Key Takeaways
- Panic attacks are intense but time-limited, usually peaking within about 10 minutes and then gradually easing on their own
- Immediate tools work quickly: controlled breathing, grounding techniques like the 5-4-3-2-1 method, progressive muscle relaxation, and focusing on a nearby object can all help calm your body and mind
- Long-term coping strategies—including therapy, medication management, and lifestyle changes—can significantly reduce how often panic attacks happen
- Naming the experience matters: simply telling yourself “this is a panic attack” can reduce fear and help you respond more effectively
What Is a Panic Attack? (And Why It Feels So Overwhelming)
A panic attack is a sudden surge of intense fear or discomfort that reaches a peak within minutes. It often feels like it comes “out of the blue,” even when you’re doing something completely ordinary like grocery shopping, sitting in a meeting, or riding the T.
Common Physical Symptoms
During a panic attack, your body experiences a cascade of physical sensations that can include:
- Racing heartbeat or heart pounding
- Shortness of breath or feeling like you can’t get enough air
- Chest pain or tightness
- Dizziness or lightheadedness
- Trembling or shaking
- Nausea or stomach discomfort
- Hot or cold flashes
- Sweating
- Numbness or tingling in hands, feet, or face
Common Mental and Emotional Symptoms
The mental experience of a panic attack can be just as distressing:
- Overwhelming fear of dying or having a heart attack
- Fear of “going crazy” or losing control
- Feeling detached from yourself or your surroundings (sometimes called derealization or depersonalization)
- A sense that something terrible is about to happen
Why Your Body Reacts This Way
These symptoms are driven by the fight or flight response—your body’s built-in alarm system designed to protect you from danger. The problem is that during a panic attack, this alarm misfires when there’s no actual threat.
Your nervous system floods your body with adrenaline, preparing you to fight or run. Your heart rate increases. Your breathing speeds up. Your muscles tense. These physical changes are uncomfortable and frightening, but they are not dangerous for most medically healthy people.
Having a first panic attack is surprisingly common. However, if you experience frequent, unexpected attacks plus ongoing fear of future panic attacks, you may be dealing with panic disorder or another anxiety condition.
Important: If you’re unsure whether your symptoms are a panic attack or a medical emergency—especially if you have new chest pain, difficulty breathing, or symptoms that feel different from past episodes—seek urgent or emergency medical care to be safe.
First Steps During a Panic Attack: Tell Yourself What’s Actually Happening
How you talk to yourself during a panic attack can make a real difference in how intense and how long the symptoms last. Your internal dialogue can either fuel the panic or help you find your way through it.
Reassuring Statements to Repeat
When panic hits, try silently repeating one or more of these statements:
- “This is a panic attack, not a heart attack.”
- “These feelings are uncomfortable but not dangerous.”
- “My body is having a stress response, and it will wind down.”
- “I’ve gotten through this before, and I can get through it again.”
Name What’s Happening
One of the simplest and most effective techniques is to label the experience out loud or in your head: “I am having a panic attack.”
This might sound too simple to help, but naming the experience reduces the confusion and fear that comes from not understanding what’s happening to your body. When you know what it is, you can remind yourself that it will pass.
Remember the Timeline
Panic attacks typically peak within about 10 minutes. After that, symptoms gradually ease. Reminding yourself of this timeline can help you feel less trapped.
Accept Rather Than Fight
Instead of desperately trying to make the panic stop, aim for an attitude of acceptance:
- “I can ride this wave.”
- “I don’t need to stop it instantly; I just need to stay with it safely.”
- “These sensations are temporary.”
Fighting the feelings often creates more anxiety and makes the attack feel worse. Allowing the sensations to be there—without adding fear on top of them—can actually shorten the experience.
These mental coping skills are core components of Cognitive Behavioral Therapy (CBT), which is available at facilities like Back Bay Mental Health in Boston.
Breathing Techniques to Calm the Body Quickly
Panic often triggers overbreathing (hyperventilation), which can cause dizziness, tingling in your hands and face, and a sensation of not getting enough air. These symptoms then fuel more panic. Controlled breathing reverses this cycle and signals safety to your nervous system.
