How to help someone having a panic attack: 3 immediate actions you can take
It happened in the last place I wanted it to: the airport security line at Newark Liberty International Airport. Someone had accidentally taken my laptop and I had a panic attack.
I knew what was happening, even as I asked an overwhelmed TSA agent what I was supposed to do about my bag. My breath started to rattle. My heart rate jumped. My skin crawled with chills, and my environment started to appear distorted. I sat down. People stared, their concerned eyes looking at me over their face masks.
As I tried to breathe, an angel appeared. Vanessa from United Airlines crouched next to me in heels, gently asked if I wanted help, if she had permission to touch my arm, and basic, grounding questions. Then she led me to a private space to compose myself.
Having a panic attack sucks, but it’s also difficult to know how to help someone having an attack with such grace as Vanessa. Most people will have one or two panic attacks at some point in their life. If you haven’t had one, it’s likely you’ll come across someone who is in the midst of a panic attack. What Vanessa did helped me. Experts tell me there are other helpful steps you can take, too.
What is a panic attack?
Panic attacks are both common and distressing. Triggers for a panic attack can vary — like financial stress or a painful memory — but they can also have no clear cause.
Critically, a panic attack is not a measure of your ability to cope, explains psychologist Jenn Cooper.
“These physical sensations are very real and not ‘in their head,’” Cooper tells me.
During a panic attack, the body’s sympathetic nervous system becomes activated and the parasympathetic nervous system is dulled. This is why the body shifts into “fight or flight” mode, rather than “rest and digest.” Blood pressure rises and the parts of the brain which respond to fear become hyperactive.
A 2011 study published in the journal Biological Psychiatry suggests only three of 13 symptoms associated with panic attacks are psychological:
- A feeling of unreality
- A fear of losing control
- A fear of dying
The physical symptoms, like chest pain and shortness of breath, can cause people to initially believe they are having a heart attack.
Importantly, if you have a panic attack, it does not mean you have panic disorder, but they are a feature of the condition. When people meet the criteria for the disorder, however, and they seek help for panic attacks, they are often advised to try cognitive behavioral therapy. Raphael Rose, a clinical psychologist and a researcher at the University of California, Los Angeles, explains this approach encourages people to face their fear and build resilience.
“People with panic often interpret their avoidance behavior — such as leaving a situation, pulling the car off the road; lying down when feeling dizzy — as proof that they were out of control or bad things were going to happen, when in fact it just really supports how scared or worried they felt,” Rose tells me.
This approach encourages people to not fall back on avoidance behaviors and instead face the situation. The idea is they will learn that the thing they fear won’t happen and realize they are capable of coping.
How to help someone with panic attacks
Helping someone having a panic attack is grounded in the same approach: The goal, Cooper explains, is to help someone regulate their physical sensations and make them feel safe.
First, she recommends approaching the person and offering to help them sit or find a quiet space. Everyone reacts differently in these kinds of situations, Cooper explains, so it’s good to ask if they need or want your help first. Then there are three powerful actions you can take.
1. Focus on breath
“The most powerful tool to help someone with a panic attack is to encourage them to breathe,” Cooper says.
A panic attack can make breathing become rapid and shallow, which actually perpetuates the feeling of being threatened. Try to encourage a person having a panic attack to breathe deeply and slowly: Cooper recommends breathing in for 4 seconds and out for 4 seconds. Even better, do it with them, she says.
“Model it for them so they follow along rather than having to do the thinking,” Cooper says.
2. Bring them cold water
Cold water can be useful because it triggers our parasympathetic nervous system, which is calming. This system essentially switches the body’s function back from a high alert mode to a restful mode after an emergency passes.
“A really cold glass of water, running wrists under cold water, or splashing our faces with cold water can be helpful,” Cooper says.
3. Distract them
“Distraction is also really useful for panic as our brains can’t really focus on more than one thing at a time,” Cooper says.
“Chat away to them — without expecting a response — to get their minds distracted from the panic.”
One option: Ask them to describe what is happening. This can help take their focus away from feeling unsafe.
“Encourage them to sit with the feelings.”
Another option is more dependent on the person you’re interacting with: You can hold the person’s arm as you stand facing them. But the person experiencing panic may not want to be touched, so you need to ask them permission before you touch them. Remember you are trying to help them regulate their nervous system.
If a person is learning how to manage panic attacks with cognitive behavioral therapy, Rose says you can encourage them in their practice. Rose says he sometimes holds a therapy session with the client and their trusted friend or family member so that they can learn more about panic and how they can best support the person.
Typically, Rose encourages them to “validate that the person is experiencing intense anxiety or fear and to encourage them to sit with the feelings and learn they can tolerate and face them in ways they didn’t think they could.”
How to know if someone is having a panic attack
Panic attacks, Rose says, are usually not overtly noticeable. Anxiety and fear are typically private feelings: You’re more likely to see someone leaving a situation because they feel anxious or are worried about panicking (as seen in Ted Lasso), rather than letting you be privy to the experience.
“Distraction can be really powerful in this instance.”
With that in mind, you should be careful not to assume a person you see experiencing distress is having a panic attack, Cooper says. Instead, ask them if they are okay, do they need help, and do they need you to call someone or an ambulance.
“If someone is having a panic attack in a public place, having everyone notice them might be their worst nightmare and make it worse,” Cooper says. “If the person has someone else with them, then I would suggest giving them some space.”
If they are on their own and say yes to your help, you could guide them to a safe and quiet place and then ease into simple conversation, like telling them about yourself or the weather.
“Distraction can be really powerful in this instance,” Cooper says.
Be explicit in your communication, Cooper says. For example, you can ask: “Why don’t we move over to this bench so you can catch your breath? Is it okay if I put my hand on your arm and we breathe together?”
Whether you’re helping a stranger or someone you’re close to, it’s important to remember that seeing someone having a panic attack may trigger some degree of panic in yourself, Cooper says. Notice your anxiety, tell yourself it will be okay, and work on your breathing.