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Coping with a familiar panic attack: a simple plan

Alanoud AlturkiMedical review: Tatmeen team7 min read
دوامة حمراء وكحلية تعبر مشهدًا أزرق للماء والجبال، وتظهر دائرة فاتحة في السماء.
Article contents
  1. Reduce what you need to do right now
  2. Start with one comfortable step
  3. Should you stay or leave?
  4. After the wave settles
  5. What helps outside an attack?
  6. A short plan to prepare before the next episode
  7. Frequently Asked Questions
  8. Sources and references
  9. Writer and reviewer

If a doctor has assessed your symptoms and identified panic attacks, you may remember the explanation when you feel calm but struggle to recall it when your heart starts racing. Prepare a short plan at a calm moment: where you can stop safely, what helps and whom you would like nearby. You can refer to it when fear starts, while watching for symptoms that need medical help.

Call 997 for an ambulance in Saudi Arabia if you have any of these warning signs:

  • Severe breathing difficulty, such as gasping, choking or being unable to speak.
  • Chest tightness or heaviness, or pain spreading to the arm, back or jaw.
  • Very pale, blue or grey lips or skin.
  • Sudden confusion.

Loss of consciousness1 also requires medical help. Do not wait for the episode to end or a calming technique to work, and do not drive yourself. A previous panic diagnosis does not rule out a new medical problem.

If this is your first episode, or symptoms are new or different, seek appropriate medical assessment rather than assuming panic. The following steps are for a familiar pattern already assessed. They do not replace your doctor's or therapist's plan.

For symptoms, why attacks may begin, and how a panic attack differs from panic disorder or generalized anxiety, read the panic recognition and assessment guide after addressing any need for medical care.

Reduce what you need to do right now

If you are driving or operating machinery, stop safely and step away from the task requiring full attention. Sit somewhere suitable3 if you can.

A brief reminder may help: “This resembles the episodes my doctor assessed. A panic wave generally subsides with time5. I'll start with one step from my plan and seek help if symptoms change.” You can do this while still feeling afraid.

Start with one comfortable step

Choose something from your plan that suits you. You might keep your feet on the ground and look at one stationary object, such as a chair: notice its colour and position, then return to what you are doing. Or ask someone you trust to sit quietly beside you. Paying attention to your surroundings6 is an optional form of support. It does not establish the cause of your symptoms, and you do not need to count a set number of objects.

If your existing plan shows that gentle breathing helps, let your breath move in and out comfortably4 without forcing a deep breath or holding it. Count if you find that comfortable, or leave counting out altogether.

If focusing on breathing increases discomfort or dizziness, stop the exercise and return your attention to your surroundings or to support from someone you trust. Do not breathe into a paper bag3: it can worsen the situation if symptoms have another cause.

You do not need to try every technique. You may still feel afraid despite using suitable coping steps; there is no deadline for becoming calm. If the plan adds to your distress or is hard to use, bring that up at follow-up so you and your clinician can adjust it.

Should you stay or leave?

Choose what keeps you safe now. You can move to a less crowded place if you want to and can reach it safely. If that is not possible, start with what you can do where you are. If treatment involves gradually addressing avoidance, agree with your therapist what to do if an attack returns in the situations you are working on together.

Therapeutic exposure is an agreed part of treatment5 and may involve learning to respond to feared bodily sensations. It is not an improvised instruction to induce dizziness or a racing heart alone, and a companion should not force you to do it.

After the wave settles

Allow enough time before returning to driving or another activity requiring alertness. Seek medical advice if an unusual symptom persists or you are unsure what explains it. Fear subsiding does not establish the cause of a symptom.

You can make three brief notes: what happened, what differed, and what helped or made things harder. For example: “Fear started while I was waiting. My friend sitting quietly helped, but counting breaths made me focus more on choking.” Take the notes to an appointment. You do not need to monitor every heartbeat or record each minute.

If fear of attacks is changing your journeys, work or sleep, a technique used during episodes may not be enough. Panic treatment addresses attacks, avoidance and the time between episodes.

What helps outside an attack?

Enough sleep, activity appropriate for your health, and social support can support recovery, but do not replace treatment when needed5. If symptoms seem linked to stimulants, a medicine or an activity, tell your doctor rather than stopping prescribed treatment independently.

You can seek psychological treatment now if you need it. A doctor may also discuss medication based on your needs and preferences. Explain what you can manage in your day and what is difficult, so those circumstances inform the plan.

A short plan to prepare before the next episode

You can put this card into your own words and discuss it with your therapist:

When my familiar pattern appears: I stop any hazardous task and choose one step that has helped before.

The person I would like nearby: … What I want from them: brief conversation / quiet company / another agreed form of help.

I call 997 for an ambulance in Saudi Arabia if any of these warning signs occur:

  • Severe breathing difficulty.
  • Chest tightness or heaviness, or pain spreading to the arm, back or jaw.
  • Very pale, blue or grey lips or skin.
  • Sudden confusion or loss of consciousness.

I do not wait for calming to work or drive myself.

First, new or different symptoms without these signs: I seek appropriate medical assessment; this card does not establish panic.

At follow-up: I describe avoidance and fear between episodes, and what helped or troubled me during them.

You do not need to complete the whole card while afraid. Its value is reducing the decisions required in the moment while leaving room to change the plan when needed.

Frequently Asked Questions

What should I do during a panic attack?

Stop safely first, then start with one comfortable step from your plan. If you are driving or operating machinery, stop safely and sit somewhere suitable if you can. You might keep your feet on the ground and look at one stationary object, or ask someone you trust to sit quietly beside you. You can do this while still feeling afraid. These steps are for a familiar pattern already assessed; new or different symptoms need medical assessment.

When should I call an ambulance during a panic attack?

Call 997 for an ambulance in Saudi Arabia if you have severe breathing difficulty, such as gasping, choking or being unable to speak; chest tightness or heaviness, or pain spreading to the arm, back or jaw; very pale, blue or grey lips or skin; or sudden confusion. Loss of consciousness also requires medical help. Do not wait for the episode to end or a calming technique to work, and do not drive yourself. A previous panic diagnosis does not rule out a new medical problem.

Does breathing into a paper bag help a panic attack?

Do not breathe into a paper bag: it can worsen the situation if symptoms have another cause. If your existing plan shows that gentle breathing helps, let your breath move in and out comfortably without forcing a deep breath or holding it. If focusing on breathing increases discomfort or dizziness, stop the exercise and return your attention to your surroundings or to support from someone you trust.

What if I still feel afraid after trying to calm down?

You may still feel afraid despite using suitable coping steps, and there is no deadline for becoming calm. A panic wave generally subsides with time, and you do not need to try every technique. If the plan adds to your distress or is hard to use, bring that up at follow-up so it can be adjusted. If symptoms are new or different, seek appropriate medical assessment rather than assuming panic.

When do panic attacks need treatment?

If fear of attacks is changing your journeys, work or sleep, a technique used during episodes may not be enough. You can seek psychological treatment now if you need it, and a doctor may also discuss medication based on your needs and preferences. Enough sleep, activity appropriate for your health and social support can support recovery, but do not replace treatment when needed.

Writing and article review

Alanoud AlturkiWritten byAlanoud Alturki

Content writer and researcher at Tatmeen, writing in Arabic and English on mental health and everyday life topics, including relationships, stress, work, habits, and family.

Tatmeen teamMedical reviewTatmeen team

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