Panic attacks are short spurts of intense fear that come on suddenly, often with an unknown or disproportionate reason. An emotional or environmental trigger stimulates the amygdala, the part of the brain that detects danger, and the fight-or-flight system of the body is activated.
Panic attacks can produce a range of symptoms—difficulty breathing, a rapid heartbeat or palpitations, trembling, sweating (especially cold sweats) nausea or stomach upset, feeling faint, lightheaded, or dizzy—and they are often very distressing to the person experiencing them. But in addition, that distress can also be felt by friends and family who witness these symptoms.
There seems to be plenty of advice available for people who suffer panic attacks, but not as much for those who witness the attack, and try to offer immediate support. Here’s what to do and what not to do when supporting someone who’s experiencing a panic attack.
DO prioritise their safety
First thing’s first: remove your friend from a situation or place that could pose a threat to their safety. Find somewhere they can sit out the panic attack that’s well-ventilated and preferably private.
If you can identify what triggered the attack—whether that’s a person, thing, or situation—remove them from the trigger. If you are in a crowd, public place, or high-pressure situation, lead them somewhere quieter, or offer to take them home.
Take charge firmly, calmly, and gently. However, don’t force or pressure them to do something they absolutely do not consent to.
DON’T let their denial fool you
Your friend who’s suffering from a panic attack may feel embarrassed or ashamed that they’re inconveniencing you. They might try to brush off what’s happening to them, and tell you they’re fine and that you should go on ahead.
While you mustn’t force them to do anything they don’t want to do, it’s also important that you ensure their safety, especially if you recognise the symptoms of a panic attack.
Continue to reassure them that it’s no trouble for you to support them and stay by their side.
DO help them breathe through it
One of the hallmarks of a panic attack is that it’s very difficult for the person to breathe. It’s a terrifying sensation – like drowning or choking – and it can make them feel like they’re losing control, or even that they might die. More urgently, a decrease in oxygen reaching the brain might make them faint or lose consciousness, opening up a host of all-new complications.
Encourage your friend to breathe slowly and deeply. Try the 4-7-8 breathing technique: coach your friend to breathe in for 4 seconds, hold the breath for 7 seconds, and breathe out for 8 seconds. Deep breathing is a naturally calming activity and ensures that there is enough oxygen getting to the brain.
DON’T minimise what they are going through
It’s very tempting to say things like “just calm down” or “just relax” to someone having a panic attack. Perhaps you don’t know what to say because this is the first time you’ve seen them have a panic attack, or perhaps you’ve actually seen them have a dozen panic attacks before—therefore aware of how this plays out.
Even if you know the fear causing the attack is irrational, do NOT say that to someone having a panic attack. If panic attacks were as simple as “just calming down”, no one would have them! Every single panic attack is as scary and stressful to the person having them as it is to others. If you can’t think of anything soothing to say, keep your opinions to yourself and stick to reminding your friend to breathe.
DO reassure them that they can take back control
Panic attacks typically last for 5-20 minutes, and that’s 5-20 minutes of feeling like the world is about to cave in even if nothing harmful or threatening is actually going to happen. To the person in the thick of it, a panic attack can be overpowering and feel like it will never end.
Remind your friend that their panic is reversible and temporary. It will end soon, and they are in a harmless environment where there is nothing to be afraid of. Say things like “You’re not in any danger, you’re safe”, “You’ve survived this before, and you can handle this time too”, or “This feels unpleasant, but it will pass.” You may think small statements like these won’t do much, but they go far in supporting people in the throes of panic and recalling them back to themselves.
DON’T make fun
They say laughter is the best medicine, but there’s a time and place for it and it isn’t in the middle of a panic attack. Humour is another tempting way to cope with a stressful situation you don’t understand, but the person experiencing a panic attack isn’t going to find anything funny when they’re struggling to breathe and thinking they’re going to die.
Refrain from joking around, asking trivial questions, or telling them “not to go into the light.” Such comments are unhelpful in the moment, and could have long-lasting consequences. Your friend might feel like they are not being taken seriously and cannot rely on others for support, and this could contribute to them isolating themselves to avoid being made fun of when they get panic attacks.
DO be patient
Panic attacks come on unpredictably. They could happen in the middle of a movie, during a movie, at school or the workplace, while driving, or any other setting where someone losing control could be inconvenient.
Be patient and understanding – don’t make them feel like it’s their fault, because it isn’t. No matter how complicated the situation, remember the person experiencing the panic attack wouldn’t have chosen to do this here and now if they had a choice.
Reassure your friend that what they’re going through is valid and accepted. Panic attacks are a real medical condition. You understand the symptoms of the condition, you are here to help, and there’s nothing to be ashamed of.
DON’T leave them alone
Given their symptoms and their mental state, there’s a chance that the person could get hurt when left alone – imagine them fainting in a public place, for instance, or alone in their flat with no one knowing what has happened to them!
Leaving a person alone during a panic attack not only risks their safety, but can also make them feel abandoned while they’re in a vulnerable position. Respect their space but stay with them until you’re certain the attack has passed.
Panic attacks can be traumatic, and your friend might intentionally avoid things that could trigger their panic attacks. Sometimes they might develop coping mechanisms, such as being dependent on others to protect them from their triggers. Observe for these changes in your friend after a panic attack, as they can impair normal activities and quality of life. You may need to refer them to a mental health professional.
As scary as they can be, the good news is that panic attacks are both common and treatable. You might know of someone who has experienced one – perhaps it’s fair to assume you’re here reading this because you would like to help them. Remember to keep your friend safe, help them breathe, and remain patient and reassuring. While, ultimately, your friend will have to learn to manage their panic attacks, your support and understanding will be invaluable to their recovery.