What to do during a panic attack (and why it feels like you’re dying)
Your heart is going too fast. Your chest is tight, your hands have gone strange and tingly, the room has taken on a slightly unreal quality, and somewhere underneath all of it is a single, absolutely certain thought: something is very wrong with me and I need help right now.
If you have ever wondered what to do during a panic attach, you have probably already discovered that the usual advice; breathe deeply, stay calm, it’s just anxiety, is close to useless in the moment. That’s not because you’re doing it wrong. It’s because a panic attack isn’t really a thinking problem. It’s a full physiological event with its own timeline, and understanding what’s actually happening in your body changes what helps.
What is a panic attack?
A panic attack is an abrupt surge of intense fear or discomfort that peaks within minutes, usually accompanied by a cluster of physical symptoms: pounding heart, sweating, trembling, breathlessness, chest pain, nausea, dizziness, numbness or tingling, hot flushes or chills, and a distinct sense of unreality or detachment from yourself and your surroundings.
Two features make it particularly frightening. The first is how fast it arrives, often with no obvious trigger at all. The second is the moment of the fear itself, which is rarely about anything external. Most people in the middle of a panic attack aren’t afraid of a situation. They’re afraid of their own body, and specifically that they are having a heart attack, losing control, or about to die.
Estimates suggest around a third of people will experience at least one panic attach at some point in their lives. A much smaller proportion go on to develop panic disorder, which is defined not by the attacks themselves but by the persistent fear of having another one.
Why a panic attack feels like a heart attack
The overlap isn’t in your imagination. A surge of adrenaline produces almost exactly the same symptoms people associate with a cardiac event; racing heart, chest tightness, breathlessness, sweating, a sense of impending doom. Emergency departments see this constantly. Nobody who ends up there is being dramatic.
Here’s what’s driving it. When the amygdala registers threat, real or misread, it triggers a sympathetic nervous system response before you’ve had any conscious thought about it. Adrenaline floods the system. Your heart rate climbs to move blood faster. Blood is redirected away from your extremities and digestive system towards the large muscles, which is why your hands go cold, tingly, or numb and why your stomach turns over. Pupils dilate, which contributes to that odd, too-bright, slightly unreal quality the world takes on.
Every single one of these responses is your body preparing you to survive something. The problem is purely one of accuracy. The machinery is working perfectly; it has simply been switched on in a Sainsbury’s queue rather than in front of an actual threat.
The breathing paradox
Why “take a deep breath” makes it worse
This is the part almost nobody is told, and it matters enormously.
During panic, breathing speeds up. That feels like the right response, because the overwhelming sensation is one of not getting enough air. But over-breathing doesn’t raise your oxygen levels in any useful way. What it does is blow off carbon dioxide faster than your body produces it, which shifts your blood chemistry towards respiratory alkalosis.
The symptoms of that shift are: dizziness, lightheadedness, tingling in the hands, feet, and around the mouth, chest tightness, and a strong sensation of breathlessness.
Read that list again. Hyperventilation produces the exact same symptoms that convince you something catastrophic is happening, which increases fear, which increases the breathing rate. It’s a closed loop, and it’s the engine of most panic attacks.
Which is why being told to take a big deep breath so often backfires. Deeper inhales makes the imbalance worse. What actually helps is the oppostie: slowing down and lengthening the exhale. A longer out-breath than in-breath engages the parasympathetic branch of the nervous system through the vagus nerve, and it lets carbon dioxide levels recover. Breathing out for longer than you breathe in, without trying to gold air, does more in ninety seconds than any amount of reassurance.
The catastrophic misinterpretation loop
Psyhcologist David Clark’s 1986 cognitive model of panic remains the most useful explanation of why some people spiral and others don’t, and it underpins the CBT approaches that have the strongest evidence base for panic disorder.
His argument is that panic attacks begin with an ordinary bodily sensation. A skipped heartbeat after coffee. Breathlessness after stairs. Lightheadedness from standing up too quickly. Most people register these and move on. But if that sensation is interpreted as a sign of imminent catastrophe, my heart is failing, I’m about to collapse, the interpretation itself triggers an anxiety response, which produces more sensations, which appear to confirm the original fear.
