Panic Attacks: How to Cope and Find Calm Again

Dr. Boris Wydoff

Panic attacks can happen unexpectedly: your heart suddenly starts racing, you find it difficult to breathe, you feel dizzy, and intense fear takes hold. How can you cope with a panic attack while it is happening? First, stop and find a stable, comfortable position. Straighten your shoulders, relax your chest, and try to breathe evenly without taking sharp breaths. Do not force yourself to take in as much air as possible. Then shift your attention away from the unpleasant sensations to a calming image, and remind yourself that the attack will pass. After that, gradually return to your usual activities. If these episodes keep happening, it is important to work with a doctor to find out what is causing them.

What Is a Panic Attack and What Does It Feel Like?

A panic attack is a sudden episode of intense fear accompanied by pronounced physical and emotional sensations. It can begin very quickly, even when a person cannot see any obvious reason to feel worried. The experience can be so intense that the person feels something dangerous is happening to them.

Panic attack symptoms can vary. Most often, people notice a racing heartbeat, sweating, trembling hands or legs, dizziness, and a feeling of not getting enough air. Sometimes nausea, chest pain, chills, hot flashes, dry mouth, and unpleasant sensations in the stomach also occur.

Some people experience tingling or numbness in their fingers, a choking sensation, and weakness. They may feel as though what is happening is unreal or as though they are somehow detached from their own body. An attack is often accompanied by a fear of dying or an expectation that something terrible is about to happen.

The duration of an attack varies. Usually, episodes last from a few minutes to twenty minutes, although the sensations sometimes persist longer. After experiencing an episode, a person may spend a long time thinking about what happened and worrying that it will happen again.

It is particularly difficult for people who begin avoiding certain places and activities. For example, someone may stop using public transport, going out alone, or visiting shops. Gradually, a vicious cycle develops: the fear of having another attack becomes a source of additional anxiety in itself.

Why Do Panic Attacks Happen and What Triggers Them?

The causes of panic attacks are not always obvious. Even when a person is not going through a specific upsetting situation, an attack can occur unexpectedly. The exact origins of panic disorder have not been fully established, but doctors associate it with several possible factors.

These include severe or prolonged stressful events. This could be the loss of a loved one, major life changes, or another traumatic experience. After such events, anxiety sometimes persists even when the immediate danger has passed.

Family history also matters. If a close relative has had panic disorder, the likelihood of experiencing a similar problem may be higher. Another possible factor is the way neurotransmitters work. These are chemical messengers involved in transmitting signals in the brain.

It is not always possible to identify a single cause. Sometimes several factors act together: past stress, family predisposition, and the way the nervous system functions. That is why looking for one single culprit does not always help explain what is happening.

Additional distress can develop when a person starts constantly monitoring their heartbeat and breathing. Any unusual sensation causes concern, and the expectation of another attack increases tension. Gradually, this creates a habit of living in constant anticipation of danger.

How Can You Tell a Panic Attack from Other Health Problems?

The signs of panic attacks can resemble symptoms of other conditions. A racing pulse, dizziness, chest pain, and difficulty breathing do not occur only in anxiety disorders. For example, palpitations can also accompany other health problems.

That is why you should not diagnose yourself based only on a few matching sensations. Even if you have experienced attacks before, a new or unfamiliar symptom should not automatically be attributed to panic.

Your doctor will ask what exactly you feel, how often the episodes occur, and how long they have been happening. A physical examination may also be necessary to rule out other conditions that can cause similar symptoms.

Panic disorder is assessed by looking at the overall picture. In particular, the doctor considers recurring unexpected attacks and prolonged worry about them happening again. A racing heartbeat, dizziness, or any other individual symptom alone is not enough to establish a diagnosis.

It is important to distinguish a single episode from a recurring problem that starts interfering with everyday life. If you constantly change your plans because you are afraid of another episode, that is another reason to discuss the situation with a specialist.

Panic Attacks: What to Do at Home

When an attack begins, it can be difficult to concentrate even on simple actions. That is why it helps to remember a sequence of steps in advance so you do not feel lost. You do not need to try to control every sensation at once or get rid of the fear immediately. Take things one step at a time, focusing on your posture, breathing, and shifting your thoughts.

Here are seven steps to help you organize what to do during an attack.

