What can you do during a panic attack?
When panic strikes suddenly, the first impulse is often to get rid of it as quickly as possible. But it’s precisely this struggle that can create additional pressure. In the heat of the moment, simple strategies can help prevent the alarm reaction from intensifying further and refocus your attention on the here and now.
1. Try not to further intensify the physical alarm response
A panic attack can feel so overwhelming that the immediate thought is: “This has to stop.” You start monitoring your body more closely, and every change seems to confirm that something is wrong. It can be more helpful to consciously try a different approach to the situation: stay calm, don’t let your breathing speed up any further, and remind yourself that the panic will subside again.
You don’t need any complicated breathing techniques to do this. For example, try inhaling calmly and then exhaling slowly. Some people find structured breathing exercises helpful. However, if counting seconds causes additional stress, you don’t have to force yourself to do it. What matters less is the perfect technique and more the mindset behind it: you don’t have to get the panic under control within a few seconds. You can give your body time to come out of its state of alertness.
2. Bring Your Attention Back to the Here and Now
During a panic attack, your entire focus may turn inward. You might be monitoring your pulse, controlling your breathing, and at the same time, your thoughts may be racing about what might happen next. In such moments, it can help to consciously shift your focus back outward. For example, feel the floor beneath your feet. Pick out an object in the room and describe it in your mind. Notice the sounds you can hear right now. The well-known 5-4-3-2-1 method also works on this principle, directing your attention sequentially to different sensory impressions.
But you don’t need to do five different exercises at once. A simple method that you’re familiar with and can use in the moment is perfectly sufficient. The goal isn’t to push the fear away. Rather, it’s to ensure that the panic doesn’t have your full attention for a moment.
3. Why You Don’t Have to Fight the Panic
As unpleasant as it sounds, sometimes an important step is to simply let the fear be there for a moment. If you constantly check during an attack to see if it’s finally subsiding, you remain mentally tied to it. Every new sensation takes on significance. And if the fear is still there after two minutes, the next thought may already arise: Why isn’t my breathing exercise working? As a result, what was meant to be immediate relief can quickly turn into yet another form of control.
A more helpful mindset might be: The fear is here right now. It’s okay for it to be unpleasant. I don’t have to get rid of it right away. This point is crucial. Because what brings short-term relief during a panic attack can, in the long run, contribute to the fear taking up more and more space.
Why Running Away Can Intensify Anxiety in the Long Run
A panic attack often triggers a strong urge to flee. Leaving the supermarket, getting off the train, or retreating as quickly as possible to a supposedly safe place—this brings relief at first. In the long run, however, this very strategy can contribute to the fear persisting.
1. When avoidance brings short-term relief
Imagine you suddenly start to panic while shopping. You leave your shopping cart behind, go outside, and after a short while notice that the tension is easing. At first, it feels like the right decision: I’m glad I left. The problem is what your brain might learn from this. The relief becomes associated with fleeing. The next time you go shopping, this might trigger the thought even before you start: What if it happens again and I can’t get out in time?
A single situation like this can lead to more and more restrictions. At first, you might just avoid crowded supermarkets; later, perhaps the shopping mall or riding public transportation. At some point, some people affected only feel comfortable if a trusted person is with them or if a quick escape seems possible. Avoidance thus reduces anxiety in the short term, but can perpetuate it in the long term. The German Anxiety Help organization also describes avoidance behavior as an important factor that can perpetuate the cycle of anxiety.
2. Why Your Brain Doesn’t Learn Anything New This Way
To be able to reframe a panic attack differently in the long term, you need new experiences. If you walk away from a situation every time your anxiety rises, you’re missing a crucial experience: you can experience anxiety without the feared scenario necessarily having to occur. This is precisely why confronting feared situations plays an important role in the treatment of anxiety and panic disorders. It’s not about forcing yourself into the worst-case scenario unprepared. Rather, fears are addressed in a targeted and therapeutically meaningful way, instead of organizing your life more and more around them.
So-called safety strategies can also play a role here. Perhaps you only go shopping if a certain person comes along. Or you look for the exit first in every building. Such strategies can provide a sense of security—but at the same time, they can reinforce the belief that you cannot cope with a situation without this safety net. This does not mean that during your next panic attack, you absolutely must stay alone or prevent any escape. Especially in cases of severe panic disorder, confronting feared situations shouldn’t become a self-imposed endurance test. The key idea is different: The long-term goal isn’t to skillfully avoid every panic attack. It’s about gradually giving fear less power over what you do and what you avoid.
Why Avoiding the Situation Can Perpetuate Fear
What helps with panic attacks in the long term?
Acute exercises can help you better manage a panic attack. However, if the attacks keep recurring, it’s often not enough to simply learn a new breathing or distraction technique for the moment. In the long run, the goal is to change how you deal with anxiety itself.