Paced Breathing Exercise
This is one of the simplest and most effective breathing exercises for panic:
- Inhale slowly through your nose for a count of 4
- Exhale slowly through pursed lips for a count of 6
- Repeat for 2-5 minutes
The longer exhale activates your parasympathetic nervous system—the “rest and digest” system—helping to counter the fight or flight response.
Box Breathing
Box breathing (sometimes called 4-4-4-4 breathing) is especially useful when panic spikes in public places, like on the MBTA or in a work meeting:
Step | Duration |
Inhale | 4 counts |
Hold | 4 counts |
Exhale | 4 counts |
Hold | 4 counts |
Repeat for 4-6 cycles or until you feel your body begin to calm.
Check Your Breathing Position
Place one hand on your belly and one on your chest. Focus on making the belly hand rise more than the chest. This indicates you’re using your diaphragm for deeper, calmer breaths rather than shallow chest breathing.
Practice When You’re Calm
The most important thing about breathing exercises is to practice them daily—not just during a panic attack. Spend 5 minutes in the morning and evening practicing slow, controlled breathing. This builds muscle memory so the technique feels familiar and automatic when you need it most.
In therapy, clinicians often help people track which breathing style works best for them and adjust techniques for conditions like asthma or chronic lung issues.
Grounding Skills: Bringing Your Mind Back to the Present
Grounding means anchoring your attention in the present moment using your senses. When panic hits, your mind often spirals into “what if” thoughts about the future. Grounding pulls you back to right now, where you can observe that you’re actually safe.
The 5-4-3-2-1 Sensory Method
This classic grounding technique engages all five senses:
- 5 things you can see (the brick building across the street, your coffee cup, the blue sky)
- 4 things you can feel (your feet on the ground, the texture of your jeans, the cool air on your face)
- 3 things you can hear (traffic sounds, a conversation nearby, birds)
- 2 things you can smell (coffee, fresh bread from a bakery)
- 1 thing you can taste (the mint from your gum, water)
For example, if you’re sitting on a bench on Newbury Street when panic starts, you might notice: the brownstone storefronts, people walking dogs, the weight of your bag on your lap, the smell of coffee from a nearby café, and the taste of the latte you’re drinking.
Focus-on-One-Object Technique
Pick a nearby object—a coffee cup, a building, a tree—and silently describe everything about it:
- What color is it?
- What shape?
- What texture does it look like it has?
- How big is it?
- Are there any logos, patterns, or details?
This deliberate, detailed focus pulls your attention away from internal sensations and anxious thoughts.
Carry a Grounding Object
Consider keeping a small grounding object in your pocket or bag:
- A smooth stone
- A textured keychain
- A piece of jewelry with interesting details
During panic, hold the object and pay close attention to its temperature, edges, weight, and texture. This simple act can interrupt the panic cycle.
Body Awareness Grounding
Try these physical grounding techniques:
- Press your feet firmly into the floor and notice the pressure
- Feel the chair or seat supporting your body
- Gently push your palms together and focus on the sensation
Cold Sensation Technique
If you have access to something cold—a chilled water bottle, cold water from a tap—use it to interrupt the panic:
- Press a cold bottle against your wrist
- Splash cool water on your face
- Hold ice cubes in your hands briefly
The cold sensation can quickly shift your focus and reduce the intensity of panic symptoms.
Muscle Relaxation and Gentle Movement
Panic often causes your muscles to tense up—especially in the jaw, shoulders, and chest. This tension feeds back into the panic cycle. Your brain interprets the tense muscles as confirmation that something is wrong. Relaxing these muscles sends a “calm” signal back to your brain.
Quick Progressive Muscle Relaxation
Progressive muscle relaxation involves intentionally tensing and then releasing muscle groups:
- Hands: Make a fist and squeeze for 5 seconds, then release for 10-15 seconds. Notice the difference between tension and relaxation.
- Shoulders: Shrug them up toward your ears for 5 seconds, then let them drop.
