How to calm down a panic attack: what to do right now

What should I do during a panic attack?

During a panic attack, stay where you are if it's safe, slow your breathing so the out-breath is longer than the in-breath, and remind yourself that this is panic and it will pass. Then shift your attention to things outside your body until the wave comes down. These six steps work at a desk, in a metro coach or in the bathroom at a wedding.

1. Stop and stay. If you're driving, pull over. Otherwise sit or stand where you are. Running out of the room teaches your brain that the room was the danger, which makes the next attack more likely there.
2. Breathe out slowly. In through the nose for a count of four, out through the mouth for six to eight, as if blowing on hot chai. During panic people tend to over-breathe, and that drop in carbon dioxide is what causes the tingling hands and light head. Slower breathing brings it back.
3. Add a double inhale if you can. Breathe in, take a second small sip of air on top, then a long sigh out. In Balban and colleagues' 2023 study, five minutes a day of this "cyclic sighing" lowered breathing rate and improved mood more than mindfulness meditation. The physiological sigh guide paces it for you.
4. Name it. Say silently or out loud: "This is a panic attack. It's adrenaline. It peaks and it passes." Lieberman's 2007 brain-imaging study found that putting a feeling into words reduced activity in the amygdala, the brain's alarm centre.
5. Anchor outside your body. Press your feet into the floor, hold something cold, and find 5 things you can see, 4 you can touch, 3 you can hear. The 5-4-3-2-1 grounding exercise walks you through it.
6. Let it peak. Instead of "make it stop", try "okay, let it do its worst for a minute". Panic feeds on the fight against it. Watching it rise, crest and fall is the quickest way down.

MimiYou don't have to stop the wave. Just breathe out slowly and let it pass over you.

Why does a panic attack feel so frightening?

A panic attack feels frightening because your body launches its full fight-or-flight response with no visible threat, so your mind goes looking for one and lands on the scariest explanation: a heart attack, fainting, going mad. Adrenaline speeds up your heart, your breathing gets fast and shallow, and blood moves to your big muscles.

Each of those changes has a harmless explanation. A pounding heart is adrenaline. Tingling fingers and dizziness come from breathing out too much carbon dioxide. The chest feels tight because the muscles between your ribs are tense. The feeling of unreality, as if you're watching yourself, is a common part of high arousal. Knowing this breaks the loop where scary sensations cause scary thoughts, which cause more sensations.

What are the symptoms of a panic attack?

The most common panic attack symptoms are a racing or pounding heart, shortness of breath, chest tightness, sweating, trembling, dizziness, nausea, tingling in the hands, and an overwhelming sense of dread or that you're about to die or lose control. They come on suddenly and peak within minutes.

Is it a panic attack or a heart attack?

You can't always tell from the inside, which is why a first attack, or chest pain that is new or different, should be checked by a doctor or with a call to 112. Panic usually comes with fast breathing, tingling and fear, peaks within minutes, and eases on its own. Heart pain is more often a crushing pressure that can spread to the arm, jaw or back and doesn't ease.

This table is a rough guide, not a way to rule anything out. If in doubt, get it checked.

What should I avoid during a panic attack?

Avoid the things that feel like they'll help but keep panic going: gulping big breaths, running away, searching your symptoms online, and repeatedly checking your pulse. Each one tells your brain the danger is real, so the alarm stays on longer.

• Big deep breaths. Gasping in more air makes over-breathing worse. Aim for slow and gentle, with the emphasis on the out-breath. Meuret and colleagues' 2010 trial found that training people with panic disorder to breathe more slowly and less deeply corrected their low carbon dioxide levels and reduced panic symptoms.
• The paper bag. Re-breathing from a bag isn't recommended; if the breathlessness has a physical cause, it can be unsafe.
• Escaping. Leaving brings relief now and a bigger fear of that place later.
• Caffeine and energy drinks afterwards. The third cup of coffee produces the same racing heart. See caffeine and sleep for how long it stays in your system.

What should I do after a panic attack?

After a panic attack, give your body ten to fifteen minutes to settle: sip water, walk slowly, eat something small if you've skipped a meal, and go back to what you were doing if you can. Feeling drained and shaky is normal. Going back, rather than going home, stops the place itself from becoming frightening.

Later, write two or three lines: where you were, what you'd had (sleep, caffeine, food), and what was on your mind. Over a few weeks a pattern often shows up, such as attacks after short nights, on Sunday evenings before a work week, or during family gatherings. If the fear of the next attack has started running your days, the what-if thoughts guide helps with that anticipatory worry.

How do I help someone having a panic attack?

To help someone having a panic attack, stay calm and close, speak in short, steady sentences, and breathe slowly alongside them so they can match you. Tell them it's a panic attack and that it will pass. Don't tell them to "relax" or "calm down", and don't crowd them or make a scene.

• Move somewhere quieter if they want to, but don't rush them out.
• Ask, "Have you had this before?" If it's their first time, or they have chest pain, call 112.
• Count breaths out loud: "in, two, three, four… out, two, three, four, five, six."
• Ask simple grounding questions: "What colour is that wall? Can you feel the chair?"

How common are panic attacks?

Panic attacks are much more common than most people think. In the WHO World Mental Health Surveys, which interviewed about 143,000 people across 25 countries, de Jonge and colleagues found that 13.2% had had at least one panic attack in their lifetime. Only a small share of them went on to develop panic disorder.

In India, panic often goes unnamed. People describe it as "ghabrahat", a BP problem or gas, and many go through ECGs and tests before anyone mentions anxiety. Getting checked is the right first step. Once your doctor says your heart is fine, it's worth taking the panic itself seriously.

When should I see a professional about panic attacks?

See a doctor, psychiatrist or clinical psychologist if panic attacks keep coming back, if you've started avoiding places, travel or people because of them, or if fear of the next attack is with you most days. These are signs of panic disorder, and structured psychological approaches such as CBT have strong research support for it.

If you don't know where to begin, Tele-MANAS (14416 or 1-800-891-4416) is the government's free, confidential helpline, open 24×7 in many Indian languages. In an emergency, call 112. The anxiety guide covers panic disorder alongside the other types of anxiety, and the anxiety self-check takes two minutes.

How Mentis fits in

Mentis is a daily wellness app, not a substitute for professional care. It helps with the practice part, because breathing techniques work best in a panic when you've rehearsed them on calm days. The Overthinking plan has a chapter called "Out of the head, into the body", with activities like "When it's the body, not the thought", "The word on the breath" and "Tighten, let go". The Work stress plan adds "Steady when it spikes", including "Two sighs, and a name on it" for the moment a bad hour starts. Your daily check-in with Mimi shows mood as weather, and over time Mimi can point out what tends to come before your stormy days. You can also practise the box breathing tool on this site right now.