1. Why Psychotherapy Brings About More Lasting Change Than Individual Immediate Exercises
People who experience panic attacks may develop a whole range of strategies over time: carrying water, checking their pulse, avoiding certain places, or always having a trusted person with them. This can provide a sense of security. At the same time, however, the belief can become entrenched: “Without these things, I can’t cope with a panic attack.” Psychotherapy, therefore, does not focus solely on individual attacks. It can help you understand which thoughts, beliefs, and behaviors perpetuate the panic—and how this cycle can be broken.
For panic disorder, cognitive behavioral therapy (CBT) is among the recommended treatments. The German S3 guideline explicitly recommends it; for panic disorder with agoraphobic avoidance behavior, exposure therapy should also be an integral part of CBT. This involves, for example, not automatically interpreting physical sensations as signs of an imminent catastrophe and gradually changing previous avoidance strategies. This distinguishes the treatment from purely immediate relief: a breathing exercise is meant to help you through a difficult moment. Therapy, on the other hand, addresses why panic gains so much power over the long term.
2. The Role Confrontation Can Play in Panic Attacks
At first glance, exposure therapy may sound unappealing. After all, the natural impulse is to avoid situations where another attack might occur. From a therapeutic perspective, however, it is precisely this confrontation that can be important. For example, someone who no longer rides the train out of fear of a panic attack can, as part of behavioral therapy, gradually re-engage with such situations. The goal isn’t to endure as much fear as possible or to prove something to oneself. Rather, new insights can emerge: I can stay in this situation. The anxiety can subside again. I don’t have to flee every time. For panic disorder with agoraphobic avoidance, the S3 guideline recommends such exposure elements and also advocates offering therapeutically guided exposure. Especially in cases of severe symptoms, confrontation should therefore not be viewed as a self-imposed endurance test. It can be carefully planned and therapeutically guided.
3. How Sleep, Stress, and Caffeine Play a Role
In addition to the actual treatment, it’s also worth taking a look at daily life. Lack of sleep, persistent stress, or large amounts of caffeine can contribute to physical sensations such as restlessness or a faster heartbeat. Those who are already highly attuned to such changes may, in turn, perceive them as threatening. It can therefore be helpful to observe whether certain habits or periods of stress are linked to the attacks. However, this does not mean: less coffee + more sleep = no more panic attacks.
A healthy daily routine can be supportive, but it is no substitute for effective treatment of a panic disorder. Furthermore, the body of research on self-help measures and relaxation techniques is, in some cases, more limited than that for established psychotherapeutic approaches. This is precisely why daily life shouldn’t become yet another task you have to control. You don’t have to monitor every cup of coffee, every bad night’s sleep, and every stressful day as a potential trigger. It makes more sense to take recognizable sources of stress seriously without organizing your entire life around avoiding the next panic attack.
When Should You Seek Help for Panic Attacks?
A single panic attack does not automatically mean you have a panic disorder. However, if the attacks recur or the fear of them begins to affect your everyday decisions, it’s worth seeking professional help. Panic disorder is treatable; the German S3 guideline recommends cognitive behavioral therapy, among other approaches.
1. When the fear of the next attack dominates your daily life
Sometimes, the single panic attack is no longer the biggest problem; instead, the question becomes: When will it happen again? Perhaps you cancel a long train ride because an attack might occur along the way. A concert suddenly seems too risky because the exit is far away. Or you only go shopping if someone comes with you. That’s exactly when fear begins to limit your freedom of action.
Constant precautionary measures can also be a sign. Anyone who always needs water, medication, or a specific companion; who is constantly looking for escape routes; or who plans activities based on how quickly a “safe place” can be reached may be spending a significant portion of the day worrying about the next attack. At the very latest when avoidance, anticipatory anxiety, or recurring panic attacks start to limit your daily life, you shouldn’t try to solve the problem solely with breathing exercises and other immediate coping strategies.
2. Where to Find Professional Support
Your primary care physician’s office can be a good first point of contact—especially if your symptoms haven’t yet been medically diagnosed. There, potential physical causes can be considered, and next steps can be discussed. If you’re experiencing recurring panic attacks, you can also contact a psychotherapy practice directly. During a psychotherapy consultation, it can be determined whether you actually have a panic disorder or another anxiety-related condition and which treatment is appropriate. Effective treatment options are available for panic disorder. The S3 guideline recommends both psychotherapy and medication and highlights cognitive behavioral therapy as the recommended psychotherapeutic approach. Which treatment is appropriate depends on your individual situation and personal preferences.
Above all, it’s important not to wait to seek help until it seems almost impossible to do anything without feeling anxious. After all, the long-term goal isn’t simply to keep collecting more and more coping strategies to deal with the next panic attack. The goal is to ensure that anxiety plays an increasingly smaller role in how you manage your daily life.
