What should you do during a panic attack?

First, make sure that it is a panic attack. The NHS says that most panic attack symptoms can also be symptoms of other conditions. If you have chest pain that feels tight or squeezing, or chest pain that spreads to your arms, neck or jaw, call 999 in the UK or 911 in the US (NHS). If you are not sure, call. MedlinePlus says to call 911 even if you are not sure it is a heart attack (MedlinePlus).

What should you do during a panic attack? The Short Answer

Step	What to do	Source
1	Check for heart attack signs. If you see them or you are not sure, call 999 (UK) or 911 (US).	NHS, MedlinePlus
2	Stay where you are, if possible.	NHS
3	Breathe slowly and deeply. Count 1 to 5 in and 1 to 5 out.	NHS
4	Tell yourself that the attack will pass and that it is not life threatening.	NHS
5	Focus on a peaceful image, or on what is around you now.	NHS, Cleveland Clinic
6	See a GP or doctor if attacks come back.	NHS

Call for emergency help first when you are not sure

A panic attack can feel like a heart attack. NIMH says that panic attacks often include physical symptoms that might feel like a heart attack, such as trembling, tingling or a rapid heart rate (NIMH). You cannot always tell the two apart by yourself.

The NHS says to call 999 if (NHS):

• Your chest pain feels tight. It can feel like squeezing on your chest.
• Your chest pain spreads. It goes to your arms, neck or jaw.
• You have severe difficulty breathing. You gasp, choke or cannot get words out.
• Your lips or skin are pale, blue or grey. On brown or black skin, this can be easier to see on the palms of the hands.
• Someone has passed out. They do not respond normally.

Cleveland Clinic says to get emergency medical care if you have chest pain, trouble breathing or lose consciousness (Cleveland Clinic). In the US, call 911. MedlinePlus says that calling 911 gets you care faster, because emergency services can start treatment when they arrive.

Do not wait to find out. A call is the safe choice when you do not know.

How to breathe during a panic attack

Slow your breathing down. Cleveland Clinic says that hyperventilating is a symptom of panic attacks that can increase fear, and that deep breathing can reduce symptoms of panic during an attack.

The NHS gives this calming breathing exercise for stress, anxiety and panic (NHS):

1. Get comfortable. Stand, sit in a chair that supports your back, or lie down. Put your feet flat on the ground, about hip-width apart.
2. Breathe into your belly. Let your breath flow as deep into your belly as is comfortable. Do not force it.
3. Breathe in through your nose. Breathe in gently and regularly. Count from 1 to 5 if it helps.
4. Breathe out through your mouth. Let the breath flow out gently. Count from 1 to 5 again.
5. Keep going for at least 5 minutes.

The NHS says that you may not be able to reach 5 at first. That is acceptable. Count as far as you can and keep the breath gentle. Use the timer on this page to practise the 5-in, 5-out rhythm.

Cleveland Clinic also says to close your eyes and focus on your breathing. If deep breaths feel hard, read how to do belly breathing on a calm day.

Other things you can do while it passes

A panic attack ends. The NHS says that most panic attacks last between 5 and 20 minutes, and some have been reported to last up to an hour (NHS). Cleveland Clinic says that symptoms usually peak within 10 minutes.

Cleveland Clinic gives these steps to manage the symptoms until the attack ends:

• Name it. Tell yourself that you are having a panic attack. Remind yourself that it is temporary and will pass.
• Relax your muscles. Relax one muscle group at a time to reduce tension.
• Focus on the present. A panic attack can make you feel detached from your body. Focus on what is around you now.

If you help someone else, Cleveland Clinic says to stay with them and stay calm. Ask what they need. Speak in short, simple sentences. Help them breathe slowly by counting to five for each breath in and each breath out. Tell them gently that they are safe and that the attack is temporary.

Panic attack or panic disorder

One panic attack is not a diagnosis. The NHS says that panic disorder is an anxiety disorder where you regularly have sudden attacks of panic or fear. A doctor may diagnose it if you have regular, unexpected attacks, then at least a month of worry about more attacks (NHS).

Panic disorder can be treated. The NHS says that talking therapies, such as cognitive behavioural therapy (CBT), and medicine are the main treatments. See a GP if you have symptoms of panic disorder. Cleveland Clinic says to call a healthcare provider if your panic attack symptoms last longer than 15 minutes, or if anxiety interferes with daily life.

The NHS also gives ways to prevent another attack:

• Learn breathing exercises. The NHS says that they can help ease symptoms.
• Exercise regularly. It can reduce stress and tension.
• Cut down on triggers. Sugary food and drinks, caffeine, alcohol and smoking can all make attacks worse.

If you need urgent help for your mental health in the UK, call 111 and select the mental health option (NHS). You can call Samaritans on 116 123. In the US, call or text the 988 Suicide & Crisis Lifeline (NIMH). If a life is at risk, call 999 in the UK or 911 in the US.

How Steady fits in

Steady is a breathing timer for iPhone and iPad. It does not diagnose or treat panic attacks or panic disorder. The NHS says that you get the most benefit from its breathing exercise when you do it regularly, as part of your daily routine. Steady gives you a timer for that practice on calm days.

• Make a 5 – 5 pattern. Use a Custom Program to breathe in for 5 and out for 5, the NHS count. Read what coherent breathing is for more about this rhythm.
• Breathe with your eyes closed. Audio and Vibration Cues tell you when to breathe in and out.
• Practise at the same time each day. Set up to 3 daily reminders.
• Try other patterns. The built-in programs include Box Breathing (4 – 4 – 4 – 4). See how to do box breathing.

Some features need Steady Pro. During an attack, the NHS steps above come first. If you are not sure that it is a panic attack, call for emergency help before you open any app.

This guide is general information, not medical advice. Talk to a doctor about symptoms.