Coping With Panic Attacks: What Helps When It’s Happening

Attie Hope | BABCP Accredited Anxiety Therapist | Central London

This page focuses on practical, in-the-moment support. Attie specialises in CBT for anxiety, including panic disorder, and works with clients to address the pattern long term when they’re ready. 

Right now, your heart might be pounding. Your chest might feel tight. Maybe you’re on a packed Central line platform, in a meeting near Liverpool Street, or lying awake at home in London, and part of you is wondering if this is something worse than panic. That question deserves a real answer, not just reassurance.

You’re not imagining any of this, and you’re not the only one going through it. Roughly 1 in 3 people have at least one panic attack in their lifetime, most without it ever becoming anything more than that. What’s happening in your body right now has a clear explanation, and understanding it tends to take some of the fear out of it.

You’re also not meant to just sit through this unaided. There are things you can do that actually interrupt what’s happening, not just distract from it. We’ll get there. First, let’s answer the question that’s probably loudest right now.

Attie Hope

BABCP Accredited CBT Therapist

Specialising in Anxiety Disorders — Central London

10 years of experience

Why a Panic Attack Feels Like a Heart Attack, and Why It Isn’t One

A panic attack can feel like a heart attack because adrenaline raises your heart rate and tightens your chest muscles, but it doesn’t cut off blood flow to your heart the way a heart attack does.
Let’s go through this properly, because that fear deserves a real explanation, not just “don’t worry.”

What’s actually happening

Panic starts with a rush of adrenaline. Adrenaline’s job, evolutionarily, is to prepare your body to run or fight something dangerous, what’s known as the fight-or-flight response. So it does exactly that: your heart rate climbs, and the muscles across your chest wall tighten. That’s the pounding heartbeat and the tight, pressured feeling in your chest, both are your body gearing up for a threat that isn’t actually there.

Adrenaline also explains another common fear people have mid-attack: fainting. It doesn’t tend to happen, because adrenaline raises your blood pressure, it doesn’t drop it, and a drop in blood pressure is usually what causes fainting. So while it can feel like your legs might go, or like you’re about to lose control of your body entirely, that’s very unlikely to actually happen. Your body isn’t breaking down, it’s just firing its alarm system at the wrong moment.

If your breathing has also sped up and gone shallow, a second process kicks in. Fast, shallow breathing lowers the carbon dioxide in your blood quicker than your body can rebalance it. That drop is what causes the tingling in your fingers, the sudden light headedness, the sense that you might faint. It’s an uncomfortable chemical shift, not a sign anything is failing.

Why the pain feels different

Anxiety chest pain doesn’t come from one single cause. Sometimes it’s the tense muscles across your chest. Sometimes it’s your oesophagus tightening, which can genuinely feel like pressure behind the breastbone. Sometimes it’s simply that your nervous system has turned up how intensely you feel any physical sensation right now. It can vary from person to person, and even from one attack to the next.

What tends to set it apart from a heart attack isn’t its exact source, it’s how it behaves. Anxiety pain usually stays fairly local, centred in the chest. Heart attack pain more often spreads, into the arm, the jaw, the back, because it’s travelling along shared nerve pathways that also serve those areas. That’s a pattern doctors look for, not an absolute rule, which is exactly why checking still matters whenever you’re unsure.

If you’ve already been checked out

Maybe this isn’t your first time feeling this. Maybe you’ve been to your GP, had an ECG, sat in A&E waiting for bloods, and every single time you’ve been told your heart is fine. That history is real evidence, and it doesn’t expire just because today’s attack feels intense.

This is one of the most common things I hear in session, someone who’s had every test come back clear and still can’t quite let themselves believe it. That reaction makes complete sense, it doesn’t mean you’re overreacting.

At the same time, panic attacks can happen to people who also have heart conditions, so a clean history is a strong reason to trust your body, not a reason to stop noticing it. Both things are true at once.

A fast way to think it through

When you don’t have time to read paragraphs, here’s the short version:

• Sudden onset, peaks within minutes, feels familiar, heart already ruled out by a doctor → likely panic.
• Pain spreading to your arm, jaw, or back, or getting steadily worse rather than easing → call 999 or get to A&E. Don’t drive yourself.
• First time ever, or anything about it feels different → get it checked, every time.

