Understanding what is happening during a panic attack

A panic attack is a sudden surge of intense fear or discomfort that usually peaks within about ten minutes. The body releases a wave of adrenaline, and the nervous system switches into a false alarm. Heart rate climbs, breathing becomes fast and shallow, the chest tightens, hands and lips may tingle, and vision can narrow. Many people are convinced they are having a heart attack, suffocating, or losing control. It feels genuinely terrifying, but it is not dangerous, and it will pass.

Knowing that helps you more than you might realise. If you can hold on to the fact that this is a surge of adrenaline with a natural end point, you will stay steadier. Your calm is contagious — and it is the most useful thing you can offer.

Be a steady, quiet presence

Stay close, but do not crowd or tower over them. Lower your voice, slow your movements and use short, plain sentences. Ask before touching them: a hand on the arm can comfort one person and feel trapping to another.

• Helpful things to say: "I'm here with you." "You're safe right now." "This will pass — it always does." "Take your time, there's no rush."
• Things to avoid: "Calm down." "There's nothing to worry about." "You're overreacting." Anything that sounds like a diagnosis or a lecture.

Try not to reason them out of it. During a panic attack the thinking part of the brain is temporarily offline, so logic lands badly. Reassurance repeated gently and simply works far better than explanation. If they ask questions, answer briefly and then return to steady reassurance.

Support their breathing without making it harder

Resist the urge to say "take a deep breath and hold it". Holding the breath can increase feelings of suffocation. Instead, breathe slowly and audibly beside them so they have a rhythm to follow. A good pattern is in through the nose for four, out through the mouth for six — a slightly longer exhale tells the body it is safe to settle.

Grounding is often more effective than breathing alone. Talk them through the 5-4-3-2-1 technique: five things they can see, four they can touch, three they can hear, two they can smell, one they can taste. Physical anchors also help — feet flat on the floor, palms pressed together, or holding something cold such as a glass of water or a set of keys.

Practical steps that help in the moment

• Move somewhere quieter or cooler if you can — outdoors, near an open window, or into a hallway away from a crowd.
• Give them room. Do not block the exit or stand directly in front of them.
• Offer water and suggest small sips rather than a large glass.
• Stay until it passes, even if they insist they are fine. The peak usually eases within ten minutes, but the shakiness can linger much longer.
• If they carry a written plan or prescribed medication, help them follow it as they have been instructed.
• Avoid caffeine, alcohol and anything that raises the heart rate further.

Afterwards: recovery and follow-up

Panic attacks are exhausting. Once the worst has passed, people often feel shaky, tearful, and embarrassed. Keep things low-key. Offer a lift home, a cup of tea, a quiet room and the chance to sit down. Do not interrogate them about what happened or ask them to explain themselves while they are still recovering.

A short message the next day — "just checking you're alright" — matters more than most people expect. If attacks are happening regularly, or they are starting to avoid places and situations because of them, encourage a GP appointment. Talking therapies such as cognitive behavioural therapy are effective, and self-referral is often available. A simple note of what happened, what seemed to trigger it and what helped can be genuinely useful for that conversation.

When to seek urgent medical help

Panic symptoms overlap with real emergencies, so trust your instincts. Call 999 if someone has crushing or radiating chest pain, severe difficulty breathing that does not ease as they settle, fainting or loss of consciousness, blue lips or fingertips, or signs of a stroke such as facial drooping, slurred speech or weakness on one side. The same applies if they are pregnant, or have a known heart or lung condition.

If you are unsure, call 111 for advice. And if someone expresses thoughts of harming themselves, do not leave them alone — call 999 or take them to A&E. Panic attacks are frightening, but with calm company, steady breathing and the right support afterwards, most people come through them and recover well.