What to Do During a Panic Attack: A CBT Therapist's Guide
Panic attacks can feel terrifying. Your heart may race, your breathing may change, and you may feel dizzy, shaky, or disconnected from your surroundings. Many people worry they are having a medical emergency, losing control, or that something terrible is about to happen.
If you've ever experienced a panic attack, you're not alone. Panic attacks are common and highly treatable. While the symptoms can feel intense, there are effective strategies that can help you respond differently when panic occurs.
From a cognitive behavioral therapy (CBT) perspective, the goal is not necessarily to make a panic attack stop immediately. Instead, the goal is to change how you respond to panic so that it becomes less frightening and less disruptive over time.
What Is a Panic Attack?
A panic attack is a sudden surge of intense fear or discomfort that reaches a peak within minutes (American Psychiatric Association, 2022).
Common panic attack symptoms include:
A racing or pounding heart
Shortness of breath
Chest tightness
Dizziness or lightheadedness
Sweating
Shaking
Nausea
Tingling sensations
Feeling detached from yourself or your surroundings
Fear of losing control
Fear of dying
These symptoms are very real. However, they are not signs that something dangerous is happening. They are signs that your body's alarm system has been activated.
Why Panic Attacks Feel So Scary
Panic attacks are driven by the body's fight-or-flight response. This response evolved to help humans respond quickly to danger.
When the brain detects a threat, adrenaline is released. Heart rate increases, breathing changes, and the body prepares to respond.
The problem is that during a panic attack, these normal physical changes are often misinterpreted as signs of danger.
For example:
A racing heart may be interpreted as a heart attack.
Dizziness may be interpreted as fainting.
Shortness of breath may be interpreted as suffocation.
These interpretations increase fear, which increases physical symptoms, creating a cycle that fuels panic.
The CBT Model of Panic Attacks
CBT understands panic attacks as a cycle involving thoughts, physical sensations, emotions, and behaviors.
The cycle often looks like this:
A physical sensation, stressful situation, or anxious thought appears.
The sensation is interpreted as dangerous.
Anxiety increases.
Physical symptoms intensify.
Safety behaviors occur, such as reassurance-seeking, symptom checking, escaping, or trying to force calm.
Unfortunately, these behaviors often keep the cycle going because they reinforce the belief that panic is dangerous.
What to Do During a Panic Attack
When panic occurs, the goal is not to eliminate every symptom immediately. The goal is to respond in ways that reduce fear and allow the panic to run its natural course.
Step 1: Recognize That You're Having a Panic Attack
One of the most important things you can do is accurately identify what is happening.
Instead of thinking:
Something is wrong.
I'm losing control.
I can't handle this.
Try reminding yourself:
This is a panic attack.
My body's alarm system is activated.
These sensations are uncomfortable, but they are not dangerous.
This simple shift can reduce the fear that fuels panic.
Step 2: Stop Fighting the Symptoms
Many people try to force panic away by tensing up, monitoring symptoms closely, or desperately trying to calm down.
Unfortunately, fighting panic often makes it stronger.
Instead, try accepting and allowing the sensations to be present.
You might tell yourself:
I don't like this feeling, but I can handle it.
I can let these sensations be here.
My body will settle on its own.
Paradoxically, panic often decreases more quickly when we stop battling it.
Step 3: Resist the Urge to Escape
One of the strongest urges during a panic attack is to leave the situation immediately.
While escaping may reduce anxiety temporarily, it teaches the brain that the situation was dangerous and that escape was necessary.
Whenever it is safe to do so, try staying where you are.
This allows your brain to learn:
Panic can happen and pass.
Anxiety does not require escape.
You are capable of handling discomfort.
Step 4: Bring Your Attention Back to the Present
Panic pulls attention toward catastrophic predictions.
Instead of focusing on those predictions, gently redirect your attention to what is happening right now.
Notice:
What you can see
What you can hear
What you can physically feel
The goal is reconnecting with the present moment rather than the frightening story anxiety is telling.
Step 5: Allow Your Breathing to Slow Naturally
Breathing often changes during a panic attack. Many people begin taking rapid, shallow breaths, which can increase dizziness and other symptoms.
Rather than trying to control your breathing perfectly, focus on slowing it gently.
The goal is not to force relaxation. It is to reduce urgency and allow your body to settle naturally.