What the next half hour usually looks like

Roughly, here’s the shape of it: the sensations build over the first couple of minutes, peak around 10 minutes in, then start to ease. By the 20 to 30 minute mark, most people are through the worst of it, even if a bit shaky or drained afterward. Knowing that shape in advance can make it a little easier to get through, because you know it has an end point, even while it’s happening.

You don’t have to just wait it out unaided though. There are two specific things you can do that interrupt what’s happening in your body rather than just distracting from it, and that’s exactly what’s next.

Why a Panic Attack’s Intensity Peaks, Then Passes

A panic attack’s physical intensity usually peaks around the 10 minute mark, then eases over the next 20 to 30 minutes, a longer window than the well-known 90 second rule, which wasn’t built for panic attacks.
That comparison is worth unpacking properly, since the 90 second rule shows up everywhere online. It’s a popular idea, associated with neuroanatomist Jill Bolte Taylor, but it isn’t an established, widely proven timeline, and it wasn’t built for panic attacks specifically. Using it here can actually work against you.

Where the 90 second rule actually comes from

The idea describes something a bit different: the initial physiological component of ordinary emotional reactions, like anger flaring up after a rude comment, or that hot flush of embarrassment. The general concept, that emotional reactions have an early physical surge, is reasonable. The specific 90 second figure is much less settled than the way it gets shared online might suggest.

A panic attack follows a different pattern. It’s not one quick spike, it’s a sustained cascade, adrenaline, a faster heart rate, changed breathing, all feeding into each other for several minutes at a time. Different process, different timeline. So if you’ve been waiting for it to lift at 90 seconds and it hasn’t, that doesn’t mean anything has gone wrong. It means you’re using a clock that was never built for this.

What’s actually happening between 90 seconds and 10 minutes

This stretch is usually the hardest part, and it’s worth knowing what’s going on in it. Your body is still ramping up. Adrenaline is still circulating. If you’re breathing fast, the carbon dioxide in your blood is still dropping, which is what keeps the tingling and light headedness going. For many people, the attack is still building toward its peak during this window, though the exact pattern varies from person to person, some are already close to their peak by this point.

That’s not a sign the attack is spiralling out of control. It’s the attack doing what panic attacks do, running its natural course. Knowing that this stretch is expected, not exceptional, can make it easier to get through without adding a second layer of fear on top, the fear that something’s wrong because it hasn’t stopped yet.

So if 90 seconds passes and you still feel awful, you haven’t failed at anything.

The core process isn’t something you’re failing to control. That said, things like repeatedly checking your pulse or spiralling into catastrophic thoughts can genuinely keep the fear and distress going longer, even if the underlying physical process is running its own course. Which is exactly what the next section can help with.

A more honest timeline

Panic attacks tend to build for the first couple of minutes, reach their most intense point around the 10 minute mark, then start to ease from there. By 20 to 30 minutes, most people are through the worst of it, even if they’re left feeling tired or a bit wrung out afterward.

That’s a longer window than 90 seconds, and that’s the point. Knowing the real shape of it, build, peak, ease, gives you something to hold onto that’s actually true, rather than a countdown that quietly sets you up to feel like it’s not working.

Two Techniques That Actually Interrupt a Panic Attack

Paced breathing and 5-4-3-2-1 grounding are two of the most practical ways to interrupt a panic attack, because they work directly against what’s happening in your body rather than just distracting from it.
There are dozens of things people suggest for panic attacks, cold water, humming, tapping, sour sweets, and several of them do have a real physiological basis, not just distraction. But two are worth learning properly, because they’re the most practical almost anywhere, and the reasoning behind them is easy to hold onto in the moment.

Start with paced breathing

If you only try one thing, make it this. Breathe in slowly through your nose for about 4 seconds, hold for 4, then breathe out slowly for 6. Repeat.

