Anxiety attack — what to do

In the moment (first aid)

• Name it. “This is a panic/anxiety attack; it’s intense but time-limited.” Education reduces catastrophic misinterpretation that fuels the cycle. nhs.uk+1
• Breathe low and slow (about 6 breaths/min) for 2–3 minutes. Place one hand on the belly and one on the chest; let the belly rise more than the chest. This counters hyperventilation and reduces physiological arousal. Evidence shows paced/diaphragmatic breathing reduces anxiety and sympathetic activation; it’s often used as part of CBT packages. NHS Inform+1
• Ground your senses (5-4-3-2-1) or pick a steady external focus (e.g., a cool surface, your feet on the floor). Grounding is recommended in clinical self-help guidance for panic. NHS Inform
• Stay where you are if safe; ride the wave. Escaping reinforces fear. Exposure/response-prevention principles in CBT encourage staying and letting the surge peak and fall. jcbpr.org
• Avoid paper-bag breathing and stimulants. Paper bags aren’t recommended; caffeine/nicotine can worsen symptoms. Mind

When to seek urgent medical care

New or atypical symptoms (severe chest pain, one-sided weakness, fainting, shortness of breath not settling), or cardiac risk factors—get urgent medical evaluation to rule out medical causes. 

Evidence-based treatments to prevent future attacks

• Cognitive-behavioural therapy (CBT) — first-line
  Strong evidence that CBT reduces panic symptoms and relapse; exposure to feared sensations (interoceptive exposure), cognitive restructuring, and behavioural experiments are key. Internet/remote and group formats are effective, broadening access. BioMed Central+3NICE+3PMC+3
• Medication
  SSRIs/SNRIs are first-line pharmacotherapy for panic disorder; TCAs are similarly effective but less well tolerated than SSRIs. Continue for at least several months after response; taper gradually. Cochrane+3AAFP+3Cambridge University Press & Assessment+3
  Benzodiazepines can reduce acute symptoms but carry risks (sedation, dependence); most guidelines avoid them as first-line and prefer time-limited, carefully monitored use. Cochrane
• Combined care
  CBT plus antidepressant can be considered when single-modality response is partial; shared decision-making and stepped care are recommended in guidelines. NICE
• Lifestyle supports (adjuncts, not substitutes)
  Sleep regularity, physical activity, reduced alcohol/caffeine, and social support have supportive evidence and are recommended by public-health authorities. National Institute of Mental Health

A brief science explainer

• Why breathing helps: Panic often involves hyperventilation → lowered CO₂ → dizziness/tingling/chest tightness → catastrophic thoughts → more panic. Slow diaphragmatic breathing restores CO₂ and interrupts that loop; in CBT it’s paired with exposure so the body relearns safety.
• Why staying put helps: Avoidance maintains panic via negative reinforcement. Exposure (to places, sensations) disconfirms catastrophic predictions and reduces fear over time.

A simple step-by-step script (for handouts)

1. Say to yourself: “This is panic. It will crest and pass.”
2. Sit/stand, feet flat. One hand on belly, one on chest.
3. Inhale through the nose for ~4–5 sec → pause → exhale through pursed lips for ~6–7 sec (about 6 breaths/min). Repeat for 2–3 min.
4. Name 5 things you can see, 4 you can feel, 3 you can hear, 2 you can smell, 1 you can taste.
5. Resume activity without rushing. Log the episode (triggers, thoughts, sensations, what helped) to discuss in therapy. NHS Inform

For loved ones (what helps)

• Stay calm, speak slowly, validate (“I can see this is scary; I’m here”).
• Encourage slow breathing/grounding; don’t push paper-bag breathing or “snap out of it.”