What to do to cope with a panic attack
Expert tips to help you get through what feels like the worst 10 or 15 minutes of your life.
By Nicole Spector May 29, 2018
When you feel a panic attack coming on, lower your head until it's almost between your knees and focus on taking slow, deep breaths.
When I had my first panic attack at the age of 19, I believed with absolute certainty that I was in mortal danger. I lie in my dorm room bed for what felt like hours, clutching my pounding heart and gasping for air. Fifteen interminable minutes later, it was as if it had never happened, and I felt relatively normal — but that wouldn't be the last incident. I went on to have many more panic attacks and have since been diagnosed with a panic disorder (PD). I'm among two to three percent of Americans with PD; while 18.1 percent of Americans have anxiety disorders in general — the most common mental illness. Since that day, I’ve treated my condition both with therapy and medication.
Despite managing my PD, I do still suffer the occasional panic attack, but with professional guidance (a must), I’ve learned that there are simple things I can do to stop a panic attack in its tracks. I talked with mental health professionals to discuss why my own techniques work and what more those of us living with panic attacks can do.
A panic attack comes out of nowhere and is not an anxiety attack
Though we tend to use the terms “panic attack” and “anxiety attack” interchangeably, it’s worth noting that professionally speaking (and when referencing the Diagnostic and Statistical Manual of Mental Disorders, aka, DSM–5), there’s actually no such thing as an anxiety attack, per se.
“Anxiety is an excessive persistent worrying over an imminent event that can last a while. A panic attack is a burst of intense fear that typically lasts fewer than 30 minutes,” Dr. Carolyn Rodriguez, assistant professor of psychiatry and behavioral sciences at Stanford tells NBC News BETTER. She says that she would never use the term “anxiety attack” to define any such event, noting that the term is something of a “lay approach”.
Additionally, when panic attacks are linked to a panic disorder, they come out of the blue with no apparent trigger, but anyone can experience a panic attack. “If you’re afraid of heights for instance, and are up on the roof, you might have a panic attack.” The difference here is that in this case, the panic attack has a clear cause, whereas with a panic disorder there’s no obvious culprit in the environment.
Know the signs of a panic attack
"Often, when you don't know the physiological signs of a panic attack you may feel more scared imagining you're having a heart attack," says Annie Wright, LMFT and the owner and clinical director of Evergreen Counseling. "Read up on the signs of a panic attack so you know what you're dealing with."
Dr. Rodriguez recommends scouring the Anxiety and Depression Association of America's website, which covers all the symptoms:
Palpitations, pounding heart or accelerated heart rate
Trembling or shaking
Sensations of shortness of breath or smothering
Feelings of choking
Chest pain or discomfort
Nausea or abdominal distress
Feeling dizzy, unsteady, light-headed, or faint
Chills or heat sensations
Paresthesia (numbness or tingling sensations)
Derealization (feelings of unreality) or depersonalization (being detached from oneself)
Fear of losing control or “going crazy”
Fear of dying
Rodriguez adds that it’s critical to also get a physical exam to rule out other problems.
Write out the facts and mantras on an index card and keep it on you
One of the tools that has helped me is knowing that even the most vicious panic attack can’t kill me. Dr. Rodriguez recommends writing this fact down on an index card or in your phone to read when you feel one coming on. “Panic attacks are not life-threatening,” she says. “Write this down. And maybe add the note to yourself, ‘You have survived panic attacks before. You will survive this one.’”
Dr. Prakash Masand, founder of the Center for Psychiatric Excellence, recommends writing down some positive mantras to get you out of a catastrophic thought pattern. “Or better yet, prepare your own. When you have the negative thoughts of gloom and doom, write down some positive and more realistic rebuttals.”
Visualize your panic as a wave
“When you begin to feel panic sensations, instead of trying to shut them out, visualize each feeling as a wave which you are riding until it comes to rest on the shore,” says Dr. Chuck Schaeffer, a strength-focused psychologist. “Anticipate the wave passing and becoming less and less intense as it crests. Remind yourself that just because you might feel like you'll drown beneath the wave, it doesn't mean you can't swim. You might also remind yourself that the panic sensations are just passing waves on the constant, powerful ocean that is you.”
