptoms turn out to be something other than a panic attack. Pursed-lip breathing accomplishes the same carbon dioxide rebalancing without the risk.
Don’t crowd them. If you’re in a group, it helps if one person takes the lead and others give space. A ring of worried faces staring at someone is the opposite of calming.
Panic Attack vs. Heart Attack
These two can look disturbingly similar. Both cause chest discomfort, a racing heart, sweating, and dizziness. But there are patterns that help tell them apart.
Panic attack chest pain tends to be sharp and intense, often in one spot. Heart attack pain is more commonly described as pressure, squeezing, or a heavy weight on the chest, and it can radiate to the jaw, arm, or back. A panic attack usually peaks and begins fading within 10 to 20 minutes. A heart attack won’t resolve on its own; the pain persists or worsens until the person gets medical treatment.
Panic attacks also tend to happen in the context of emotional distress or high anxiety, while heart attacks often strike without a clear emotional trigger. That said, if chest pain or discomfort lasts longer than 10 minutes, call 911. It’s always safer to rule out a cardiac event than to assume it’s anxiety.
After the Attack Passes
The panic attack itself may be over in 20 minutes, but the aftermath can linger. The flood of stress hormones leaves the body feeling drained, shaky, and sometimes sore from muscle tension. Many people describe it as a “panic hangover.” This is normal and not a sign that something is still wrong.
Encourage them to drink water, sit somewhere comfortable, and rest. Gentle movement like a short walk can help burn off residual adrenaline and relieve tension. Avoid offering caffeine or alcohol, both of which can reignite anxiety symptoms.
Once they’ve stabilized, let them talk about it if they want to, but don’t push. A helpful reframe to offer: “That was your body’s alarm system misfiring. It felt terrible, but you weren’t in danger, and you got through it.” This kind of cognitive reframing can reduce the fear of having another attack, which is often the most distressing part of panic disorder.
For longer-term recovery, daily relaxation practice makes a real difference. Even 10 to 20 minutes of slow, deep belly breathing or progressive muscle relaxation (tensing and releasing each muscle group from toes to head) can lower the body’s baseline anxiety level over time. Regular exercise, adequate sleep, and limiting caffeine and nicotine also reduce the frequency and severity of future attacks.
When It Might Be More Than a Panic Attack
A single panic attack doesn’t necessarily mean someone has a panic disorder. But recurring attacks, especially ones that happen at night or without an obvious trigger, warrant a medical evaluation. Panic symptoms can also overlap with conditions like thyroid problems, heart rhythm irregularities, asthma, or reactions to certain medications and substances. A doctor can run basic tests to rule these out.
If someone you know is having frequent panic attacks, gently suggest they talk to their primary care provider. Panic disorder responds well to treatment, and most people improve significantly with the right support. It’s also worth knowing that panic disorder is associated with higher rates of suicidal thoughts, particularly when symptoms are severe. If the person expresses hopelessness or mentions self-harm, take it seriously and help connect them with professional care.