If you’ve been breathing fast and shallow, this helps for a specific reason. Hyperventilating drops the carbon dioxide in your blood, and that drop is a large part of what’s driving the tingling and light headedness. Slowing your breathing, and especially lengthening the exhale, helps carbon dioxide build back toward normal. You’re not just calming yourself down, you’re working directly against one of the physical processes involved.

It takes a minute or two to feel a difference. That’s normal. You’re not doing it wrong if it’s not instant.

Then, or alongside it: 5-4-3-2-1 grounding

Look around and name 5 things you can see. 4 things you can touch. 3 things you can hear. 2 things you can smell. 1 thing you can taste.

This works differently to breathing, but for a real reason too. In simple terms, part of your brain is currently treating ordinary sensations as threats, while another part is capable of calmer, more deliberate thinking. Deliberately noticing specific, neutral details around you, the pattern on the seat opposite you on the Overground, the sound of traffic outside, gives that calmer part something concrete to engage with. It’s a genuine shift in what your attention is doing, not just a way of ignoring the panic.

Why these two, in particular

Cold water on your face or wrists is a real technique too, worth knowing about. It can trigger something called the mammalian dive reflex, an old, automatic response that can slow your heart rate when cold water touches your face, though how strongly that happens varies from person to person. It’s a good option at home, less practical standing on a platform at Bank or in a meeting room.

Breathing and grounding both work anywhere, need nothing, and each addresses a different part of what’s going on, breathing mainly helps if hyperventilation is part of it, grounding mainly shifts where your attention and thinking are focused. Between them, they cover a lot of ground.

One more thing that matters: try not to fight it

It sounds counterintuitive, but fighting a panic attack, tensing against it, willing it to stop, arguing with your own body, tends to keep it going longer. Treating the panic itself as a threat gives your body’s alarm system something to keep reacting to. Letting the feeling be there, while you keep breathing and grounding yourself, tends to let the whole thing settle faster.

You don’t have to feel calm to do any of this. You just have to keep breathing and keep noticing what’s around you, and let the rest happen in its own time.

What Makes a Panic Attack Worse, Even When It Feels Like It’s Helping

Checking your pulse, trying to leave, holding your breath, and searching your symptoms online are common instincts during a panic attack that tend to make it feel worse rather than better.

Some of the things that feel like the right response to a panic attack are actually the things keeping it going. Not because you’re doing anything wrong, they’re just natural instincts that happen to backfire here. Worth knowing, so you’re not fighting yourself as well as the panic.

Checking your pulse, over and over

It feels sensible, you want to know if your heart is actually okay. But repeatedly checking pulls your attention straight back onto your body, and your body right now is already flooded with adrenaline. Every check finds a racing heart, because of course it does, that’s what’s happening. Finding it again reads as new evidence something’s wrong, which raises the anxiety, which raises the heart rate further. You end up feeding the exact loop you’re trying to check your way out of.

This is one of the patterns I see most often in session, someone convinced that checking will finally bring certainty, when it’s actually doing the opposite.

Trying to leave the situation

This one’s harder to hear, because leaving genuinely does bring relief in the moment. But that relief teaches your brain something specific: I escaped, therefore it was dangerous. Next time you’re in a similar situation, that lesson is already loaded in, and the anxiety shows up faster and stronger. If you can bear to stay, even just a bit longer than instinct says to, you’re teaching your brain the opposite lesson, that nothing actually happened, which is what makes the next time easier rather than harder. This is about staying with panic specifically, not about pushing through if something feels genuinely different or wrong, that’s always worth checking out, as covered earlier.

Holding your breath or breathing irregularly

Under pressure, breathing often goes wrong in ways you don’t notice, sometimes shallow and fast, sometimes briefly held, sometimes both at different points in the same attack. Whatever shape it takes, it disrupts the steady rhythm your body needs to settle the carbon dioxide levels that are partly driving the tingling and light headedness. Uneven breathing tends to prolong those sensations rather than ease them.

Googling your symptoms mid-attack

Searching “racing heart chest pain” while you’re panicking often turns up frightening explanations alongside the reassuring ones, and when you’re already anxious, the frightening ones tend to be what sticks. Reading through that mid-attack can easily add fuel right when you need the opposite.

