How to stop a panic attack

A panic attack doesn't feel like "anxiety." It feels like dying. The heart races, the chest tightens, the hands tingle, the room goes slightly unreal, and a voice in your head insists you're having a heart attack or losing your mind. Then, minutes later, it drains away and leaves you shaky and exhausted.

If that sounds familiar, two facts are worth holding onto. Panic attacks are common. The NIMH describes them as "a sudden wave of fear or discomfort or a sense of losing control even when there is no clear danger or trigger." [2] And while they're frightening, the NHS is plain about it: "they're not dangerous." [1]

What's happening in your body

A panic attack is your threat system firing at full power with no actual threat. The DSM-5 describes it as an abrupt surge of intense fear or discomfort that peaks within minutes, with at least four symptoms such as a pounding heart, sweating, trembling, shortness of breath, chest pain, dizziness, tingling, or fear of dying or losing control. [3]

Breathing is woven through it. Under threat, many people start to over-breathe: faster, bigger, upper-chest breaths. That blows off carbon dioxide faster than the body makes it. Low CO₂ (hypocapnia) can itself cause dizziness, tingling in the hands and lips, and chest tightness. These are the same sensations that convince you something is wrong, so the fear grows and the breathing speeds up. A review of the research concluded that while the theories aren't settled, the findings "suggest an important role of low carbon dioxide (CO₂) levels" in panic. [4]

That's why breathing is a powerful lever. It's one of the few parts of the loop you can change by choice.

How to stop a panic attack, step by step

1. Stay where you are and name it

If you're somewhere safe, stay put. Leaving or fleeing teaches your brain the situation was dangerous. Say it plainly, out loud or in your head: "This is a panic attack. It's not dangerous. It will pass." The NHS advice during an attack is to stay where you are if possible, breathe slowly and deeply, remind yourself it will pass, and remember it is not life-threatening. [1]

2. Slow your breathing down, gently

This is where most advice goes wrong. "Take a deep breath" often turns into big, fast gulps, which is more over-breathing. The aim is slow and soft, not big. The NHS breathing guide puts it well: "Let your breath flow as deep down into your belly as is comfortable, without forcing it. Try breathing in through your nose and out through your mouth. Breathe in gently and regularly." Count steadily from 1 to 5 on the way in and 1 to 5 on the way out. [5] If you can, let the exhale run a little longer than the inhale.

Don't expect the first few breaths to fix anything. You're not trying to force calm. You're stopping the over-breathing so the sensations it causes can settle on their own over the next few minutes.

3. Let the sensations come, and don't fight them

Counterintuitive, and important. Fighting the racing heart or the dizzy feeling tells your brain they're dangerous, which pours more fuel on the attack. Notice them like weather. "Heart's fast. Hands are tingling. That's adrenaline and over-breathing. It peaks and passes." This attitude of letting body sensations happen until they lose their power is the core of the most effective therapy for panic, called interoceptive exposure. [6]

4. Anchor your attention outward

If your mind is spiralling, give it a concrete job: name five things you can see, four you can feel, three you can hear, two you can smell, one you can taste. This "5-4-3-2-1" grounding is a widely used way to shift attention. It hasn't been tested as a treatment in trials, but it's harmless and many people find it helps them ride out the peak.

5. Let it finish

Panic peaks and falls. The NHS says most attacks last 5–20 minutes. [1] When it ebbs, don't rush off. Keep breathing slowly for a few more minutes, have some water, and give yourself credit. You just stayed with one of the most intense experiences the body can produce.

Three things not to do

Don't breathe into a paper bag

The idea is to rebreathe CO₂. The problem is that it also drops your oxygen. In healthy volunteers, paper-bag rebreathing lowered blood oxygen substantially. The same 1989 Annals of Emergency Medicine paper reported three deaths when it was used on people whose breathlessness was actually caused by low oxygen or heart problems. [7] Slow breathing does the same job safely.

