What to Do During a Panic Attack: Practical Strategies
What to Do During Panic Attacks: Practical Strategies That Actually Work
A panic attack causes sudden, temporary feelings of fear and strong physical reactions in response to ordinary, nonthreatening situations. If you’ve ever experienced a panic attack, you know how terrifying it feels—your heart races, you can’t catch your breath, and you might genuinely believe you’re having a heart attack or dying. These symptoms are frightening, but they aren’t dangerous and they will pass. Panic attacks do not represent immediate danger and do not cause physical harm, even though the sensations may feel life-threatening.
Whether you’re in Baltimore, Towson, or elsewhere in Maryland, understanding what happens during panic attacks and knowing practical strategies to manage them can make a significant difference.
How Does a Panic Attack Feel?
Panic attacks are sudden episodes of intense fear or discomfort that peak within a few minutes. The experience can be overwhelming and may feel life-threatening, even though panic attacks are not actually dangerous.
During a panic attack, you may experience physical symptoms like:
Racing heartbeat - Your heart pounds or feels like it’s skipping beats
Chest pain - Tightness or discomfort that can feel similar to a heart attack, leading to emergency visits
Difficulty breathing - Shortness of breath or feeling like you’re being smothered
Sweating and shaking - Your body may tremble and you might sweat profusely
Dizziness - Feeling lightheaded, unsteady, or like you might faint
Stomach upset - Nausea or abdominal distress
You might also experience intense psychological symptoms:
Feeling like you’re losing control or “going crazy”
Fear of dying or having a heart attack
Sense of impending doom
Feeling detached from reality or yourself
Intense anxiety that seems to come from nowhere
These physical and psychological symptoms are common symptoms of panic disorder and are used by mental health professionals to help diagnose the condition.
Most panic attacks last from a few minutes to about 30 minutes. The intensity typically peaks within 10 minutes and then gradually subsides. Some symptoms may linger longer. Physical symptoms of panic attacks typically resolve with time, but residual fear can lead to ongoing anxiety. Some people experience panic attacks during sleep, waking suddenly with physical symptoms and intense fear.
The physical sensations during panic attacks are your body’s fear response activating without an external threat. Your fight-or-flight system kicks in, flooding your body with adrenaline—even when there’s no actual danger present.
We often tell clients in our Baltimore practice that one of the most frightening aspects of panic attacks is how real they feel. The chest pain, the racing heart, the difficulty breathing—these aren’t “just in your head.” They’re genuine physical sensations caused by your nervous system’s alarm going off. What helps many people is understanding that these symptoms, while terrifying, are your body trying to protect you from danger that isn’t there. Once you recognize panic for what it is, the symptoms become less scary.
What Is the Root Cause of Panic Attacks?
Panic attacks can be caused by a mix of biological, psychological, and environmental factors. Panic attacks can also be associated with other psychiatric disorders, such as PTSD, OCD, or social anxiety disorder. Understanding these root causes can help you feel less confused about why panic attacks occur.
Biological Factors
Research suggests that genetics play a role in who develops panic disorder. Having a family history of anxiety disorders increases your risk. Women are two times more likely to have panic disorder than men, suggesting hormonal factors may also contribute.
Brain chemistry and the way your nervous system responds to stress also matter. Some people have a more sensitive fear response system, making them more prone to panic attacks even in non-threatening situations. Panic disorder often begins in the late teens or early adulthood, though panic attacks can occur at any age.
Psychological Triggers
Common triggers for panic attacks include:
Specific anxiety-provoking situations - Crowded places, driving, public speaking, or other scenarios associated with previous panic attacks
Reminders of past trauma - Events, places, or situations that connect to a traumatic event can trigger panic attacks
Anticipatory anxiety - Worrying about having another panic attack, which can actually trigger one
Major life stressors - Death of a loved one, divorce, job loss, or financial concerns
Chronic stress and exhaustion can prime the body's stress response system, increasing the likelihood of panic attacks. When you're already operating at high stress levels, it takes less to trigger your fight-or-flight response. Stressors like the death of a loved one, divorce, and financial concerns can increase susceptibility to panic attacks.
Environmental and Lifestyle Factors
Certain substances can induce panic-like symptoms or trigger panic attacks:
Stimulants - Caffeine, nicotine, and certain medications
Alcohol - Both intoxication and withdrawal can trigger attacks
Substance use - Various drugs can cause or worsen panic attacks
Physical health issues can also contribute. Conditions affecting the heart, thyroid, or respiratory system can produce symptoms similar to panic attacks. A physical exam can help rule out medical conditions that might cause panic-like symptoms, such as low blood pressure or heart problems.
