Helping Someone During a Panic Attack: A Step-by-Step Support Guide

Panic attacks are acute, overwhelming surges of fear with intense somatic symptoms (palpitations, dyspnea, chest pain, derealization). Your calm, structured response can significantly shorten duration and reduce distress.

Immediate Action Framework (ALGEE Adapted)

1. Assess Safety & Environment

• Move to quieter, less stimulating space if possible.
• Offer seated or grounded position (feet flat, back supported).
• Remove hazards (sharp objects, hot liquids).

2. Listen Non-Judgmentally & Reassure

• "I'm here with you. You're safe. This will pass."
• Validate: "What you're feeling is terrifying, but it's a panic attack—not a heart attack."
• Avoid: "Calm down," "It's nothing," "Breathe!" (commands increase pressure).

3. Guide Grounding & Breathing

• 5-4-3-2-1 sensory grounding: Name 5 things you see, 4 feel, 3 hear, 2 smell, 1 taste.
• Paced breathing: Inhale 4 sec → hold 2 → exhale 6 sec. Model it visibly.
• Box breathing: 4-4-4-4 (inhale-hold-exhale-hold).
• Do not use paper bag rebreathing (outdated, can worsen hypoxia).

4. Respect Autonomy & Boundaries

• Ask before touching: "Is it okay if I put a hand on your shoulder?"
• Some want contact; others feel trapped. Follow their lead.
• Offer water (sips) only after acute hyperventilation subsides.

5. Time & Patience

• Peak intensity: 5–10 minutes; residual anxiety: 30–60+ minutes.
• Stay present. Silent companionship is powerful.

6. Post-Attack Support

• Debrief gently when they're ready: "Want to talk about what triggered it?"
• Encourage professional help if attacks are recurrent, unexpected, or life-limiting.
• Provide resources: therapist directories, crisis lines (988 US), apps (Insight Timer, Calm).

Red Flags → Call Emergency Services

• Chest pain radiating to arm/jaw, crushing quality
• Syncope, seizure, confusion persisting >10 min post-attack
• First-ever attack in older adult or cardiac history
• Self-harm ideation expressed

Your role: Anchor, not fixer. Presence > perfection.