Don't gulp big breaths

As above, bigger isn't better when you're already over-breathing. Gentle, slow and "without forcing it" is the instruction to follow. [5]

Don't rely on a "magic technique" claim

You'll see cyclic sighing (two inhales, one long exhale) recommended for panic, and it's a good breathing pattern. In a 2023 Stanford-led trial, five minutes a day improved mood more than mindfulness meditation over a month. [8] But that study was in healthy adults and excluded people with moderate to severe psychiatric conditions. It hasn't been tested during panic attacks. Use it as daily practice, not as a guaranteed off switch.

What the breathing research actually shows

Breathing training for panic disorder has been tested more rigorously than most people realise. In a randomized trial of 37 people with panic disorder, four weeks of capnometry-assisted respiratory training (using a sensor to learn to breathe slower and raise CO₂) produced moderate-to-large improvements that held at 12-month follow-up. [9]

There's an honest twist. A later 74-person trial compared training people to raise CO₂ with training them to lower it, and both worked about equally well. The authors concluded the improvement depended on what the therapies shared, including "exposure to ominous bodily sensations, and attention to regular and slow breathing," rather than the CO₂ change itself. [10] So breathing practice probably helps in two ways: it steadies the body, and it teaches you, through repetition, that the scary sensations are safe.

More broadly, slow breathing reliably increases heart-rate variability, a marker of the body's calming branch [11], and a meta-analysis of randomized trials found breathwork produces small-to-moderate reductions in stress and anxiety. Its authors warned against "a miscalibration between hype and evidence." [14] Breathing is a genuine skill worth building. It's not a cure on its own.

If panic attacks keep coming back

Repeated, unexpected panic attacks plus ongoing worry about the next one may be panic disorder, and it is very treatable. UK NICE guidelines recommend cognitive behavioral therapy (typically 7–14 hours in total) as a first-line treatment, with an SSRI antidepressant as the main medication option. NICE advises that benzodiazepines "should not be prescribed" for panic disorder because of poorer long-term outcomes. [15] The NIMH calls CBT the "gold standard." [2]

Talk to a doctor or a licensed therapist. In the UK you can refer yourself to NHS talking therapies. In the US, your primary care provider is a good first call.

Panic attack or heart attack?

Panic can produce "physical symptoms that might feel like a heart attack" [2], and the reverse is also true. You shouldn't try to sort them out alone on the floor of a bathroom. Call emergency services if:

• it's your first episode, or it feels different from your usual attacks
• you have chest pain that feels tight, heavy or squeezing, or pain spreading to your arms, neck, jaw or back [12]
• you have heart disease or risk factors (age, smoking, high blood pressure, diabetes)
• you're simply not sure. Getting checked is the right call. [13]

Where BreathFly fits

The best time to learn a breathing pattern is before you need it. In the middle of an attack you won't be reading instructions. BreathFly is built for that practice: a full-screen visual expands and contracts at a slow pace, and gentle haptic taps mark each inhale and exhale, so you can follow without counting, even with your eyes closed. Short daily sessions of calm, extended-exhale breathing and cyclic sighing make the rhythm familiar, so it's there when panic shows up. Each exercise shows the study or expert behind it. It's free on iPhone, with no account.

BreathFly is a practice tool, not a treatment for panic disorder. Use it alongside professional care, not instead of it.

Common questions

How do you stop a panic attack fast?

You usually can't switch a panic attack off instantly, but you can stop feeding it. Stay where you are if it is safe, tell yourself this is panic and it will pass, and breathe slowly and gently through your nose with a longer, unhurried exhale instead of gulping air. Let the sensations rise and fall without fighting them. Most panic attacks pass within 5 to 20 minutes.

What is the best breathing technique for a panic attack?

Slow, gentle breathing works better than big deep breaths. The NHS advises letting your breath flow into your belly without forcing it, breathing in through your nose and out through your mouth, and counting steadily from 1 to 5 on each breath. Over-breathing during panic can lower carbon dioxide and add to dizziness and tingling, so soft and slow beats big and fast.

