A first panic attack is one of the most frightening experiences a person can have, because it does not feel psychological at all. It feels like a heart attack, a stroke, the moment before collapse. People end up in casualty, are told their heart is fine, and go home unconvinced — because nothing that felt like that could possibly be "just anxiety".

I have worked with anxiety for a very long time, so let me start with reassurance and then get practical. A panic attack is your body's alarm system firing at full volume when there is no fire. It is horrible. It is not dangerous in itself. And it responds well to treatment.

See a doctor first — genuinely

This belongs at the top, because it matters. Symptoms that look exactly like panic can have physical causes: thyroid problems, heart-rhythm disturbances, asthma, anaemia, low blood sugar, side effects of some medications, too much caffeine, withdrawal from alcohol or certain drugs.

If this is new, or the pattern has changed, get checked by a doctor before assuming it is anxiety. No counsellor should diagnose a racing heart from across a screen, and I won't. Once physical causes are ruled out, you can treat the panic knowing you are treating the right thing — and that knowledge is itself calming.

What is actually happening in a panic attack

Below conscious thought, your nervous system decides you are in danger and does what it evolved to do: adrenaline floods the system, the heart speeds up, breathing quickens. A superb response if there is a leopard. Deeply unpleasant in a supermarket queue.

Almost every terrifying symptom follows from that surge. Fast breathing changes the balance of gases in the blood, producing the dizziness, tingling hands, tight chest and unreal, far-away feeling that frightens people most. Adrenaline gives you the pounding heart and the shaking. Then comes the second wave, the real engine of panic: you notice the symptoms, conclude something is catastrophically wrong, and the fear of them produces more adrenaline. The alarm is now feeding itself.

Two things worth holding on to. Panic peaks and then falls — the body cannot sustain that surge, so it passes, usually within minutes. And fainting is unlikely, because fainting requires blood pressure to drop, while panic raises it.

Why "just breathe" is such unhelpful advice

The advice isn't wrong. The delivery usually is. Telling someone mid-panic to calm down and breathe lands as "you are overreacting and inconveniencing me", which adds shame to terror. And "take a deep breath" is close to the opposite of what helps — hauling in more air is exactly what over-breathing already is.

What helps is slow breathing out. The out-breath is connected to the body's braking system. In for a count of four, out for six or seven, unhurried. It will feel like it isn't working for the first minute. Do it anyway.

What genuinely helps in the moment

The aim is counter-intuitive: stop fighting the wave and let it pass through you. Fighting panic is fuel; riding it out takes the fuel away.

  • Name it. "This is panic. It has happened before. It peaks and it goes." Said out loud or under your breath, it breaks the catastrophic story mid-sentence.
  • Breathe out longer than you breathe in. In for four, out for six or seven. Soften your shoulders and unclench your jaw as you do it.
  • Ground through your senses. Name five things you can see, four you can hear, three you can feel, two you can smell, one you can taste. Not a distraction trick — it drags attention out of the alarm and back into the room.
  • Get into your feet. Press both feet into the floor and feel the ground taking your weight. Cold water on the wrists helps some people.
  • Let time do the work. Instead of "make it stop", try "let it crest" — waiting for a wave to break, not trying to win.
  • Stay put if you safely can. Remaining where you are for a few minutes after the peak teaches your nervous system that the place did not, in fact, harm you.