Here's what's important to understand: panic attacks usually happen without warning and aren't always due to another mental health condition. Some people have just one panic attack in their lifetime, while others develop panic disorder with repeated attacks.
How to Calm Down a Panic Attack
When a panic attack occurs, having practical strategies ready can help you manage the symptoms and reduce their intensity. Here are evidence-based techniques that actually work: These strategies are commonly used to treat panic attacks and can help reduce their severity.
Immediate Coping Strategies
Breathing exercises are one of the most effective tools during a panic attack. When you're panicking, you tend to breathe rapidly and shallowly, which worsens symptoms like dizziness and chest tightness.
Try breathing slowly with this technique:
Breathe in slowly through your nose for 4 counts
Hold for 4 counts
Breathe out slowly through your mouth for 4 counts
Pause for 4 counts
Repeat until you feel your breathing slow
Grounding techniques help reduce feelings of detachment and bring your focus back to the present moment. The 5-4-3-2-1 method works well:
5 things you can see - Look around and name them
4 things you can touch - Feel the texture of your clothes, the chair beneath you
3 things you can hear - Notice sounds around you
2 things you can smell - Identify any scents present
1 thing you can taste - Notice any taste in your mouth
Remind yourself the panic attack will pass. These symptoms are not dangerous and will resolve on their own. Repeat reassuring phrases like "This is temporary," "I've gotten through this before," or "I'm not in actual danger."
We approach panic with this framework: the more you fight it, the stronger it becomes. In our work with clients experiencing panic attacks, we've seen that people who try to force the panic away or immediately flee the situation often develop more fear. Instead, we teach a counterintuitive approach—staying with the discomfort while using grounding and breathing techniques. When you can ride out a panic attack without running or fighting, you prove to yourself that you can handle it. That's when real change begins.
Relaxation Techniques
Relaxation techniques can help reduce the intensity of panic symptoms. Practice these when you're calm so they're easier to use during a panic attack:
Progressive muscle relaxation - Systematically tense and release muscle groups
Mindfulness exercises - Focus on your breath or body sensations without judgment
Visualization - Imagine a peaceful, safe place in detail
What NOT to Do During a Panic Attack
Avoid these common mistakes:
Don't fight the panic attack - Resisting or trying to force it away often makes symptoms worse
Don't leave situations immediately - If possible, stay where you are; running away reinforces fear
Don't catastrophize - Avoid thoughts like "What if this never stops?" or "Something terrible is happening"
Don't consume more stimulants - Avoid caffeine or other substances that could worsen symptoms
Preventing Panic Attacks
Preventing panic attacks? It's about way more than just scrambling to react when you're already spiraling—you're building a foundation of resilience and self-awareness that helps you manage anxiety before it takes the wheel. Sure, panic attacks usually blindside you without warning, but here's the thing: there are practical steps you can take to dial down their frequency and intensity, giving your overall mental health the support it deserves.
One of your first moves in prevention is learning to spot the early warning signs of a panic attack. Notice things like your heart suddenly racing, struggling to catch your breath, or that wave of intense fear washing over you—catching these signals early lets you jump in with calming strategies before things get out of hand. By tuning into what your body's trying to tell you, you can use techniques like slow breathing and grounding exercises to keep panic symptoms from spiraling into that full-blown, overwhelming storm.
Cognitive behavioral therapy (CBT) remains one of your most powerful tools for preventing panic attacks and getting a handle on anxiety disorders. Through talk therapy, you'll learn to identify and challenge those unhelpful thought patterns that love to run the show, develop healthier ways to cope, and gradually face situations that trigger anxiety—think of it as training your brain to stay steady when things get rocky. For some folks, medication like selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) might be recommended to treat depression or persistent anxiety symptoms as part of a comprehensive treatment plan that's tailored just for you.
Lifestyle changes? They're game-changers when it comes to preventing panic attacks. Regular physical activity helps you manage stress and keep your mood on an even keel, while eating well and getting enough sleep give your body the fuel it needs to cope with anxiety. Weaving relaxation techniques into your daily routine—think deep breathing exercises, progressive muscle relaxation, and mindfulness meditation—can help bring down your overall anxiety levels and make it way easier to handle panic symptoms when they try to crash the party.
