The first time someone has a panic attack, they often think they're having a heart attack. This is understandable. Racing heart, tight chest, tingling hands, a sense that something is very wrong. Many people end up in an emergency department, get told their ECG is fine, and leave feeling more confused than when they arrived.
Understanding what a panic attack actually is can take a lot of the power out of it. Not because the sensations stop, but because they stop meaning what you thought they meant.
What's actually happening in your body
A panic attack is your fight-or-flight system firing at full volume in a situation where there's no immediate physical threat. Everything it does is designed to help you survive a threat: your heart rate goes up to pump blood to your muscles, your breathing shifts to get more oxygen, your pupils dilate, your gut slows down (because digestion isn't the priority right now).
None of this is dangerous. It's an exquisitely designed emergency system doing its job. The issue isn't the system — it's that the alarm is firing when the house isn't on fire.
Why "just breathe" doesn't work
Well-meaning advice to "just breathe" often makes it worse, because in a panic attack you're often already over-breathing. Rapid, shallow breathing changes the CO₂ balance in your blood, which produces the tingling, the dizziness, the sense of unreality. More big breaths make that worse, not better.
What actually helps in the moment
1. Slow the exhale
The exhale is the calming part of your breath. Breathe in for 4, out for 6 or 7. Focus on the out-breath being longer than the in. Do this for a minute. You are not trying to stop the panic — you're telling your nervous system the emergency isn't real.
2. Name what's happening
Out loud, in your head, however works. "This is a panic attack. My body is doing what it does. Nothing is wrong. It will peak and pass." The naming matters. It reactivates the thinking part of your brain, which the panic has temporarily side-lined.
3. Ground through your senses
Five things you can see. Four you can hear. Three you can touch. Not to distract — to bring your attention back into the present moment, out of the future-catastrophe your brain is running.
4. Don't fight it
Fighting the panic is what makes it a disorder. The panic itself won't hurt you. What escalates it is the second wave — the fear of the fear. The panic that comes because you're panicking about panicking. If you can let the first wave be there without fighting it, it will peak and pass in a few minutes. Every time.
The longer game
Managing a panic attack in the moment is one thing. Reducing how often they happen — and how much of your life is being organised around avoiding them — is another. That's where therapy is genuinely useful. Cognitive Behavioural Therapy has some of the strongest evidence in the entire field for panic; most people see substantial change within 8 to 12 sessions.
If panic is a regular feature of your week, please reach out. This is one of the most treatable things I work with.