Why watching for it makes it worse

All of this comes back to one pattern: closely monitoring your body for signs of danger tends to make you notice more of what you’re looking for. It’s called self-monitoring. Ordinary sensations, a slightly fast heartbeat, a bit of dizziness, get picked up faster and felt more intensely simply because you’re watching so closely for them. That heightened awareness can intensify how the whole thing feels, even without changing anything else.

What tends to help instead

Not checking. Not leaving, if you can manage to stay. Aiming for a steady, even breath rather than a held or erratic one. Putting the phone down rather than searching. None of this is about willpower, it’s just aiming your attention somewhere other than the loop that keeps feeding itself.

What’s Actually Triggering Your Panic Attacks

Panic attacks are often triggered by small physical sensations, like a fast heartbeat or a wave of heat, that get misread as danger, though sometimes there’s genuinely no clear trigger to find.

Once the panic has passed, a common next question is: why did that happen? That’s worth digging into properly, both when there’s a clear answer and when there isn’t.

When it feels like it came from nowhere

A lot of panic attacks don’t have an obvious external trigger, no argument, no stressful meeting, nothing dramatic happening. That can feel more unsettling than having a clear cause, like your own body turned on you for no reason.

But “no obvious trigger” isn’t necessarily the same as “no trigger.” Often, there was something small enough to slip past you, an internal sensation rather than an outside event. A slightly faster heartbeat after climbing the stairs at the tube station. A flush of warmth in a crowded carriage. A jittery feeling after too much coffee. None of that registers as anything on an ordinary day. But if your nervous system is already primed, from stress, poor sleep, or a run of difficult weeks, that small sensation can get misread as the first sign of danger. And sometimes, honestly, there isn’t a clear cause you can point to at all, which doesn’t mean anything’s being missed.

How a small sensation turns into a full attack

Here’s roughly how that happens. You notice something physical, a bit of dizziness, a faster heartbeat, tightness in your chest. Your brain, already on high alert, interprets that sensation as a threat. That interpretation activates your body’s wider threat response, adrenaline among other changes, which intensifies the very sensation you noticed in the first place. Now there’s more to notice, so the alarm gets louder, producing more of that response again. Within a minute or two, a genuinely small, harmless sensation has built into a full panic attack, and by the time you’re in the middle of it, the original trigger is easy to lose track of entirely. It wasn’t random. It just moved fast.

Trigger versus risk factor, they’re different things

It helps to separate two questions that often get blurred together. A trigger is what set off today’s attack specifically, that warm carriage, that jittery coffee feeling, that sudden dizzy spell. A risk factor is what makes someone generally more prone to panic attacks in the first place, ongoing stress, poor sleep, a stretch of major life changes, or simply a nervous system that’s currently running a bit hot. Risk factors set the stage. Triggers are what happens to walk onto it. You can work on lowering your risk factors over time, while still wanting to understand what tends to trigger things right now.

If you’re still working out your pattern

For many people who are new to this, it isn’t one single dramatic trigger, more often it’s ordinary stress quietly building in the background until your body’s threshold for a false alarm sits lower than usual. Against that backdrop, everyday physical sensations, caffeine, heat, a head rush from standing up too fast, poor sleep, can be enough to act as the spark. Specific situations, crowds, certain places, particular kinds of pressure, tend to become triggers later, once your brain has started associating them with a previous attack. So if you can’t immediately spot an obvious cause, that’s genuinely common, not a sign you’re missing something you should already understand.

What clients say

Example reviews, demo content for practice purposes

“I’d been to A&E three times convinced it was my heart. Once I understood what was actually happening in my body, the fear itself started to ease.”

 _{Client who worked on panic attacks}

“Learning to stop fighting it, and just breathe through it, made more difference than anything else I’d tried.”

 _{Client who experienced panic attacks}

If This Keeps Happening: What Panic Disorder Actually Looks Like

Panic disorder is usually considered when panic attacks keep happening and are followed by at least a month of persistent worry about having another one.