Step 6: Reduce Reassurance-Seeking
When panic occurs, it is common to seek reassurance by:
Googling symptoms
Checking your pulse
Asking others if you're okay
Looking for proof that nothing is wrong
While reassurance often helps briefly, it can keep panic going long-term because it reinforces the belief that certainty is needed before you can feel safe.
Step 7: Let the Panic Run Its Course
One of the most important things to remember is that panic attacks end.
The body's alarm system cannot stay activated indefinitely.
Even when symptoms feel overwhelming, they eventually peak and decrease.
Rather than asking, "How do I make this stop?" try asking, "How do I ride this wave until it passes?"
What Not to Do During a Panic Attack
When panic strikes, it is natural to want immediate relief. Unfortunately, some of the strategies people use to feel better in the moment can unintentionally keep the panic cycle going.
Common examples include:
Constantly checking your pulse, blood pressure, or breathing
Repeatedly searching symptoms online
Calling or texting multiple people for reassurance
Leaving every situation where panic occurs
Trying to force yourself to calm down
Waiting until anxiety disappears before resuming normal activities
These behaviors may reduce anxiety temporarily, but they can reinforce the belief that panic is dangerous and must be controlled. Over time, this can make panic feel even more powerful.
A core principle of CBT is learning that panic can be tolerated without needing to escape, avoid, or eliminate it immediately.
How CBT Helps Prevent Future Panic Attacks
CBT is considered one of the most effective treatments for panic attacks and panic disorder (Hofmann et al., 2012).
Rather than focusing only on symptom reduction, CBT helps people understand and change the patterns that keep panic going.
Treatment often includes:
Learning how panic attacks work
Identifying catastrophic interpretations of physical sensations
Reducing reassurance-seeking and safety behaviors
Building tolerance for anxiety and uncertainty
Practicing exposure to feared sensations and situations
One of the most important discoveries people make during treatment is that panic symptoms are far less dangerous than they initially believed.
As fear decreases, panic often becomes less frequent, less intense, and less disruptive.
Exposure Therapy for Panic Attacks
Many people are surprised to learn that one of the most effective treatments for panic involves intentionally approaching feared sensations rather than avoiding them.
This approach is called exposure therapy.
Exposure exercises are designed to help people experience physical sensations that are commonly associated with panic in a safe and controlled environment.
Examples may include:
Spinning in a chair to create dizziness
Running in place to increase heart rate
Breathing through a straw to create mild breathlessness
Holding tension in the body and then releasing it
These exercises help people learn that the sensations themselves are uncomfortable but not dangerous.
Over time, the brain begins to respond differently to these sensations, reducing fear and helping break the panic cycle.
Frequently Asked Questions About Panic Attacks
What should you do during a panic attack?
If you are having a panic attack, the most helpful thing you can do is recognize what is happening and respond to it differently than your anxiety is urging you to. Panic often creates a strong sense of urgency and danger, which can make you want to escape, seek reassurance, or fight the symptoms. While these reactions are understandable, they often keep the panic cycle going.
Instead, try reminding yourself that you are experiencing a panic attack and that the symptoms, while uncomfortable, are not dangerous. Allow the sensations to be present rather than trying to force them away. Focus on staying where you are if it is safe to do so, gently slowing your breathing, and bringing your attention back to the present moment. The goal is not to eliminate panic immediately but to allow it to run its course without adding more fear to the experience.
Is my panic attack harmful?
Although panic attacks can feel frightening, panic attacks themselves are not harmful. The symptoms are caused by the body's fight-or-flight response—a normal survival system designed to help you respond to perceived danger.
During a panic attack, you may experience a racing heart, dizziness, shortness of breath, chest tightness, shaking, sweating, or tingling sensations. These symptoms can feel alarming and are often mistaken for signs of a medical emergency. However, in healthy individuals, panic attacks do not cause heart attacks, suffocation, loss of control, brain damage, or permanent physical harm.
One reason panic becomes so distressing is that the symptoms are often misinterpreted. For example, a racing heart may be interpreted as a heart problem, or dizziness may be interpreted as a sign that you are about to faint. These interpretations increase fear, which increases the body's alarm response and intensifies symptoms.
If you are experiencing new or concerning symptoms, it is always important to seek medical evaluation. However, once medical causes have been ruled out, understanding that panic symptoms are uncomfortable—but not dangerous—can be an important step toward reducing fear and breaking the panic cycle.
Will my panic never stop?