Dr. Rodriguez seconds this metaphor, adding that the waves will rise and fall, and that typically a panic attack peaks at 10 minutes and then abates.
Use your smartphone for distraction
“Games like crossword puzzles and word searches [are helpful],” says Dr. Masand. “The idea is it can act as a distraction to the fear or the body symptoms of anxiety. Our smartphones offer a plethora of great coping tools, and this is something the majority of us already carry with us. Download some games that will distract you and get your mind off the unpleasant symptoms you are feeling. You can also download relaxing music and guided relaxation sessions.”
Slow, deep breathing is key, but you should practice every day
Long, deep breaths calm your body down, but they can be tricky to implement if you’re not used to doing them. Dr. Schaeffer suggests that to make this practice easier, you should do it daily — anxious or not.
“Practice full-body breathing every day,” he tells NBC News BETTER. “Breathe in deeply through your nose and imagine your whole body filling up with air like a balloon. Next, make your mouth small like you are exhaling through a straw. Slowly exhale through your mouth until you feel like all the air has completely emptied from your body. Repeat this about 10 times and notice any changes in your heart rate or body tension. Once you are comfortable with this kind of breathing, use it during a panic attack to slow your heart rate and calm down.”
One of the worst symptoms of panic attacks in my experience is that sense of “unreality” — like I’m somehow outside my body. Dr. Rodriguez recommends carrying items with you that can help engage your senses to help ground you.
“Things like essential oils (try lavender or peppermint) can help bring you back into your body,” she says, adding to carry a soft, fuzzy piece of fabric or even feel your own shirt. “Feel it, think about it, listen to it.”
“Other ways of anchoring yourself during an attack include rubbing your hands or bare feet on a surface such as a chair, couch or rug,” says Dr. Schaeffer. “Put an ice cube in a paper towel and squeeze it as hard as you can in one hand for a minute until you can feel the coldness and discomfort. Switch hands and repeat until you have the same sensations in your other hand.” When we avoid panic or treat it like an enemy, we make it stronger.
Don’t run away — you’ll only strengthen your fears
I used to avoid places and situations where I’d had a panic attack for fear of having another, but I found that actually going to that intimidating concert or overwhelming shopping mall, or whatever the case may be, has helped me regain freedom over the fear. Dr. Misti Nicholson, a psychologist and the director of clinical services at Austin Anxiety and Behavioral Health Services, calls this “using paradox.”
She explains: “Logic and intuition tell us to run away or fight when we are in danger; however, when we avoid panic or treat it like an enemy, we make it stronger. Instead, it is important to take a paradoxical and counter intuitive approach to panic. I often encourage my patients to do the opposite of what anxiety is expecting them to do. This often means moving toward what they are afraid of when anxiety is telling them to back away.”
Find some private space to ‘normalize’ with this posture
While you shouldn’t, say, bolt from the company meeting if you’re having a panic attack, you may want to take a break in a quiet place where you can sit.
“When you feel one coming on, if possible, try and go to your nearest bathroom or a private conference room, then, lower your head until it's almost between your knees and focus on taking slow, deep breaths,” says Wright. “You may be able to self-regulate and de-escalate the panic attack by doing this. If you can't go somewhere private and this happens in a meeting, pretend you must lean down to tie your shoe or ‘accidentally’ drop your phone on the ground and stay down until you feel yourself normalizing.”
Thank your body for fighting, even if it was misled
It’s easy to get upset at ourselves when we have a panic attack, even though they’re not our fault. Rather than feeling bad about these episodes, thank your body for the hard work it’s done after a panic attack.
“Be gentle and kind to yourself and don’t underestimate your body's response — respect it. Think, ‘Wow my body is strong, it really got ready to fight and now we have to rest a little bit now.’ A positive attitude can be so helpful [in allowing you] to lean into the anxiety instead of avoiding it. And remember, there are therapists here to help you. This is very treatable, and you don’t need to suffer.”