The most important thing you can do for someone having a panic attack is stay calm yourself, stay present, and help them ride it out. Panic attacks typically peak within 10 minutes and last 5 to 20 minutes total, though some stretch up to an hour. The person isn’t in medical danger, but their body is reacting as though they are. Your job isn’t to fix anything. It’s to be a steady, reassuring presence until the wave passes.
What’s Happening in Their Body
A panic attack triggers the same fight-or-flight system that would activate if the person were facing a physical threat. Their adrenal glands flood the bloodstream with adrenaline and noradrenaline, which raises blood pressure, accelerates the heart rate, tenses muscles, and sharpens mental alertness. Blood redirects away from the digestive system and toward the large muscles, preparing the body to run or fight. Blood sugar spikes. Breathing becomes rapid and shallow.
All of this happens involuntarily. The person cannot simply decide to stop it, any more than you could decide to stop sweating in a sauna. A second, slower stress response also kicks in, releasing cortisol and keeping the body on high alert even after the initial surge fades. This is why someone can still feel shaky and exhausted well after the attack itself ends.
Stay Calm and Keep It Simple
Your tone and body language matter more than your words. Speak in short, simple sentences. Avoid long explanations or rapid-fire questions. If you look panicked yourself, you’ll reinforce the feeling that something truly dangerous is happening.
Helpful things to say:
- “You can get through this.”
- “What you’re feeling is scary, but it’s not dangerous.”
- “Tell me what you need right now.”
- “Concentrate on your breathing. Stay in the present.”
- “I’m right here.”
Ask before touching them. Some people find a hand on the shoulder grounding; others feel more trapped by physical contact. Let them tell you what helps.
What Not to Do
Don’t say “just calm down,” “there’s nothing to be afraid of,” or “you’re overreacting.” These phrases dismiss what the person is physically experiencing, and they can make someone feel ashamed on top of terrified. Their body is producing a real physiological event. Telling them to relax is like telling someone with a stomach flu to stop feeling nauseous.
Don’t crowd them. If you’re in a group, gently steer onlookers away or move the person to a quieter spot if they’re willing. A circle of concerned faces staring at someone mid-attack increases the sense of overwhelm. Don’t force them to talk, explain what triggered it, or answer questions beyond what’s immediately necessary. And don’t leave abruptly without checking whether they want to be alone. Some people do prefer solitude during an attack, but being abandoned without choosing it can feel frightening.
Guide Their Breathing
Rapid, shallow breathing is both a symptom and a fuel source for panic. Hyperventilation drops carbon dioxide levels in the blood, which causes tingling, dizziness, and a feeling of suffocation, all of which convince the brain that something is seriously wrong. Slowing the breath interrupts that cycle.
The simplest approach: breathe with them. Inhale slowly through your nose, visibly, and exhale slowly through your mouth. Say “breathe with me” and let them follow your rhythm. If they can handle a more structured exercise, try the 4-7-8 technique: inhale through the nose for four counts, hold for seven counts, exhale through the mouth for eight counts. Repeat three or four times. The long exhale activates the body’s calming response and counteracts the adrenaline surge. Don’t push a specific technique if it’s making them more anxious. Just matching your slow, steady breathing is enough.
Use Grounding to Anchor Them
Panic attacks often come with a feeling of unreality or detachment. Grounding techniques pull attention back to the physical environment and out of the spiral of fear. The most widely recommended is the 5-4-3-2-1 method, which walks through the senses one at a time.
Walk the person through it gently:
- 5 things they can see. Ask them to name five objects around them. A chair, a light, a tree outside the window. Anything.
- 4 things they can touch. The texture of their clothing, the floor under their feet, a cool wall, the arm of a chair.
- 3 things they can hear. Traffic outside, a clock ticking, the hum of a refrigerator.
- 2 things they can smell. If nothing is obvious, suggest walking to a sink to smell soap, or stepping outside briefly.
- 1 thing they can taste. Gum, water, coffee, or just the taste already in their mouth.
You don’t need to be rigid about the numbers. The point is to redirect the brain toward concrete sensory input. Even asking “What color is the wall?” can help interrupt the feedback loop of panic.
After the Attack Passes
When the acute symptoms subside, the person won’t bounce right back. The stress hormones circulating in their system take time to clear, and the experience is physically draining. They may feel exhausted, embarrassed, shaky, or numb. Don’t rush them back to whatever they were doing.
Offer water. Suggest sitting somewhere comfortable for a few minutes. A short walk can help burn off residual adrenaline if they’re up for it. Let them set the pace on conversation. Some people want to talk about what happened; others absolutely do not. Both are fine. Avoid dissecting the attack or offering unsolicited advice about therapy or medication in that moment.
In the hours and days that follow, gentle physical activity, adequate sleep, and relaxation exercises (even 10 to 20 minutes of deep breathing or stretching) help the nervous system reset. Caffeine, alcohol, and nicotine can all raise baseline anxiety and lower the threshold for another attack, so it’s worth mentioning this if the person is open to it. Connecting with a friend, support group, or counselor also helps. Being alone with the memory of a panic attack tends to make it loom larger than it is.
Panic Attack or Heart Attack
This is a legitimate concern, because the symptoms overlap significantly. Both can involve chest pain, a pounding heart, sweating, dizziness, and a sense that something is very wrong. Here’s what sets them apart in practice.
Panic attack chest pain tends to be sharp, intense, and localized. Heart attack discomfort is more often a pressure, squeezing, or heaviness, like something sitting on the chest. Panic attacks typically have an emotional trigger (even if the person can’t identify it in the moment), while heart attacks usually strike without a clear psychological precipitant. The heart rate during a panic attack can spike dramatically, sometimes as high as the person’s body can push it for their age. And critically, panic attacks are time-limited. They peak and fade within minutes. A heart attack will not resolve on its own.
The practical rule: if chest pain or discomfort lasts longer than 10 minutes and isn’t clearly improving, call 911. You’re not overreacting. Even emergency physicians acknowledge that the two conditions are difficult to distinguish without testing, and no one will fault you for erring on the side of caution.