The most important thing you can do for someone having an anxiety attack is stay calm yourself and stay present with them. An anxiety attack typically peaks within 10 minutes and lasts 5 to 20 minutes total, though some can stretch up to an hour. Knowing what’s happening in their body, what to say, and how to guide them through it can make those minutes significantly less frightening.
What’s Happening in Their Body
During an anxiety or panic attack, the body’s fight-or-flight system fires as though there’s a real physical threat. The nervous system floods the body with adrenaline and norepinephrine, which increases heart rate, speeds up breathing, dilates the pupils, and diverts energy away from digestion. These changes are designed to help someone escape danger, but when they happen without an actual threat, the sensations feel overwhelming and confusing.
This is why the person may be clutching their chest, hyperventilating, shaking, or saying they feel like something terrible is about to happen. Their body is genuinely responding as if they’re in danger. Understanding this helps you respond with patience rather than frustration. They can’t just “snap out of it” any more than you could will your heart rate down after sprinting.
Stay Calm and Keep It Simple
Your composure is the single most stabilizing thing you can offer. Speak slowly and in short sentences. Don’t crowd them or touch them without asking first. Some people want a hand on their shoulder; others feel more trapped by physical contact during an attack.
A few phrases that help:
- “I’m here for you. You’re not alone.” This provides reassurance without pressure.
- “What can I do to help you?” This gives them some control in a moment where they feel they have none.
- “Do you want to do something to take your mind off of things?” This gently opens a door to distraction or grounding techniques.
Equally important is what not to say. Avoid “You’ll get over it” or “Snap out of it,” which dismisses what they’re experiencing. Don’t say “I know, that makes me really anxious too,” because it shifts the focus to you. And resist the urge to say “Have you tried ___?” Troubleshooting in the middle of an attack feels like pressure, not help.
Guide Their Breathing
Hyperventilation is one of the most distressing parts of an anxiety attack, and it creates a feedback loop: fast, shallow breathing makes the person feel more lightheaded and panicked, which makes them breathe even faster. Slowing their breathing down interrupts that cycle.
Ask if they’d like to try breathing with you. Breathe in gently through your nose, counting steadily from 1 to 5, then breathe out through your mouth for the same count. They may not be able to reach 5 at first, and that’s fine. The goal is to gradually lengthen each breath, not to hit a perfect number. Do this together for at least 5 minutes. Matching your breathing gives them something external to focus on and physically activates the body’s calming response.
Try a Grounding Technique
If the person is able to engage with you verbally, grounding exercises can pull their attention away from the internal panic and anchor it to the physical world around them. The most widely used method is the 5-4-3-2-1 technique, recommended by the NHS as a way to interrupt spiraling thoughts.
Walk them through it step by step:
- 5 things they can see. Ask them to name five objects in the room or space around them.
- 4 things they can feel. The texture of their clothing, the chair beneath them, air on their skin.
- 3 things they can hear. Traffic, a fan humming, birds outside.
- 2 things they can smell. This might take some effort, which is part of the point.
- 1 thing they can taste. Offer them a sip of water or a mint if available.
Not everyone will be able to do all five steps during a severe attack. That’s okay. Even getting through two or three shifts their focus outward and gives their nervous system a chance to start calming down.
Know When It Might Be Something Else
Anxiety attacks and heart attacks share some overlapping symptoms, including chest pain, shortness of breath, and a sense of dread. If the person has never had an anxiety attack before, or if something feels different from their usual episodes, it’s worth knowing the key differences.
During an anxiety attack, chest pain tends to stay in the chest and often feels sharp or stabbing. Heart attack pain typically radiates to the arm, jaw, or neck and feels more like pressure or squeezing. Heart attacks tend to follow physical exertion, like climbing stairs or heavy lifting, while anxiety attacks are triggered by emotional stress or sometimes nothing identifiable at all. An anxiety attack peaks and fades within minutes to an hour. Heart attack pain changes in intensity but doesn’t go away.
If you’re not sure which it is, treat it as a medical emergency. Someone waking up with chest pain who has no history of panic attacks, or someone whose pain keeps coming in waves without letting up, needs emergency care.
What to Do After the Attack Passes
When the acute symptoms fade, the person won’t feel instantly fine. Many people describe a “panic hangover,” a period of exhaustion, mental fog, and lingering unease that can last hours. Their muscles may ache from prolonged tension. They may feel embarrassed or drained.
Give them time to return to full alertness before they drive or do anything that requires sharp focus. Encourage them to relieve residual tension with gentle movement, like a walk, or with progressive muscle relaxation, where they slowly tighten and release each muscle group from their toes up to their head. A glass of water, a quiet environment, and your continued calm presence all help.
In the hours and days after, steer clear of offering caffeine, alcohol, or nicotine, all of which can increase anxiety levels and make another attack more likely. If they want to talk about what happened, listen without trying to fix it. If they don’t want to talk, let them know you’re available when they’re ready. Sometimes the most supportive thing you can do afterward is help them plan low-key, structured activities, since both too much and too little to do can fuel anxiety.
If someone is having frequent attacks, gently encourage them to explore ongoing support. Panic attacks are highly treatable, and recurring episodes usually respond well to therapy. But in the moment, your job isn’t to be their therapist. It’s to be steady, kind, and present while their body works through something it can’t control.