If you’ve ever had a panic attack, you know that the experience can be more terrifying than anything has a right to be. It’s easy to think that your physical symptoms (like shortness of breath, chest pain, and feeling like you’re choking) could be a heart attack, allergic reaction, or some other potentially fatal occurrence. And that doesn’t begin to cover the spiral of worry and dread that comes with panic attacks.
While panic attacks might make you feel like something serious is very wrong, experts often view them as false alarms—a misfiring of the body’s fight-or-flight mechanism. This happens when your sympathetic nervous system responds to a perceived threat by revving physical processes like your heart and breathing rate.
“Panic is a natural bodily reaction that occurs in all humans. It was adaptive to our survival and preparing our bodies to either flee or fight in the presence of danger,” Ellen Bluett, Ph.D., a clinical assistant professor of medicine in behavioral science at the University of Montana, tells SELF. “Panic that develops into panic attacks is simply our body experiencing the flight-or-fight response out of context.”
Even if you don’t have panic disorder—which is when you have recurrent attacks and are in constant fear of them—many people will experience a panic attack or two during their lifetime, usually triggered by major stress or even at random. While you can’t change your body going all in on that fight-or-flight response at the wrong time, there are actionable steps you can take to make panic attacks more tolerable so that you can sit with them until they inevitably pass. Here are seven techniques to try next time a panic attack tries to make your life hell.
1. Don’t fight it.
It might seem counterintuitive, but one of the most effective ways to react in the midst of a panic attack is to ride it out instead of resisting it, Julia Martin Burch, Ph.D., a psychologist at the McLean Anxiety Mastery Program and an instructor at Harvard Medical School, tells SELF.
For example, if you’re in a movie theater and you start to notice symptoms creep up, you may have the urge to leave. But if you do, leaving wherever you are might become what’s known as a “safety behavior,” or a strategy you employ to avoid a feared situation, which can get in the way of dealing with panic attacks long-term.
“This reinforces the idea that when you leave, you feel better, and then you may start to avoid situations where you’ve had panic attacks in the past,” Randi E. McCabe, Ph.D., director of the Anxiety Treatment & Research Clinic at St. Joseph's Healthcare Hamilton in Ontario, Canada, tells SELF.
Instead, letting the experience wash over you and trying to tolerate the symptoms may help you view panic attacks as something you can handle—not something you have to fear or escape. We know, easier said than done. The following tips might help with this.
2. Tell yourself you’re having a panic attack.
The scary symptoms of a panic attack can often lead people to imagine worst-case scenarios, like that death is imminent, which can obviously further anxiety. If you find yourself catastrophizing like this, telling yourself it’s a panic attack can reduce anxiety both in the moment and when it comes to future attacks, explains McCabe. It also keeps you from paying too much attention to your individual symptoms, which can escalate panic, McCabe says. (You notice your heart is racing, you worry about why that’s happening, you start to sweat, you worry about that, then things get worse from there.)
Full disclosure: This is probably going to be most effective when you’ve actually had a panic attack before. If you don’t have past experience to inform whether you’re having a panic attack or something like a heart attack, don’t hesitate to seek medical attention. But once you know panic attacks are on the table, you can learn what distinguishes them from heart attacks, like the overwhelming sense of dread. Then, when one rolls in, you can tell yourself with certainty, “This is just a panic attack.”
By the way, these tactics come from cognitive behavioral therapy (CBT), a first-line therapy treatment for panic disorder. In short, CBT teaches you to think about and react to panic attacks differently, and that can help lower their frequency. “Leaning in and facing fear of fear is a core component of CBT,” says Martin Burch.
3. Repeat calming mantras.
Emotions are like waves—this is going to roll over me. I can handle these symptoms until they pass. This feeling isn’t comfortable, but I can accept it. Positive statements like these may help reframe your relationship with panic, says Bluett, noting another CBT technique.
Veronica P., 45, a yoga and meditation teacher who’s experienced multiple panic attacks in the past three years, uses positive affirmations such as I am safe and All is well to get her through attacks. “Focusing on being safe now without going into the dark places of my mind helps,” she tells SELF.
Or it might be more effective to concentrate on your power to make it through the panic. This is a coping mechanism for Lacey B., 23, who is living with severe anxiety and has dealt with around a dozen panic attacks. “It helps me calm down because I'm reminding myself that I'm a strong woman and that it will end soon,” she tells SELF.
It might take some trial and error to find out which mantras help you, but once you find one that rings true, it’s a useful thing to keep in your panic attack toolkit.
