How to Calm Down from a Panic Attack

Although they’re harmless, panic attacks can be scary. Common symptoms include a racing heart, trembling, shortness of breath, and a feeling of fear or dread. These symptoms can feel so intense that people might think that they’re having a medical episode. In fact, a significant number of individuals who visit the E.R. with heart attack symptoms are actually having a panic attack.

If you’ve had a panic attack, you’re not alone. Up to 11% of people in the U.S. experience a panic attack each year. In this article, we’ll provide you with some actionable tips on how to calm down during a panic attack and prevent future panic attacks.

What is a Panic Attack?

A panic attack is characterized as a sudden period of intense and overwhelming fear, along with physical symptoms, like sweating, chest pain, and a racing heart. While panic attacks can be intense and overwhelming, they typically don’t last for long. Most panic attacks reach their peak within 10 minutes.

Common Symptoms of a Panic Attack

Panic attacks can include a range of both physical and psychological symptoms. Physical symptoms include:

• Pounding or racing heart
• Sweating
• Chills
• Shaking or trembling
• Shortness of breath
• Chest pain
• Stomach ache or nausea
• Headache
• Dizziness or lightheadedness
• Numbness or tingling in the extremities

Psychological symptoms include:

• A feeling of impending doom
• A fear of being out of control
• Intense fear or anxiety
• Feeling of detachment or like things aren’t real
• Feeling like you’re being choked or smothered

Why Do Panic Attacks Happen?

We don’t know what causes panic attacks. Some people will experience a single panic attack, and then never experience another one. Others may develop a panic disorder, meaning that they have repeated panic attacks, which leads to fear about future panic attacks. However, there are some risk factors that can make you more likely to experience panic attacks. These include:

• A family history of panic disorder and mental health conditions, as these tend to run in families
• Adverse childhood experiences (ACEs), which are negative experiences that are often traumatic
• Having another mental health condition, like phobias, anxiety disorders, and mood disorders
• Certain medical conditions, like thyroid issues, diabetes, heart disease, and respiratory conditions like chronic obstructive pulmonary disease (COPD)

While some panic attacks come out of the blue and other times there’s a known trigger, if you’re someone who is prone to panic attacks, then excessive stress, excessive caffeine intake, and illness might make you more likely to have a panic attack. Individuals with specific phobias may also have panic attacks that are triggered by their phobia.

Immediate Steps to Take During a Panic Attack

When you start to feel the symptoms of a panic attack coming on, it can create even more panic. However, there are some calming techniques for panic attacks that can help you feel better.

Focus On Your Breathing

A panic attack often causes rapid, shallow breathing. This can lead to physical sensations like dizziness, which can cause you to feel more panicked. Switching to deeper, slower breathing can help to calm your body and release tension. Breathe in slowly and deeply through your nose and exhale slowly out through your nose, focusing on making the exhale just as long as the inhale. Some people find it helpful if they place a hand on their belly to encourage them to breathe deeply.  

Use Grounding Techniques

When you’re having a panic attack, it can feel as though you’re not present in reality or in your body. Grounding techniques can help you to focus on the present, which can make symptoms of panic attacks feel less intense. You might focus on the way that the ground feels under your feet, or do some gentle exercise like taking a walk or stretching. Temperature changes can also help to bring your focus back to the present. You can hold an ice cube or place a cold cloth on your neck. If you’re somewhere where this isn’t accessible, running your hands under cold water can be helpful. 

Practice Mindfulness and Acceptance

Mindfulness means focusing your attention on the present and observing without judgement. One way to do this is with a body scan, which involves paying attention to each part of your body. Starting with your feet, observe how they feel, breathing away any tension. Acknowledge any feelings or thoughts that come up, but allow them to pass. Continue in this way, progressing up your body until you reach your head. Completing this body scan meditation can help relax you while teaching you to accept how you are feeling without judgement.

Accepting that you are having a panic attack can reduce the fear and tension you feel, which can help to reduce the panic attack’s intensity and duration. Identify what you are feeling and remind yourself that panic attacks pass.

Engage Your Senses

Engaging your senses is another way to help bring you into the present. A commonly suggested calming technique for panic attacks is the “5-4-3-2-1” method. Here’s how it works:

• Name 5 things you can see
• Name 4 things you can touch
• Name 3 things you can hear
• Name 2 things you can smell
• Name 1 thing you can taste

Some people also find it helpful to smell or taste something strong. Popping a mint in your mouth or smelling some lavender oil are some examples.

Repeat a Calming Mantra

When you’re experiencing a panic attack, negative thoughts can come up in your mind, and focusing on these can draw you deeper into the feeling of panic. Instead, repeating a mantra that counteracts these thoughts can help. For example, “I am safe” or “This will pass”. This positive self-talk can help you interrupt anxious thought patterns.

Techniques to Prevent Panic Attacks in the Future

Once you’ve had one panic attack, it’s natural to be worried about having another panic attack in the future. Luckily, there are some techniques that can help you prevent future panic attacks and reduce their intensity.

