The most important thing you can do for someone having a panic attack is stay calm, stay present, and keep your words simple. A panic attack typically peaks within 10 minutes and lasts 5 to 20 minutes total, so your job isn’t to fix what’s happening. It’s to be a steady presence while their nervous system winds back down.
What’s Happening in Their Body
A panic attack is the body’s fight-or-flight system firing at full intensity with no actual threat present. The person may experience a racing or pounding heart, chest pain, shortness of breath, trembling, dizziness, numbness or tingling in their hands, nausea, chills, or hot flashes. Many people feel a crushing sense of impending doom or a genuine fear that they’re dying. Some experience derealization, a disorienting feeling that the world around them isn’t real, or depersonalization, where they feel detached from their own body.
None of this is voluntary. The person cannot think their way out of it, and they’re not exaggerating. Understanding that helps you respond with patience instead of frustration.
What to Say
Keep your voice low, even, and unhurried. Short, grounding statements work best. Try phrases like:
- “I’m here for you.”
- “You’re not in trouble.”
- “What would help you right now?”
- “You can do this.”
- “Would it help if we went somewhere quieter?”
You don’t need to narrate what’s happening to them or explain that it’s “just” anxiety. You also don’t need to fill every silence. Sometimes the most reassuring thing is simply sitting next to someone without saying a word, letting them know through your presence that they’re not alone.
If you’re not sure what they need, ask. “What would help you right now?” puts them back in the driver’s seat, which matters because a core feature of panic is feeling completely out of control.
What Not to Say
“Calm down.” When someone’s nervous system is in overdrive, being told to calm down makes them feel more misunderstood and more alone. Panic isn’t a choice, and framing it that way adds shame on top of terror.
“You’re okay. It’s not that bad.” From the outside, a panic attack can look disproportionate. From the inside, it feels life-threatening. Dismissing that experience, even with good intentions, is invalidating. You can acknowledge that the attack will pass without minimizing how it feels right now.
“Just take a deep breath.” This one surprises people. Most individuals mid-panic are already hyperventilating, meaning they’re over-breathing. Telling them to take an even bigger breath can worsen the imbalance of oxygen and carbon dioxide in their body and actually intensify symptoms. If you’re going to guide breathing, you need a more structured approach (more on that below).
Guide Their Breathing Carefully
If the person is open to it, box breathing is one of the most effective techniques you can walk them through. Ask first: “Would it help if we tried breathing together?” If they nod or say yes, here’s what to do:
- Breathe in slowly through the nose for a count of four.
- Hold for a count of four.
- Exhale slowly through the mouth for a count of four.
- Hold again for a count of four.
- Repeat the cycle.
Count out loud for them. Doing the breathing alongside them is more effective than just giving instructions, because it gives them a rhythm to match. Keep your own breathing visible and audible. If four counts feels too long, start with three. The specific number matters less than the slow, even pattern.
Try a Grounding Exercise
Panic pulls a person out of the present moment and into a spiral of fear about what’s happening inside their body. Grounding techniques work by redirecting attention to the external world. The most widely used is the 5-4-3-2-1 method, which walks through the senses one by one:
- 5 things you can see. Ask them to name five visible objects. A light fixture, a crack in the wall, your shoes, anything.
- 4 things you can touch. The texture of their shirt, the chair beneath them, the ground under their feet.
- 3 things you can hear. Traffic outside, a fan humming, birds. Focus on sounds outside the body.
- 2 things you can smell. If nothing is immediately obvious, suggest walking to a window or smelling soap on their hands.
- 1 thing you can taste. The lingering taste of coffee, gum, or just the inside of their mouth.
You can walk through this with them conversationally. “Tell me five things you can see right now” feels less clinical than reciting a list of instructions. Not everyone will be able to speak during the worst of it, so be ready to adapt. If they can’t talk, try placing a cold water bottle in their hands or suggesting they press their feet firmly into the floor. Physical sensation pulls attention back to the body in a concrete way.
Change the Environment
Sensory overload makes panic worse. If you’re in a crowded, noisy, or brightly lit space, try to move somewhere quieter. A hallway, a parked car, an empty room, or just stepping outside can make a noticeable difference. Reduce noise where you can: turn off music, close a door, lower your voice. If moving isn’t possible, position yourself between the person and the busiest part of the room to create a visual buffer.
Fresh air helps too. If you’re indoors, opening a window or stepping onto a porch gives them something cooler to breathe and a broader visual field, both of which can interrupt the claustrophobic feeling that often accompanies panic.
After the Attack Passes
When symptoms ease, the person will likely feel exhausted, shaky, and possibly embarrassed. Don’t rush them. Give them time to return to full alertness before they drive or do anything that requires sharp focus. Offer water. Sit with them for a few minutes without pressuring them to talk about what happened.
Some people want to debrief immediately; others need space. A simple “How are you feeling now?” lets them decide. Avoid analyzing what triggered it or offering theories about why it happened. That conversation can come later, if they want it at all.
If this is their first panic attack, or if attacks are becoming more frequent, gently mentioning that effective treatments exist can be helpful. Panic disorder responds well to therapy, and many people see significant improvement. But the minutes right after an attack are about comfort, not problem-solving.
When It Might Not Be a Panic Attack
Panic attacks and heart attacks share several symptoms: chest pain, sweating, shortness of breath, and a feeling that something is terribly wrong. There are some general differences. Heart attack pain tends to feel like pressure, squeezing, or heaviness in the chest, and it may radiate to the arm, jaw, or neck. Panic attack pain is more often sharp and localized. Heart attacks can strike without any emotional trigger, while panic attacks usually occur during periods of high stress or anxiety. Panic attacks also resolve on their own within minutes, whereas heart attack symptoms persist or worsen.
That said, these distinctions aren’t always clear-cut in the moment. If the person has never had a panic attack before, if the chest pain is severe and spreading, if they have risk factors for heart disease, or if something simply feels different this time, call emergency services. It’s always better to have a panic attack evaluated and confirmed than to miss a cardiac event.