Support groups offer something invaluable: that sense of connection and understanding you get from sharing experiences with others who've walked similar paths. If anxiety or panic disorders run in your family, being aware of your genetic predisposition can help you take proactive steps to protect your mental health—knowledge is power, after all. Working with a mental health professional is key to developing a personalized treatment plan that addresses your unique needs and helps prevent those frequent panic attacks from calling the shots.
It's also worth identifying and avoiding triggers that can set off panic attacks—certain situations, substances, or high-stress environments that act like kindling for anxiety. Managing stress effectively through regular exercise, relaxation techniques, and healthy boundaries can make a significant difference in reducing anxiety and panic. Sometimes, physical symptoms of panic might actually be linked to underlying medical conditions like low blood pressure, so getting a thorough physical examination can help rule out other causes—because you want to cover all your bases.
Here's what you need to remember: panic attacks aren't life-threatening, but they can signal an underlying anxiety disorder that deserves attention. By taking a proactive approach—combining therapy, lifestyle changes, and support—you can prevent panic attacks, reduce their impact, and boost your overall well-being. With the right treatment and self-care strategies, it's absolutely possible to regain control and slash your risk of developing panic disorder. If you're struggling with anxiety and panic, reaching out to a mental health professional is a powerful first step toward lasting relief—and toward getting your life back.
What's the Difference Between an Anxiety Attack and a Panic Attack?
While the terms are often used interchangeably, anxiety attacks and panic attacks have key differences in how they develop, their intensity, and their duration.
Panic Attacks
Panic attacks are the main feature of panic disorder, though they can occur in other anxiety disorders too. They have specific characteristics:
Sudden onset - Come on rapidly, often without warning
Peak intensity - Reach maximum intensity within minutes
Intense physical symptoms - Dramatic bodily sensations like racing heartbeat, chest pain, and difficulty breathing
Shorter duration - Typically last a few minutes to half an hour
Can occur during sleep - May wake you suddenly with physical symptoms
According to the Diagnostic and Statistical Manual of Mental Disorders, unexpected panic attacks are a hallmark of panic disorder. These attacks seem to come "out of the blue" without an obvious trigger.
Anxiety Attacks
Anxiety attacks (which aren't an official clinical term but describe a common experience):
Gradual buildup - Develop more slowly in response to stress or worry
Less intense - Generally less severe than panic attacks
More cognitive - Focus more on worry and racing thoughts than physical symptoms
Longer duration - Can last from minutes to hours or even days
Context-related - Usually connected to a specific stressor or situation
The frequency of panic attacks varies between individuals. Some people with panic disorder experience panic attacks several times a day, while others may have just a few times a year. Not everyone who experiences a panic attack develops panic disorder—approximately 2% to 3% of people in the U.S. have panic disorder, while many more have isolated panic attacks.
Why the Distinction Matters
Understanding whether you're experiencing panic attacks or general anxiety matters for treatment. Panic disorder has specific treatment approaches, particularly cognitive behavioral therapy focused on panic and exposure therapy designed to reduce fear of panic symptoms.
When Panic Attacks Become Panic Disorder
Having one panic attack doesn't mean you have panic disorder. However, when panic attacks occur repeatedly and you develop persistent worry about having more panic attacks, you may have panic disorder.
People with panic disorder often experience:
Frequent panic attacks - Repeated attacks over time
Anticipatory anxiety - Constant worry about when the next panic attack will happen
Behavioral changes - Avoiding places, situations, or activities where panic attacks occurred
Agoraphobia - Intense fear of certain places or situations where escape might be difficult or help unavailable
Panic disorder frequently presents with agoraphobia, making it difficult for people with panic disorder to leave their homes or engage in normal activities.
Panic disorder can severely impact a person's quality of life if untreated. People may avoid work, social situations, or travel, significantly limiting their daily functioning. Panic disorder is part of anxiety disorders, treatable mental health conditions that respond well to professional help.
In our years working with people who have panic disorder, we consistently see a pattern: the avoidance starts small. Maybe you skip one social event where you had a panic attack. Then you avoid that location entirely. Before long, your world gets smaller and smaller as you try to prevent panic attacks by controlling your environment. What we want people in the Baltimore area to know is that avoidance might feel protective in the moment, but it actually strengthens panic disorder. Treatment works by gradually expanding your world again.
Treatment Options for Panic Attacks and Panic Disorder
The good news is that treating panic attacks and panic disorder is highly effective. Most people can manage panic attacks and feel better with appropriate treatment.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is the most effective talk therapy for panic attacks and panic disorder. CBT teaches you about panic, helps you change unhelpful thoughts, and guides you to face feared situations in a safe way.
