how to help during a panic attack

step by step, while the attack lasts

1. Say you’re here and you’re not leaving. Briefly, in a calm voice.
2. Move somewhere quieter — to a wall, a bench, a side corridor. Move slowly: sudden movements make panic worse.
3. Ask before you touch. For some people a hand on the shoulder helps, for others touch right now is unbearable. Asking takes a second. And don't hold them: if they want to stand or step away, let them — just go with them. Being held reads to the body as a trap and adds to the panic. That goes for children too, whatever the internet says about hugging them tightly.
4. Breathe visibly and slowly yourself. That’s enough: people fall into someone else’s rhythm on their own, even when words no longer reach them.
5. Count out loud if they’re ready to follow. A breath in through the nose, one more short breath on top of it, and a long breath out. That’s the physiological sigh — the fastest way to slow breathing that has run away.
6. Name what’s happening. "This looks like a panic attack. It passes in a few minutes."
7. Offer water once the sharpest part starts to ease. Not at the peak — swallowing is hard then.
8. Stay afterwards. They’ll be worn out and, most likely, embarrassed. The fact that you stayed does more for that than anything you could say.

what not to say

The usual comforting words often hurt here: the person hears "what you’re going through doesn’t count".

"Calm down" — a demand that can’t be met, so now there’s guilt on top of the panic for failing it.

"Take a deep breath" — during panic a big breath in with nothing after it makes things worse. It’s the long breath out that does the work.

"There’s nothing to be afraid of" — fear in panic has no object, so there’s nothing to argue with.

"Pull yourself together" — it reads as "you’re weak". Shame is the last thing that needs adding.

"Everyone gets this, it’s nothing" — right now the person is certain they’re dying. "It’s nothing" simply doesn’t reach them.

"Do you want me to call an ambulance?" — the question confirms that things are serious. If an ambulance is needed, it gets called, not offered.

What does sound right: "I’m here", "this will pass", "breathe with me", "you don’t have to explain anything".

breathing together

Breathing together works better than instructions, because it doesn’t ask the person to understand words — only to copy.

• Sit facing them or beside them, so they can see your shoulders.
• Make your breathing visibly slow: in through the nose, a long breath out through the mouth.
• If they can listen, count out loud: "in… and out, lo-o-ong".
• Don’t wait for it to work. If it isn’t happening, just keep breathing yourself.
• You can start the timer above and put the phone down nearby: then the rhythm is led by the timer, not by you, and nobody is hurrying anybody.

One mistake that's easy to run into: articles do circulate advising "breathe in for four, out for two". That rhythm is the wrong way round. A long inhale pushes the pulse up; what settles it is the exhale being the longer half. Count out loud to that scheme and you risk speeding up the very thing you're trying to slow.

helping over the phone or by text

Some of this survives the distance and some doesn’t. Your calm carries down a line, and so does your breathing if they can hear it. What you lose is everything you would have done with your hands and with simply being in the room.

On a call. Breathe out slowly and audibly, close to the microphone, and let them follow you. Say where you are and that you’re staying on the line. Long silences are fine — say that out loud, because otherwise silence sounds like you leaving.

By text. Short messages, one idea each: "I’m here." "This passes." "Long breath out, I’ll count." Paragraphs don’t get read in this state. Ask questions that take one word to answer — "are you sitting down?" works, "what’s going on?" doesn’t.

Ask who else is nearby. A person in the same room, or a flatmate through a wall, does more than anyone can from another city. Helping them get someone there — while you stay on the line — is often the most useful thing you can do.

the paper bag

Everyone knows the paper bag. It comes from the films, and there is a theory underneath it: panic makes you breathe off too much carbon dioxide, which is where the tingling fingers and the light-headedness come from, so you breathe it back in again.

Someone put that to the test in 1989. Twenty volunteers hyperventilated into a bag with sensors inside it. The carbon dioxide crept up reluctantly — in plenty of the volunteers it never got back to a normal reading at all. The one thing the bag did dependably was take oxygen out of the air they were breathing.

The same paper describes three people who died. They were handed a bag when their breathlessness had nothing to do with panic: in some the blood was short of oxygen, in others the heart muscle was. From across the room it had looked like panic all the same.

That is the whole difficulty. A clot in the lung, an asthma attack, a heart attack — pale, breathing fast, saying they can't get any air. A 2023 review is about precisely this: pulmonary embolism taken for a psychiatric emergency and sent to the wrong ward. Standing next to someone, you cannot tell the difference, and that is why doctors gave the bag up.

The carbon dioxide comes back on its own with a long breath out.

when to call emergency services

A panic attack itself passes without doctors. Call — 911 in the US, 999 in the UK, 112 across the EU — if:

• there’s crushing chest pain radiating to the arm, jaw or back;
• one side of the face has dropped, an arm or leg is weak, speech has changed;
• the person has lost consciousness;
• the attack has lasted more than half an hour and isn’t easing;
• it’s the first attack in their life — especially if they are over forty or have a heart condition, diabetes or high blood pressure.

If you’re unsure, call. Erring on the side of calling is the safe mistake.

If the person says they don’t want to live, this is no longer about breathing. Stay with them and call a helpline: the numbers are at the end of this page.

afterwards

Leave the "what set it off" questions for later. Often they don’t know either, and questions sound like a demand to explain themselves.

What helps: warmth, water, quiet, somewhere to sit. Later — suggesting they see someone, but without pressure and not in the same hour.

If attacks keep happening to someone close to you, the most useful thing is helping them get to a therapist. Panic disorder is very treatable, and the road is shorter with someone alongside.

short answers