Regular Relaxation Practices

Stress can trigger panic attacks, so practicing relaxation may help prevent them. Relaxation exercises can also help to make you more resilient to stress, meaning that future panic attacks don’t impact you as much. In addition to deep breathing, progressive muscle relaxation can help induce feelings of calmness. This involves focusing on one muscle group at a time, tensing the muscles for five seconds, and then releasing them. You’ll work up your body, starting from your toes and ending with your face and head.

Exercise is another way to help release tension from the body and reduce stress hormones. Exercises that combine the breath with movement can be particularly helpful, such as walking, yoga, and pilates.

Cognitive-Behavioral Strategies

Cognitive-behavioral therapy (CBT) is a type of talk therapy that focuses on the connection between thoughts, feelings, and behaviors. In CBT, you’ll learn cognitive restructuring, which starts with identifying negative or unproductive thoughts. You’ll then introduce more helpful thoughts. For example, during a panic attack, you might think “I’m out of control” and work to replace this with a thought like “I’m having a panic attack, and this will pass”.

If you’re avoiding certain situations due to fear of having a panic attack, then a CBT therapist can help you to practice desensitization through exposure therapy. Exposure therapy includes gradual exposure to feared situations in a safe and controlled way to help reduce your emotional response. A CBT therapist can also help you to learn relaxation strategies and help you introduce positive self-care strategies to prevent panic attacks like healthy eating, regular exercise, and journaling.

Building a Support System

Creating a strong support system can help you to reduce your overall feelings of stress, which can help prevent panic attacks. Some people also feel worried about others seeing them having a panic attack, and having a trusted friend or family member who knows about the panic attacks can help to prevent some of this anxiety. They can also help you to find a safe, quiet place if you have a panic attack in public and practice some of your relaxation exercises with you.

When to Seek Professional Help

While panic attacks can be debilitating, they are treatable. If panic attacks are affecting your daily life, it's important to seek help. This might mean that your panic attacks are making it hard to concentrate, sleep, or visit certain places. It’s also a good idea to get checked out if your panic and anxiety symptoms worsen or change to rule out any medical conditions.

Understanding Panic Disorder

While some individuals only have one or two panic attacks in their lifetimes, others go on to develop panic disorder. This disorder is characterized by repeated panic attacks and worries about having a panic attack in the future. Some individuals may also start to avoid certain situations where they may have had a panic attack in the past. 

Types of Therapy for Panic Attacks

Therapy is one useful method for treating panic attacks. Commonly used methods include:

• Cognitive-Behavioral Therapy (CBT): CBT is an effective therapy that is often recommended as the first treatment method for panic attacks. For many people, CBT can be as effective as medication for treating panic disorder. CBT can help you understand your panic attacks better, practice more helpful thought patterns, and ease anxiety through exposure therapy.
• Acceptance and Commitment Therapy (ACT): ACT helps you to learn to accept the thoughts and feelings associated with panic attacks, using strategies like mindfulness, cognitive diffusion, and values-based action. 
• Dialectical Behavioral Therapy (DBT): DBT works to help individuals manage intense emotions through strategies like mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness. This treatment works well when panic attacks happen with other mental health issues, like generalized anxiety disorder.

Medications and Treatment Options

Some individuals use medications to treat their panic disorders. Medications can be used either alone or in combination with therapy. Common forms of medication include:

• Selective serotonin reuptake inhibitors (SSRIs): These medications work to increase the amount of serotonin available in the brain, which can help ease panic attacks. They are well-tolerated by most people. 
• Serotonin-Norepinephrine Reuptake Inhibitor (SNRI): SNRIs work to increase the amount of serotonin and norepinephrine in the brain. While SSRIs remain the first-line treatment for panic disorder, SNRIs can be helpful if SSRIs aren’t.
• Benzodiazepines: Benzodiazepines are a short-term solution because they do carry a risk of dependence and tolerance. They help to increase the amount of GABA, a neurotransmitter in the brain, which helps to induce feelings of calmness.
• Buspirone: Buspirone helps to balance the levels of dopamine and serotonin in your brain. This medication is sometimes used when SSRIs or SNRIs are not well-tolerated, and has no risk of dependence, as benzodiazepines do. Buspirone is also sometimes used alongside SSRIs or SNRIs to help relieve anxiety symptoms. 

Conclusion

Panic attacks are overwhelming and can feel debilitating. But, there are things that you can do to feel better. Strategies like deep breathing and grounding techniques can help you when you are having a panic attack. If you have recurrent panic attacks, then treatments like therapy and medication can help prevent future panic attacks and reduce their intensity.

Learn more about how virtual crisis care can help with panic attacks

Resources and Support Networks

• ‍Anxiety & Depression Association of America Panic Disorder Resources‍
• Crisis Text Line‍
• National Alliance on Mental Illness (NAMI) HelpLine