Your heart slams. You can't get a full breath. Your hands go numb, the room feels unreal, and some part of you is certain this is a heart attack or that you're about to lose your mind in front of everyone.
A panic attack is your body's threat response firing at full strength with nothing to run from. Adrenaline, faster heart rate, quick shallow breathing, blood moved toward the big muscles. Every symptom that terrifies you is your body doing exactly what it does before a sprint. It's a false alarm, and it can't hurt you.
Knowing that in the middle of one is hard. Here's what to do anyway.
In the moment
Slow the exhale
Don't try to take a deep breath. When you're panicking your lungs are already over-inflated, and gulping air makes the dizziness and tingling worse. Breathe out slowly instead, longer than you breathe in. Four in, six or eight out. If that's too hard, breathe out through pursed lips like you're cooling soup.
Name what's happening
Say it, out loud if you can. "This is panic. It peaks in about ten minutes. It has never hurt me." You're giving the thinking part of your brain a job so it stops feeding the alarm new evidence.
Put your attention outside your body
Panic pulls your focus inward, where every heartbeat becomes proof of catastrophe. Push it out. Name five things you can see, four you can hear, three you can touch. Cold water on your wrists or a cold can against your neck works too, because the temperature change is loud enough to interrupt the loop.
Stay where you are if you can
This is the hard one and it's the one that changes things. Every time you flee the grocery store, you teach your brain that the store was the danger and that leaving saved you. Staying, even sitting on the floor by the freezer section, teaches it the opposite.
Let it be there
Fighting the panic adds a second layer of fear on top of the first. Try dropping the fight. Let the wave come, notice it, and wait. It always crests. Ten minutes feels endless and it does end.
What makes it worse
Checking your pulse. You'll find it fast, and that confirms the catastrophe. Same for searching your symptoms on your phone.
Gulping air, which pushes the lightheadedness further.
Leaning on a safety behavior. If you can only go out with a water bottle, a specific person, or a pill in your pocket, that item becomes the reason you survived. The fear stays intact and gets attached to something new.
Rearranging your life around avoiding the next one. This is how a single panic attack turns into a shrinking world.
If you're with someone who's panicking
Stay calm and stay near. Don't say "calm down." Try "I'm here, this will pass in a few minutes." Breathe slowly and audibly so they have something to match. Don't rush them out of the room unless they ask. Afterward, don't make it a big discussion. They're wrung out.
Stopping the next one
The thing that keeps panic going is the fear of panic. You start scanning for early signs, and the scanning itself raises your baseline, so a normal skipped heartbeat on a Tuesday becomes the start of an attack.
Treatment works, and it works quickly for most people. In therapy we do three things. We take apart the catastrophic prediction, because "my heart is racing" and "I'm dying" are different claims. We deliberately bring on the physical sensations in session, by breathing fast or spinning in a chair, so your brain learns that a pounding heart is uncomfortable and survivable. Then we drop the avoidance, going back to the freeway and the store one step at a time.
Most people see a real change in eight to twelve sessions. If you want to know what that looks like here, our services page covers panic and anxiety treatment and current fees.
One note on safety. If this is your first episode of chest pain or breathing trouble, get checked by a doctor. Ruling out a medical cause is reasonable, and it also removes a piece of the fear.
If you'd like to talk this through with someone, I offer a free 15-minute phone consultation. You can reach me through the contact page or call (408) 827-1006. No pressure to book anything after.