- Jaw: Clench your teeth gently for 5 seconds, then let your mouth hang slightly open.
Focus first on shoulders, jaw, and hands—these areas tend to tighten most during panic. Repeat the tense-release cycle 2-3 times for each area.
Gentle Movement After the Peak
Once the peak of panic passes, gentle movement can help release built-up adrenaline:
- Slow walking
- Stretching your neck by tilting your head side to side
- Rolling your shoulders forward and backward
- Lightly shaking out your arms and hands
Combine Relaxation with Breathing
Pair muscle relaxation with slow breathing and a calming phrase:
- Inhale as you tense the muscle group
- Exhale as you release, thinking “soften” or “let go”
Practice When Calm
Like breathing techniques, muscle relaxation techniques work best when you’ve practiced them outside of panic situations. Try doing a brief progressive muscle relaxation routine before bed. When a panic attack comes, your body will remember the routine.
Using Thoughts and Mantras to Ride Out the Wave
Panic attacks are fueled by catastrophic thoughts. When your heart races, your mind might jump to “I’m going to die” or “I’m having a heart attack.” These distressing thoughts intensify the physical sensations, creating a vicious cycle.
Practicing new, realistic thoughts can interrupt this cycle and reduce panic intensity.
Specific Mantras to Repeat
Choose one or two mantras that resonate with you and repeat them slowly during an attack:
- “This is scary but not dangerous.”
- “My heart is beating fast, but it’s strong.”
- “I’ve gotten through this before; I can do it again.”
- “This will pass. It always passes.”
- “I am safe right now.”
Notice and Label Catastrophic Thoughts
When you catch yourself thinking “I’m going to faint” or “Everyone is staring at me,” try labeling the thought:
“That’s my anxious brain saying I’m in danger.”
Then gently replace it with a more balanced statement:
“My body feels strange, but I’m not actually in danger. This is anxiety.”
Use Visual Imagery
Guided imagery can be a powerful mental coping skill. Try picturing yourself:
- Sitting safely on a quiet beach on Cape Cod, watching waves come and go—just like the rise and fall of panic
- Standing in a calm forest, breathing in fresh air
- Sitting in a comfortable room with soft lighting
The key is to engage your imagination fully—notice the sounds, smells, and sensations in your mental scene.
Create a Written “Panic Script”
Write a short “panic script” ahead of time—a few sentences reminding yourself what a panic attack is and how long it typically lasts. Keep it in a phone note for quick access:
“This is a panic attack. It feels terrible, but it is not dangerous. It will peak in a few minutes and then fade. I can ride this out. I’ve done it before.”
Reading this script during panic can help ground you in reality when anxious thoughts spiral.
CBT therapists often help clients test and update their beliefs about panic—for example, tracking how often feared outcomes like fainting actually happen (spoiler: almost never).
Planning Ahead: Panic Attack Coping Skills You Can Prepare in Advance
Having a personalized coping plan can make future attacks feel less unpredictable and more manageable. When you know exactly what to do, you spend less energy on confusion and more on actually coping.
Identify Your Early Warning Signs
Most people have early warning signs before panic fully hits:
- Tight chest
- Racing thoughts
- Feeling “off” or disconnected
- Slight dizziness
- Muscle tension
Once you know your warning signs, you can start coping strategies before the panic peaks.
Create a Step-by-Step Sequence
Decide on your personal coping sequence ahead of time:
- Breathing exercise (box breathing or paced breathing)
- Grounding technique (5-4-3-2-1 or focus on an object)
- Muscle relaxation (shoulders, jaw, hands)
- Reach out to a supportive person if needed
Build a Panic Toolkit
Consider assembling a small toolkit you can keep in your bag or at your desk:
Item | Purpose |
Phone playlist of calming music or meditations | Audio distraction and relaxation |
Grounding object (smooth stone, textured keychain) | Tactile grounding |
Written mantra list or panic script | Cognitive coping |
Small bottle of scented lotion or essential oil | Sensory grounding |
Prescribed fast-acting medication (if applicable) | Medical support as directed |
Share Your Plan with Trusted People
Let one or two trusted people—a family member, partner, roommate, or close coworker—know about your panic attacks and your coping plan. Explain:
- What a panic attack looks like for you
- What helps (and what doesn’t)
- How they can support you without making it worse
Environmental Planning
Think ahead about challenging environments:
- Choose an aisle seat near exits on buses, planes, or in theaters
- Know where quieter spaces are at work or school
- Plan a brief “break” route when in crowded places in Boston (like Fenway Park or Quincy Market)—somewhere you can step away briefly if needed
Clinicians at Back Bay Mental Health can help clients write and practice a step-by-step panic plan tailored to their typical potential triggers, locations, and daily responsibilities.