The attack, in other words, is generated by the alarm about the sensation rather than by the sensation itself. This is genuinely good news, because interpretation is something that can change, and it explains why panic attacks so often arrive without any external trigger. There doesn’t need to be one.
What actually helps during a panic attack
Lengthen the exhale. Not deeper breathes. Longer ut-breaths. Breathe in through your nose for a count of four, out through your mouth for six or seven. Keep going even when it feels like it isn’t working.
Let it happen rather than fighting it. This is counterintuitive, I know. And it’s also the single most effective thing you can. do. Resistance adds a second layer of fear on top of the first. Panic attacks are self-limiting by design; adrenaline is metabolised within minutes, and the body is physically incapable of sustaining the surge. It will peak and it will come down whether or not you intervene. Telling yourself this will pass on its own, it always does is not just positive thinking. It’s an accurate description of the physiology.
Orient to the room. Look around deliberately and name what you can actually see and hear. This gives your nervous system present-tense information rather than leaving it to run on the internal alarm alone.
Try not to escape, if you safely can. This is the hardest one. Leaving the shop, getting off the train, going home, all bring immediate relief, and that relief is precisely the problem. (Hear me out). Your brain records that escaping is what saved you, which makes the same situation more threatening next time. Over months and years, this is how panic quietly shrinks your life. Staying put, even badly, even while shaking, teaches your brain something different.
Say what’s happening out loud, or in your head. “This is a panic attack. My body has released adrenaline. It is unpleasant and it’s not sangerous.” Naming the state gives the thinking part of your brain a foothold in a process that started somewhere else entirely.
Why the fear of the next one is the real problem
Psychologist David Barrow’s work on anxiety disorders describes what he calls anxious apprehension, and it’s the reason panic tends to entrench. After a bad attack, attention turns inward. You start monitoring your own heart rate. You notice every flutter, every wave of lightheadedness, every slightly odd breath.
That vigilance guarantees you’ll find things, because bodies are noisy. And each thing you find gets read through the lens of the last attack. The fear stops being about panic and becomes fear of the hear itself, which then starts making decisions for you: which trains you’ll take, which social events you’ll accept, how far from home feels manageable.
This is the point at which panic usually starts overlapping with the broader background anxiety many people carry, and with that sense of dread with no clear source that tends to sit in the background between attacks rather than during them.
When to see a GP
If this is your first panic attack, or you’re experiencing chest pain, do get medially checked. Not as reassurance-seeking, but because it’s sensible; several physical conditions, including thyroid and cardiac issues, can produce similar symptoms, and it’s worth ruling them out properly once. Doing that once is helpful. Doing it repeatedly tends to become part of the cycle rather than a way out of it.
Panic attacks also frequently arrive at night, which brings its own particular quality of alarm. If that’s your pattern, the relationship between anxiety and sleep is worth understanding alongside this, as is the way stillness itself can feel unsafe for a nervous system running hot.
Panic attacks respond well to treatment
Of all the things that bring people to therapy, panic is among the most treatable. The evidence for CBT-based approaches to panic disorder is strong and consistent, and the work is more practical than most people expect: understanding the physiology, learning to breathe in a way that doesn’t feed the loop, and gradually, at a pace that you set, testing out the situations that fear has been quietly ruling out.
What therapy also offers is space to look at what’s underneath. Panic attacks rarely appear out of nowhere. They tend to show up during periods of prolonged stress, after loss, in the aftermath of something difficult, or at points where something significant has gone unspoken for a long time. The attack is often the first thing loud enough to get your attention.
If panic attacks have become a regular feature of your life, or if you have started rearranging things around the possibility of one, that’s worth taking seriously, and it isn’t something you have to work out alone. Many people find that a few months of focused work makes a substantial difference. You can browse therapists in south west London, or find out more about how we work.