Should I breathe into a paper bag during a panic attack?

No. Paper-bag rebreathing can lower your oxygen level, and a 1989 report in the Annals of Emergency Medicine described deaths when it was used on people whose breathlessness actually had a medical cause. Slow, gentle breathing achieves the calming effect more safely.

How long does a panic attack last?

According to the NHS, most panic attacks last between 5 and 20 minutes, and some have been reported to last up to an hour. The symptoms usually peak within minutes. Although panic attacks are frightening, they are not dangerous.

How do I know if it's a panic attack or a heart attack?

You can't always tell, and you shouldn't try to diagnose it yourself. Call emergency services if it is your first attack, if you have heart risk factors, or if you have chest pain that feels tight or squeezing or spreads to your arms, neck, jaw or back. If you are not sure whether it is a panic attack or a heart attack, get immediate medical care.

What is the best treatment for panic attacks?

Cognitive behavioral therapy (CBT) is the first-line treatment for panic disorder, and UK NICE guidelines recommend 7 to 14 hours in total. An SSRI antidepressant is the main medication option. NICE advises against benzodiazepines for panic disorder because of poorer long-term outcomes. Breathing techniques are a useful coping skill alongside treatment, not a replacement for it.

Keep reading

An app to help with anxietyGuided exercises for anxious moments, on iPhone. Why can't I take a deep breath?Air hunger, sighing and when to see a doctor.

Sources

1. NHS. Panic disorder. Reviewed August 2023 — nhs.uk/mental-health/conditions/panic-disorder.
2. National Institute of Mental Health. Panic Disorder: When Fear Overwhelms. — nimh.nih.gov.
3. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Panic attack specifier.
4. Meuret, A. E., & Ritz, T. (2010). Hyperventilation in panic disorder and asthma: empirical evidence and clinical strategies. International Journal of Psychophysiology, 78(1), 68–79 — pubmed.ncbi.nlm.nih.gov/20685222.
5. NHS. Breathing exercises for stress. — nhs.uk.
6. Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23 — pubmed.ncbi.nlm.nih.gov/24864005.
7. Callaham, M. (1989). Hypoxic hazards of traditional paper bag rebreathing in hyperventilating patients. Annals of Emergency Medicine, 18(6), 622–628 — pubmed.ncbi.nlm.nih.gov/2499228.
8. Balban, M. Y., Neri, E., Kogon, M. M., et al. (2023). Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine, 4(1), 100895 — pmc.ncbi.nlm.nih.gov/PMC9873947.
9. Meuret, A. E., Wilhelm, F. H., Ritz, T., & Roth, W. T. (2008). Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder. Journal of Psychiatric Research, 42(7), 560–568 — pmc.ncbi.nlm.nih.gov/PMC2890048.
10. Kim, S., Wollburg, E., & Roth, W. T. (2012). Opposing breathing therapies for panic disorder: a randomized controlled trial of lowering vs raising end-tidal PCO2. Journal of Clinical Psychiatry, 73(7), 931–939 — pubmed.ncbi.nlm.nih.gov/22901344.
11. Laborde, S., Allen, M. S., Borges, U., et al. (2022). Effects of voluntary slow breathing on heart rate and heart rate variability: a systematic review and a meta-analysis. Neuroscience & Biobehavioral Reviews, 138, 104711 — pubmed.ncbi.nlm.nih.gov/35623448.
12. NHS. Heart attack. — nhs.uk/conditions/heart-attack.
13. Cleveland Clinic. How to tell the difference between a panic attack and a heart attack. — health.clevelandclinic.org.
14. Fincham, G. W., Strauss, C., Montero-Marin, J., & Cavanagh, K. (2023). Effect of breathwork on stress and mental health: a meta-analysis of randomised-controlled trials. Scientific Reports, 13, 432 — pubmed.ncbi.nlm.nih.gov/36624160.
15. National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113). — nice.org.uk/guidance/cg113.