Long-Term Strategies: Reducing How Often Panic Attacks Happen
While in-the-moment techniques are crucial, long-term habits and treatment can significantly lower panic frequency and intensity. The goal isn’t just to survive panic attacks—it’s to prevent panic attacks from controlling your life.
Cognitive Behavioral Therapy (CBT)
CBT is considered the gold standard treatment for panic disorder and anxiety disorders. It teaches you to:
- Identify and change patterns of thinking that maintain panic
- Recognize and challenge catastrophic misinterpretations of physical sensations
- Gradually face feared situations rather than avoid situations that trigger anxiety
A key component of CBT for panic is interoceptive exposure—safely practicing feared body sensations (like a rapid heart rate from running in place) to reduce your fear of those sensations. When you learn that a racing heartbeat isn’t dangerous, you become less likely to panic when it happens naturally.
Medication Options
For some people, medication can be an important part of managing panic attacks:
- SSRIs (selective serotonin reuptake inhibitors) are commonly prescribed for long-term management of panic disorder
- Benzodiazepines may be used short-term in some cases, though they carry risks of dependence
- Beta-blockers can help manage physical symptoms like heart racing in specific situations
Medication is typically most effective when combined with therapy—not used as a standalone treatment. A psychiatrist or psychiatric nurse practitioner can evaluate whether medication is appropriate for your situation.
Lifestyle Supports
Research links several lifestyle factors to fewer panic episodes:
- Regular aerobic exercise: Brisk walking or light jogging for 20-30 minutes, most days of the week
- Consistent sleep schedule: Aim for 7-9 hours of sleep at regular times
- Limiting stimulants: Reduce caffeine, nicotine, and certain decongestants, which can trigger panic symptoms
- Reducing alcohol and recreational drug use: These substances can worsen anxiety and trigger rebound panic in the following hours or days
Addressing Root Causes
Panic attacks don’t happen in a vacuum. They’re often connected to:
- Chronic stress from work, relationships, or finances
- Underlying depression or trauma
- Generalized anxiety that builds over time
- Major life transitions
Ongoing therapy and medication management—like what’s available at Back Bay Mental Health for people in the Boston area—can help you address these root causes rather than just managing symptoms.
When to Seek Professional Help for Panic Attacks
Occasional panic attacks can often be managed with self-help skills. But recurrent or disabling attacks often benefit from professional support. There’s no shame in reaching out—panic disorder is highly treatable, and most people see significant improvement with proper care.
Signs It’s Time to Seek Help
Consider reaching out to a mental health professional if you experience:
- Frequent attacks (several times per month or more)
- Avoidance of places or activities like driving, public transit, work, school, or social events
- Persistent fear of having another attack, even between episodes
- Major disruption to relationships, work performance, or daily life
- Depression or hopelessness alongside panic symptoms
- Feeling like your emotional well being is negatively impacted most days
Start with Your Primary Care Provider
If your symptoms are new, consider seeing your primary care provider or a healthcare professional first. They can rule out medical causes like thyroid problems, heart rhythm issues, or medication side effects that can mimic panic symptoms.
Find the Right Mental Health Support
For ongoing panic, consider:
- A licensed therapist (psychologist, social worker, or mental health counselor) experienced in anxiety and panic
- A psychiatrist or psychiatric nurse practitioner for medication evaluation if therapy alone isn’t enough
- Mental health services that offer coordinated care between therapy and medication management
Back Bay Mental Health in Boston
If you’re in the Boston area, Back Bay Mental Health offers therapy and medication management for anxiety and panic, with flexible scheduling and a focus on evidence-based care like CBT. Their clinicians understand how panic attacks can limit your life and can help you build skills to regain control.