4. Remind yourself that it won’t last forever.
Even though panic attacks can feel interminable, they tend to peak within about 10 minutes. “It’s physiologically impossible for the body to stay revved up much longer than that,” says Martin Burch.
Reminding yourself that the experience is time-constrained can help you put it in context and handle it. After a panic attack, think back on it and tell yourself something like, “That felt terrible, but it only lasted nine minutes.” Then, bring that fact front and center if you have another panic attack. “Reflecting back on a time when you did manage a panic attack can remind yourself that you have the ability to get through them,” says McCabe.
5. Breathe deeply.
When you’re anxious, your breathing can turn quick and shallow, which can increase feelings of lightheadedness and dizziness, explains McCabe. As tough as it can be, try to breathe slowly and deliberately to help reduce symptoms associated with hyperventilation. On top of that, deep, diaphragmatic breathing can trigger your body’s parasympathetic system to help you relax by calming processes like a racing heart, thereby reducing anxiety.
This can also help with the common panic attack symptom of feeling like you might be choking. “When I'm panicking, I feel like I can't breathe. I describe it to family and doctors like my throat has closed and no air is getting through,” says Lacey. “I try to regulate my breathing by taking very deep and slow breaths.”
While regulating your breathing can be useful during a panic attack, you might want to skip strict guided breathing exercises. When you focus too much on your breathing, you run the risk of that becoming a safety behavior, explains Martin Burch, leading you to feel as though you need to breathe in a specific way to overcome a panic attack.
6. Tell others how to help you.
If a friend or family member is near Lacey while she’s having an attack, she often asks them to breathe in ways that she can mimic or share positive affirmations. “It helps a lot to hear from loved ones that I will overcome what I'm going through,” she says.
Bluett notes that she often teaches friends and family members of people who have panic attacks about strategies they can employ to help their loved ones. If you have techniques that work for you, don’t be afraid to tell people you’re close to ahead of time so they can support you in the moment.
7. Distract yourself.
“Distraction is a way to divert your attention away from panic sensations to something else,” Bluett says. You might, for example, focus on your five senses, talk to someone, start singing a song, go on a walk, or do something soothing like pet your dog, she explains.
If you don’t know what kind of distraction might work best, a type of cognitive behavioral therapy called dialectical behavior therapy (DBT) has strategies for tolerating distress often called the TIPP skills. TIPP stands for temperature change, intense exercise, paced breathing, and progressive muscle relaxation.
Some of the TIPP skills involve distraction and allow you to rapidly shift your physical and mental state, Bluett says. For example, dunking your face in a bowl of cold water or holding an ice pack to your eyes and face for at least 30 seconds might provoke your parasympathetic nervous system to kick in, which can help calm you down. “By engaging in these strategies, we are able to intervene in the [panic attack] cycle,” Bluett says. You don’t want any of these distraction methods to become safety behaviors, but they can be useful from time to time.
8. Talk to your doctor or therapist for help.
If you’re really struggling to get through panic attacks, talk to your doctor or a mental health professional. They’ve heard it all before, we promise.
This will probably come as no surprise since CBT-based tactics are peppered throughout this story, but cognitive behavioral therapy is considered a first-line treatment for panic disorder, according to the National Institute of Mental Health (NIMH). While it can definitely be beneficial to practice CBT techniques that you’ve heard or read about, having a therapist help you cement these skills and work through your panic in general can be especially useful. If you don’t yet have a therapist and aren’t sure where to start, here’s SELF’s guide to finding an affordable therapist.
As another option, your doctor may prescribe medications to treat your panic attacks, like selective serotonin reuptake inhibitors (SSRIs), antidepressants that are usually taken daily to stabilize serotonin levels by blocking its reabsorption in the brain. When it comes to medications, these are considered a first-line treatment for various anxiety issues including panic attacks, according to the NIMH. Imbalanced serotonin is associated with anxiety issues, and long-term SSRI use can decrease panic attack symptoms. This can also help reduce the fear associated with future attacks, a huge part of panic disorder.
Sometimes doctors will also prescribe medications known as benzodiazepines like diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin) to reduce anxiety as quickly as possible. These medications work to calm the body by raising levels of a neurotransmitter called GABA in the brain, and taking them can absolutely be helpful to manage the symptoms of a panic attack. But doctors typically only prescribe benzos for short-term use since using them over the long-term can be habit-forming or raise your tolerance for the drug so it’s no longer as effective at handling your anxiety or panic symptoms.
All of this is to say that depending on how severe or frequent your panic attacks are, you might want to talk to a medical professional. No one should have to live in constant fear of having another panic attack—including you.
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