1. Stop and try to stay where you are. If the circumstances allow, do not run away or rush to find an exit. Find a quiet place where you can spend some time without unnecessary distractions. Do not try to do many things at once.

2. Find a comfortable body position. Straighten your shoulders, keep your back upright, and try to relax your chest. Do not tense up or tighten your muscles unnecessarily. Choose a position that makes it easier for you to breathe calmly.

3. Switch to steady breathing. Breathe in gently and exhale smoothly, trying to maintain a natural rhythm. Do not gasp for air or force yourself to breathe. Repeat this sequence until your breathing gradually becomes steadier. The main thing is not to turn the exercise into another source of worry.

4. Stop constantly checking how you feel. You do not need to monitor your heartbeat every second, assess how deeply you are breathing, or look for new signs of danger. Shift your attention to your surroundings. This will help prevent an endless cycle of anxious thoughts.

5. Remind yourself that the attack will end. You can repeat silently: "I feel frightened right now, but this feeling will pass. I can wait calmly." Do not criticize yourself for being afraid or demand that you feel calm immediately. It is important not to make the experience worse by frightening yourself even more.

6. Picture a peaceful and pleasant place. Think of a quiet seashore, a sunny meadow, or a familiar place where you feel comfortable. Try to keep your attention on this image instead of repeatedly returning to the unpleasant sensations.

7. Gradually return to your usual activities after the attack. There is no need to give up in advance on all the activities and places that remind you of the experience. Restore your normal routine gradually, taking into account how you feel and your specialist's recommendations.

These steps do not replace treatment, but they can help you organize your actions when intense fear takes hold. It is particularly useful to become familiar with breathing exercises in advance, when you feel calm. That way, you will not have to figure out how to do them for the first time during your next episode.

I would also like to emphasize one thing: do not demand that you perform every step perfectly. If any particular action makes you feel more uncomfortable, do not force yourself to continue. If attacks keep recurring, consult a doctor to identify the cause and find the right support.

How Are Diet and Lifestyle Connected to Anxiety?

Everyday habits can affect how you feel and how intense your anxiety symptoms become. Doctors recommend paying attention to foods and drinks that may make attacks worse. In particular, it is best to avoid excessive caffeine, alcohol, and foods containing large amounts of sugar.

Coffee and other sources of caffeine can intensify unpleasant sensations, especially if a person is already prone to anxiety. Alcohol should not be used as a way to relax either. Smoking is another habit that doctors recommend giving up.

Your diet should remain regular and balanced. There is no need to look for one special food that supposedly stops a panic attack. A varied diet helps maintain a normal daily routine, but it does not replace professional support for panic disorder.

Physical activity also matters. Regular walks and exercises suited to your health can help you manage everyday stress. You can consider yoga and Pilates if these activities are appropriate for you and do not cause additional discomfort.

It is helpful to learn breathing exercises for managing stress. It is best to become familiar with them in advance, in a calm environment, so you do not have to figure out the technique for the first time during an anxious episode.

If attacks interfere with your everyday life, you should not try to solve the problem solely by changing your diet or increasing physical activity. Lifestyle habits can support your general well-being, but treating panic disorder requires separate attention.

How Are Panic Attacks Treated, and Can You Cope Without Medication?

How to treat panic attacks is a question that concerns many people, especially when the episodes become regular. Modern treatment includes psychotherapy and, when necessary, medication. The specific approach depends on the symptoms and the person's overall health.

One of the main methods is cognitive behavioral therapy. During sessions, a specialist helps you understand which thoughts and reactions accompany an attack. You learn to interpret the sensations differently and change behaviors that maintain anxiety.

For example, after repeated episodes, a person may develop the belief that any increase in heart rate will inevitably lead to danger. A psychotherapist helps examine these thoughts and gradually develop a calmer response. You also learn ways to remain composed during an attack.

In some cases, a doctor may prescribe medication. Options include certain antidepressants and other medicines used to treat anxiety disorders. The specialist determines which medication to use, whether it is necessary, and how long treatment should continue.

You should not change your prescribed treatment plan, reduce doses, or stop taking medication on your own. Some medicines do not start working immediately, so you should assess the results together with your doctor.

If your condition does not improve after psychotherapy, medication, and participation in support groups, your doctor may recommend consulting another specialist. This may be a psychiatrist or clinical psychologist who can carry out an additional assessment and develop a further treatment plan.