When It’s an Emergency
If you experience chest pain, difficulty breathing, or symptoms that feel different from your usual panic attacks, seek urgent or emergency medical care. It’s always better to be safe—especially with new or unusual symptoms.
How Back Bay Mental Health Can Support You
Back Bay Mental Health is a Boston-based mental health facility that understands how disruptive panic attacks can be to your work, school, and relationships. Panic doesn’t have to limit where you go or what you do.
Services for Panic and Anxiety
Back Bay Mental Health offers:
- Individual CBT-focused therapy specifically designed for panic disorder and anxiety disorders
- Exposure-based treatments for panic disorder and agoraphobia
- Psychiatric evaluation and medication management when medication is appropriate
- Support for building a personalized coping plan tailored to your life
Personalized Coping Plans
Clinicians can help you:
- Build and practice your own panic coping toolkit
- Learn and refine breathing exercises and grounding techniques in session
- Gradually face feared situations with professional support (rather than avoiding them)
- Address underlying stress, trauma, or depression that may contribute to panic
Collaborative Care
Therapists and prescribers at Back Bay Mental Health work together on medication management—adjusting SSRIs, beta-blockers, or other medications as needed while tracking your progress over time. This collaborative approach means your treatment team communicates about what’s working and what needs adjustment.
Related Concerns
Back Bay Mental Health also provides care for concerns often linked to panic attacks, including:
- Generalized anxiety
- Depression
- Trauma-related conditions
- Stress from work, school, or major life transitions
If panic attacks are making your daily life feel smaller or more limited, reaching out for an appointment or consultation is a practical first step. You don’t have to figure this out alone.
Frequently Asked Questions About Panic Attack Coping Skills
How long do panic attacks usually last?
Most panic attacks peak within about 5-10 minutes. After the peak, symptoms gradually decrease, though some residual effects—like feeling tired or emotionally drained—can last 30-60 minutes or longer. Using coping skills during the early stages of a panic attack can help shorten or soften this curve. The key thing to remember is that a panic attack is time-limited; it will end on its own even if you do nothing.
Can panic attacks cause long-term damage to my heart or brain?
For most people without underlying medical issues, panic attacks are not physically damaging—even though they feel terrifying in the moment. Your heart is designed to handle the increased heart rate that comes with stress. However, if you have concerns about your physical health or have risk factors for heart disease, it’s worth getting evaluated by a medical provider to rule out other causes and feel safe in managing panic as an anxiety issue.
What should I do if a panic attack happens while I’m driving or on public transportation?
If you’re driving: Safely pull over to the side of the road or into a parking lot as soon as possible. Put the car in park, take a deep breath, and use your grounding and breathing techniques. Don’t try to continue driving until you feel calmer. Opening a window for fresh air can help.
On a train or bus: Focus on your feet pressing into the floor, your hands on your lap, and a neutral object you can see. Use your breathing exercises. If the panic feels overwhelming, get off at the next safe stop and find a quiet place to practice your coping skills before continuing.
Can I completely get rid of panic attacks?
Many people significantly reduce or even stop having panic attacks with CBT, lifestyle changes, and sometimes medication. However, the most realistic and helpful goal is usually to feel confident managing any future episodes rather than needing them to disappear entirely. When you know you can handle a panic attack, the fear of future attacks decreases—which often means they happen less frequently.
Is it better to face my panic triggers or avoid them?
Short-term avoidance can bring immediate relief, but it usually makes panic worse over time. Your brain learns that the avoided situation must be dangerous, which strengthens the fear. Gradual, planned exposure with support—such as what’s practiced in CBT at Back Bay Mental Health—helps your brain relearn that feared situations and physical sensations are manageable and safe. This is one of the most effective long-term coping strategies for preventing future attacks and reclaiming your life.