Exposure therapy, a specific type of CBT, is particularly helpful for panic disorder. You gradually expose yourself to the physical sensations of panic attacks in a controlled environment, learning that these sensations aren't dangerous. This helps reduce your fear of panic symptoms themselves.
Cognitive behavioral therapy helps people replace negative thoughts with positive ones about panic attacks. Instead of catastrophizing ("I'm having a heart attack"), you learn to think more realistically ("This is uncomfortable but temporary and not dangerous").
Medication Options
Medication options for panic disorder typically include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). These medications can help reduce the frequency and intensity of panic attacks. They're also used to treat depression and other anxiety disorders. The American Psychiatric Association recognizes these as first-line medication treatments.
Benzodiazepines may help with very severe symptoms, but are not recommended for long-term use because of side effects and risk of dependence. They work quickly to reduce panic symptoms but aren't a solution for ongoing panic disorder.
A mental health professional can work with you to develop a treatment plan that might include therapy, medication, or both, depending on the severity of your symptoms and your personal preferences.
Lifestyle and Self-Care Strategies
Practicing a healthy lifestyle can support the management of panic disorder:
Regular physical activity - Exercise can help reduce overall anxiety levels and manage stress
Balanced diet - Maintaining stable blood sugar and following a healthy diet supports mental health
Sufficient sleep - Poor sleep can increase vulnerability to panic attacks
Stress management - Finding healthy ways to manage stress reduces overall anxiety and can help prevent panic attacks
Substance avoidance - Limiting or eliminating caffeine, alcohol, and other substances that can trigger panic-like symptoms
Learning about panic attacks through psychoeducation can help you feel less afraid and more in control. Understanding how your body reacts during panic attacks reduces the fear of the symptoms themselves.
Finding Support in Baltimore
If you have frequent panic attacks or worry about them constantly, talking to a mental health professional is important. Support from friends, family, or support groups can help you feel less isolated when dealing with panic attacks. Seeking medical help early can prevent panic attacks from developing into panic disorder.
Panic attacks are treatable, and you don't have to manage them alone. Most people with panic disorder experience significant improvement with appropriate treatment. Whether you're dealing with your first panic attack or have struggled with panic disorder for years, effective help is available.
For urgent emotional support, you can call or text 988 for crisis support. The 988 Suicide & Crisis Lifeline provides immediate support and connects you to local resources.
If you're looking for professional help with panic attacks in the Baltimore area, the therapists at Baltimore Therapy Group are here to help. Schedule an appointment to get started.
Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding a medical or mental health condition. If you are in crisis or experiencing thoughts of self-harm, please call 988 (Suicide and Crisis Lifeline) or go to your nearest emergency room.
Frequently Asked Questions About Panic Attacks and Panic Disorder
What are the common panic attack symptoms?
Panic attack symptoms include a sudden onset of intense fear accompanied by physical sensations such as a racing heartbeat, chest pain, difficulty breathing, sweating, shaking, dizziness, nausea, and a sense of impending doom. Psychological symptoms may include feeling detached from reality, fear of losing control, or fear of dying. These symptoms occur rapidly and usually peak within minutes.
How is panic disorder diagnosed?
Panic disorder is diagnosed when a person experiences frequent panic attacks that are unexpected and recurrent. Additionally, the individual must have ongoing worry about having more panic attacks or change their behavior to avoid future attacks for at least one month. A healthcare provider will conduct a thorough physical exam and assess symptoms to rule out other mental health conditions or medical causes.
What treatment options are available for panic disorder?
Panic disorder is treated using a combination of talk therapy, particularly cognitive behavioral therapy (CBT), and medication. Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed to reduce symptoms and prevent frequent attacks. Benzodiazepines may be used for short-term relief but are not recommended for long-term use due to dependence risks.
Can lifestyle changes help reduce symptoms of panic attacks?
Yes, practicing a healthy lifestyle can support managing panic disorder. Regular physical activity, a balanced diet, sufficient sleep, and stress management techniques can help reduce overall anxiety and decrease the frequency of panic attacks. Avoiding stimulants like caffeine and substances that can trigger panic-like symptoms is also important.
When should I seek medical practice or professional help for panic attacks?
If you are experiencing symptoms of panic attacks frequently or notice changes in your behavior due to fear of having more attacks, it is important to seek help from a mental health professional. Early intervention can prevent panic attacks from developing into panic disorder and improve your quality of life. Support from healthcare providers, therapists, and support groups can be invaluable during this process.