My Advice: How to Work with Fear and Inner Tension

Over the years of my practice, I have become convinced that people experiencing panic attacks need not only to learn what to do during an episode but also to pay attention to how they deal with fear in everyday life. In my books, I discuss thoughts, emotional well-being, breathing, and movement as important parts of overall health.

I do not suggest fighting fear through willpower or forbidding yourself to feel anxious. My approach is to avoid making fear the constant center of your attention and gradually regain your usual level of activity.

First — do not feed your anxiety by constantly expecting something terrible to happen. In my book "The Power of the Mind," I discuss how recurring thoughts affect a person's emotional state. If you constantly replay scenarios involving another attack in your mind, it becomes harder to focus on everyday life. I recommend noticing these thoughts without treating every one of them as a prediction of the future. Instead of endlessly thinking about possible danger, return to the specific activity you were doing before the anxiety appeared.

Second — choose supportive words instead of constantly criticizing yourself. I explain that people should not keep telling themselves that they are weak, helpless, or unable to cope with difficulties. Such statements reinforce feelings of insecurity. I suggest using calmer phrases: "I am recovering," "I can handle this," and "I can remain calm." This is not a magic formula or a way to stop an attack with a single sentence. It is a habit of treating yourself without putting additional pressure on yourself.

Third — pay attention to a calm, steady breathing rhythm. In my recommendations, I emphasize the importance of deep, even, and natural breathing. When a person rushes, tightens their chest, and tries to control every breath, it becomes harder to relax. That is why I advise taking your time, straightening your shoulders, and breathing without sudden or forceful effort. It is best to learn breathing exercises in a calm environment so that the habit of breathing steadily can gradually become established.

Fourth — do not give up natural movement. I recommend ordinary walking, choosing a pace that suits how you feel and your breathing. In my recommendations, I emphasize the importance of keeping your body upright, relaxing your shoulders, and walking naturally. There is no need to turn a walk into a competition or demand specific results from yourself. Gradually returning to your usual activities helps prevent your entire daily life from revolving around the fear of another attack.

I consider this last point particularly important. If, after experiencing a panic attack, a person starts avoiding shops, walks, and trips, their world gradually becomes smaller. That is why you should not give up on your usual activities in advance. Return to them gradually, without forcing yourself and while following your specialist's recommendations.

My views on the role of thoughts, breathing, and inner tension are part of my personal approach to well-being. They do not replace the medical explanation of panic disorder and do not prove that thoughts themselves cause attacks. Modern medicine considers both psychological and biological factors and recommends evidence-based treatments, including psychotherapy and, when necessary, medication.

My advice can be used as a complement to professional care. However, you should not try to manage recurring attacks solely through positive thinking, walks, or breathing exercises. If your condition interferes with your life, it is important to consult a specialist.

When Should You See a Doctor?

Panic attacks involve sensations that can also occur with other medical conditions. That is why you should never automatically assume that chest pain, shortness of breath, or loss of consciousness is caused by anxiety.

When to call an ambulance.

Chest pain that spreads to the arm, especially when accompanied by cold sweats, may be a sign of a heart attack. In this situation, you must call an ambulance immediately. Do not explain these symptoms away as a panic attack or wait for them to disappear on their own.

When to make a routine doctor's appointment.

Make an appointment if your attacks keep recurring, occur without an obvious cause, or begin interfering with your everyday life. It is particularly important to seek help if you constantly fear the next episode and, as a result, avoid your usual activities and certain places.

Your doctor will ask about the nature of your symptoms, how long they last, and how often they occur. If necessary, they will perform a physical examination to rule out other possible causes. If panic disorder is diagnosed, the specialist will suggest an appropriate treatment plan.

Do not put off seeking help just because you feel uncomfortable talking about your experiences. Anxiety, fear, and emotional difficulties are just as valid reasons for a consultation as physical symptoms. If necessary, your doctor will refer you to a psychotherapist, psychiatrist, or clinical psychologist.

You can read more about my approach to this subject on the page "Sleep and the Nervous System".

Boris Wydoff — naturopath and author, Ph.D. in nutrition. For over fifty years I have helped people restore health through nutrition, cleansing and the power of the mind — in Europe, America and Asia. About the author →

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