A single panic attack, or even a couple, doesn’t automatically mean panic disorder. If that’s where you are, everything above is what you needed. But if this keeps happening, it’s worth understanding what that might mean, calmly, and without jumping to conclusions.

A simple way to check

You don’t need to memorise clinical criteria for this. A rough, honest version is: if you’ve had repeated, unexpected panic attacks, and for at least a month afterward you’ve been genuinely worried about having another one, or you’ve started changing what you do to avoid one, that’s worth mentioning to a GP. Not because something’s gone badly wrong, but because it’s the kind of pattern that responds well to the right support, and there’s no benefit in carrying it alone longer than you need to.

This doesn’t mean something is fundamentally wrong with you

If part of what’s unsettling about this is the thought that you might be broken somehow, that’s worth addressing directly. You’re not. Panic disorder is a recognised, well understood pattern, essentially your body’s alarm system firing too easily and too often. It’s common, it’s treatable, and having it says nothing about your character, your resilience, or how well you’re coping with everything else. Plenty of people managing full, demanding lives in London, work, family, the general pace of it all, develop this pattern. It’s not a personal failing showing through.

In practice, this is usually the point people mention it, not during the worst attack, but weeks later, once the pattern of worrying between attacks has become its own kind of tiring.

What counts as a normal range

There isn’t one fixed number, and how frequency should be read really depends on context, so this is genuinely worth talking through with a GP rather than judging alone. What tends to matter more than the raw count is whether the fear of another attack has started shaping your choices, where you go, what you avoid, how far ahead you plan around it. If you’re unsure where you sit, that uncertainty itself is a perfectly good reason to mention it to a GP, rather than something to solve on your own first.

Why not having an obvious external trigger is actually part of the picture

It can feel more worrying when attacks seem to come from nowhere, no clear reason, no obvious cause. But that’s not an alarming detail on its own, it’s actually a recognised feature of how panic disorder often presents. As covered earlier, “unexpected” usually means there’s no obvious external cause, not that there’s nothing behind it at all, there’s often a small internal sensation underneath that’s easy to miss. So if you’ve been searching for a trigger and can’t find one, that absence isn’t evidence something stranger is going on. It’s simply consistent with the pattern itself.

What self-help can and can’t do

Self-help like this genuinely helps with occasional panic attacks. It’s not a substitute for a proper assessment if this has become a regular pattern, that’s what a GP or therapist is for.

NHS Talking Therapies offers free CBT (Cognitive Behavioural Therapy) for anxiety and panic, and you can usually refer yourself without needing to see a GP first. For panic attacks specifically, the technique often used is called interoceptive exposure, deliberately and safely bringing on the physical sensations panic involves, in a controlled way, so your brain gradually learns they’re not dangerous. CBT for Anxiety covers what that actually looks like in practice.

If any of this sounds familiar

None of this is about diagnosing yourself, that’s something for a GP, or a psychiatrist or clinical psychologist, to do properly. It’s just about recognising a pattern clearly enough to know it’s worth a conversation. And if you’d like to understand what that conversation, or working with a specialist, might actually involve, that’s covered on the How Therapy Works page, whenever you’re ready to look at it, no pressure either way.

Frequently Asked Questions

When You’re Not Ready to Do Anything Else Yet

You don’t need to decide anything right now. Reading this page, understanding what’s happening in your body, having a couple of techniques to reach for, that’s enough for today. You don’t owe yourself a bigger next step just because you’ve been through something frightening.

Some people have one or a few panic attacks and find that’s the extent of it, no further action needed. Others notice this keeps happening and start thinking about professional support somewhere down the line. Both are common responses, and neither one is something to feel embarrassed about. There’s no timeline you’re supposed to be on.

If you do start wondering whether it’s time to talk to someone, that thought doesn’t need to be acted on immediately either. You can sit with it for a while. Come back to this page when you need it. Whenever you do decide to look into support, that’s a reasonable time to do it, there’s no wrong moment to start, even if part of you wishes you’d looked into it sooner.

When and if you do want to understand what working with someone would actually involve, that’s covered gently on the How Therapy Works page, whenever that day comes, not before.