It can feel that way during a panic attack. Many people describe feeling trapped in the experience or worrying that the symptoms will continue indefinitely. However, panic attacks are temporary by nature.
The body's fight-or-flight response is designed to be short-lived. It cannot remain at peak intensity forever. Although symptoms may feel overwhelming in the moment, panic attacks naturally rise, peak, and eventually decrease. The body's alarm system will settle, even if it feels impossible while the panic is happening.
One reason panic can seem never-ending is that people often become frightened of the symptoms themselves. This fear creates additional anxiety, which can keep the alarm system activated. CBT helps break this cycle by teaching people to respond differently to panic symptoms rather than treating them as dangerous.
With treatment and practice, many people experience fewer panic attacks, less intense symptoms, and greater confidence in their ability to handle anxiety when it occurs. Even if panic occasionally returns, it does not have to control your life. Panic attacks and panic disorder are highly treatable with evidence-based approaches such as CBT.
How long do panic attacks last?
Most panic attacks peak within several minutes and then gradually decrease. While the exact duration varies from person to person, the most intense symptoms typically do not last very long.
However, many people continue feeling anxious, emotionally drained, or physically tense after the panic attack ends. This residual anxiety can create the impression that the panic attack is continuing when, in reality, the body's alarm response has already begun to settle.
The duration of a panic attack is often influenced by how it is interpreted. When symptoms are viewed as dangerous, fear tends to remain elevated. When symptoms are understood as temporary and non-threatening, the body's alarm system often settles more quickly.
Can a panic attack make you pass out?
Passing out during a panic attack is uncommon. One reason people worry about fainting is because panic can cause dizziness, lightheadedness, or a feeling of being disconnected from their surroundings.
However, panic typically causes blood pressure and heart rate to increase. Fainting is more commonly associated with a drop in blood pressure. While dizziness can feel intense during a panic attack, it usually does not lead to loss of consciousness.
Many people with panic attacks fear they will faint, lose control, or become incapacitated. In reality, these feared outcomes rarely occur. Understanding the difference between feeling dizzy and actually fainting can help reduce some of the fear associated with panic symptoms.
What is the fastest way to calm a panic attack?
Many people search for the fastest way to stop a panic attack, but from a CBT perspective, the goal is not to force panic away. In fact, trying to eliminate panic as quickly as possible can sometimes make it stronger because it reinforces the idea that the symptoms are dangerous.
Instead, the most effective approach is often to acknowledge the panic, allow the sensations to be present, and stop fighting the experience. Focus on slowing your breathing gently, relaxing unnecessary muscle tension, and reminding yourself that the symptoms are temporary and not harmful.
Paradoxically, panic often decreases more quickly when you stop trying to control it and allow it to run its natural course. The less fear you add to the experience, the faster the body's alarm system can settle.
Can CBT help panic attacks?
Yes. CBT is considered one of the most effective treatments for panic attacks and panic disorder. Decades of research have shown that CBT helps reduce both the frequency and intensity of panic attacks by targeting the thoughts and behaviors that maintain the panic cycle.
CBT helps people understand why panic occurs, identify catastrophic interpretations of physical sensations, reduce reassurance-seeking and avoidance behaviors, and gradually build confidence in their ability to handle anxiety.
Many CBT approaches also include exposure exercises that help individuals practice experiencing feared sensations in a safe and controlled way. Over time, this reduces fear of panic itself. Rather than teaching people how to avoid anxiety, CBT helps them learn that they can tolerate anxiety and that panic symptoms are not dangerous.
As confidence grows and fear decreases, panic attacks often become less frequent, less intense, and less disruptive to daily life.
A Different Way to Respond to Panic
Panic attacks feel frightening because the body's alarm system is activated. However, the symptoms themselves are not dangerous, even when they feel intense.
From a CBT perspective, recovery does not come from eliminating every anxious sensation. It comes from learning that these sensations can be tolerated without fear, escape, or constant reassurance.
Over time, as you change how you respond to panic, the alarm system often becomes less sensitive. The goal is not to never feel anxious again. The goal is to trust your ability to handle anxiety when it shows up.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). American Psychiatric Publishing.
Barlow, D. H. (2021). Clinical handbook of psychological disorders (6th ed.). Guilford Press.
Craske, M. G., & Barlow, D. H. (2008). Mastery of your anxiety and panic: Workbook (4th ed.). Oxford University Press.
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
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. https://doi.org/10.1016/j.ijpsycho.2010.05.006