Module 6 · Worry, rumination & thought patterns · Strong evidence

Getting through a panic attack

What to do while it is happening, and why fighting it or fleeing tends to keep it coming back.

6 min read · Level: Beginner · Free — no account needed to read

The idea

During a panic attack, the instinct is to fight the feelings or escape. Both usually make panic stronger: fighting keeps the alarm on high alert, and escaping teaches the mind that the situation was dangerous. What tends to help instead is to let the wave rise and fall while steadying yourself.

Practical steps: remind yourself what it is — “this is panic, it will pass”; slow your breathing with a longer out-breath; plant your feet and notice things around you to ground yourself; and, if you can, stay where you are rather than leaving. Many people find the attack peaks and eases within ten minutes.

After it passes, be kind to yourself — it was exhausting. If attacks are happening often, if you are starting to avoid places, or if you are unsure whether it was panic, talk to a doctor or other professional. Panic responds well to help.

Why it works

Knowing what to do while panic is happening gives you something to hold on to, and responding without fleeing is what helps panic lose its grip over time.

A real example

The situation

On a crowded train, Ben feels the familiar surge — pounding heart, tight chest, the urge to get off at the next stop.

What happened

He tells himself, “this is panic, it will pass”, breathes out slowly, presses his feet into the floor and names five things he can see. The wave peaks and eases. He stays on the train to his stop, shaken but proud.

The takeaway

Letting the wave pass instead of fleeing made the next journey less frightening.

Use this when you are…

• a panic attack is starting or happening
• you want a plan for the next time panic comes
• you are helping someone through a panic attack

Common mistakes

• Breathing faster to “get more air”. Slow breathing with a long out-breath helps more.
• Leaving the situation every time. Staying, if it is safe, teaches your mind that the situation is not dangerous.
• Keeping it to yourself when attacks keep happening. Professional help for panic works well.

What the evidence says

Strong evidence: Many good-quality studies, usually including randomised trials and reviews that pool them, point the same way. Guidelines tend to recommend it.

Not fleeing during panic, slowing the breath and grounding are consistent with cognitive behavioural approaches that have strong evidence for panic. Self-help works best alongside professional support when attacks are frequent.

Where this comes from: Cognitive behavioural therapy (CBT) research; Slow-breathing and breathwork research; US National Institute of Mental Health (NIMH); UK National Institute for Health and Care Excellence (NICE).

Fields that study this: Clinical psychology.

Try it now: Practise the steps while calm

1. Say your sentence out loud: “this is panic, it will pass.”
2. Take five breaths, each out-breath longer than the in-breath.
3. Press your feet into the floor and name five things you can see.
4. Notice how your body feels afterwards.

Practise with a guided technique

• Slow breathing — (2–5 min · Moderate evidence)
• 5-4-3-2-1 grounding — (2–5 min · Practical evidence)
• The double-inhale sigh — (1–5 min · Emerging evidence)
• Box breathing — (2–4 min · Practical evidence)

Questions to think about

• What usually makes a panic attack worse for you?
• Where could you keep your panic plan so you can reach it quickly?

Try this today

Practise the panic steps once today while calm, so they feel familiar if you ever need them.

Afterwards, ask yourself

What did practising the steps while calm change about how prepared you feel?