5 Proven Techniques to Deal With Panic Attacks

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Years ago, I had a panic attack in my clinical office—the very office where I treated people who were dealing with panic. It came on unexpectedly, as panic often does.

I had just gotten to work one morning when suddenly I had the odd feeling that something was “off” in an undefinable way. It felt like I was in a strange dream that was about to turn into a nightmare. (Later, I realized I was experiencing derealization, a common panic symptom.)

I quickly left my office so someone could find me if I lost consciousness and called my brother. My symptoms subsided after a few minutes, and I went back inside. As I sat sipping a cup of water and thinking through what had just happened, it slowly dawned on me that I had had a panic attack. I had to shake my head at the irony of it.

Panic is a runaway fear reaction that hijacks the body and mind. It’s driven by our fight, flight, or freeze response, which is powered by the sympathetic branch of the autonomic nervous system. If you’ve had panic attacks, you know how terrifying they can be.

While panic can happen anywhere, like in my office on a random Wednesday morning, certain situations tend to trigger it more often, including:

• Driving on a bridge
• Being in a crowd
• Grocery stores
• Movie theaters
• Restaurants
• Airplanes
• Elevators

What do these situations have in common? In each of them, it would be difficult or awkward to escape in the event of a panic attack. As a result, we often start to avoid these situations, which only reinforces our feeling that they must be dangerous.

Rigorous research studies have shown that mindful cognitive behavioral therapy (CBT) is an effective treatment for panic. The goal of CBT is not to make sure that panic never happens again. That would be unrealistic since panic by nature is unpredictable and hard to control. Moreover, trying to avoid panic actually makes it more likely that we’ll have a panic attack, like trying not to think of a certain word, and then it’s all we can think about. Instead, treatment with CBT helps us do what’s important to us, even when panic is a possibility.

The following five techniques form the core of mindful CBT for panic (adapted from The CBT Flip Chart).

1. Take Calming Breaths

The breath is tied directly to the nervous system, and slow, even breaths are generally calming. Focus especially on slowing down the exhale, which has the biggest effect on the parasympathetic nervous system—the antidote to the sympathetic system.

Inhale for a count of four, and exhale for a count of six (or longer). Keep in mind that the point of breathing is not to make sure you don’t panic; pushing away panic with slow breathing can trigger more anxiety if it feels like it’s “not working.” Use calming breaths as a focal point and to help you stay in the situation, however you might be feeling.

2. Let Go of Resistance

Panic is an overwhelming experience, so it’s easy to understand why we spend a lot of energy trying to push it away. But resistance to panic tends to exacerbate the symptoms while being willing to panic can actually make it less likely. It’s as if by saying “yes” to what we’re feeling, the brain understands that there’s no emergency after all and shuts off the alarm. See what it's like to open yourself to panic-related sensations rather than trying to make them stop. After my office episode, I found it helpful to welcome that weird feeling that preceded the panic attack, which paradoxically would quiet my nervous system.

3. Question Scary Predictions

Panic usually shifts our thoughts toward expecting the worst. If we’re driving on a bridge, for example, we fear that panic will cause us to crash through the guardrail and plunge into the water below, or we believe that the tightness in our chest isn’t panic but a heart attack. When I panicked in my office, I strongly sensed that something very bad was happening—most likely that I was having a stroke.

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Panic-related thoughts tend to exaggerate:

• The likelihood that something bad will happen. For example, our minds might tell us that we will definitely pass out if we have a panic attack while driving when in reality, panic typically does not lead to fainting.
• The severity of how bad the outcome would be. For example, we might think that having a panic attack at work will be humiliating, but in fact, other people often don’t even notice when someone is panicking.

If you’ve dealt with panic for very long, you have probably noticed that these panic-related fears generally don’t come true. They might feel true at the moment, but a part of us can see that our fearful thoughts are not accurate. With practice, we can recognize that our minds' predictions are manifestations of fear and not true reflections of reality.

4. Bring on Physical Sensations

Bodily sensations like a pounding heart or dizziness can become associated with panic; as a result, we may start to avoid activities that bring them on, like exercise or vigorous sexual activity. However, avoiding physical sensations just reinforces the belief that they’re dangerous while further limiting the range of activities we can engage in.

In CBT for panic, we deliberately trigger panic-related physical sensations. Example exercises include hyperventilating (lightheadedness), breathing through a straw (shortness of breath), spinning in a chair (dizziness), and jumping jacks (pounding heart). With repeated practice facing these sensations, we learn that we can tolerate them, and they become less frightening.

5. Gradually Face Feared Situations

Finally, effective treatment involves exposure to the places and situations we’re afraid of because of panic. For some of us, that will mean flying on a plane, going to the movies, or using a drive-through. For others, it might involve shopping at the grocery store, riding on elevators, or leaving the house without our “safety person.” We don’t have to jump into the “deep end” with these experiences. In CBT, we start with mildly challenging activities to build our confidence and work progressively to more difficult ones.

We can use all of the preceding tools as we’re doing exposure: coming back to the breath to focus our energy and help us to move through our fear; dropping resistance as we open to the possibility that we may experience a fear reaction; challenging thoughts about bad things that might happen, and facing the possibility that we’ll have some uncomfortable physical reactions.

We don’t have to let panic control our actions and shrink our lives. I have seen these tools enable people to get back to things they had been avoiding for months or years. As we practice techniques that help us face our fears, we can reclaim the life we’ve been missing out on.

To find a therapist near you, visit the Psychology Today Therapy Directory.