Anxiety Attack: Immediate Coping & Long-Term Management

During an Attack (Peak ~10 min)

1. Box breathing: Inhale 4 sec → hold 4 → exhale 4 → hold 4. Repeat.
2. Grounding (5-4-3-2-1): Name 5 things you see, 4 feel, 3 hear, 2 smell, 1 taste.
3. Cold stimulus: Splash face, hold ice cube—activates mammalian dive reflex, slows HR.
4. Move to lower-stimulation space if possible.
5. Remind yourself: “This is a panic attack. It will pass. I am safe.”

After the Attack

• Don’t avoid the situation—avoidance reinforces fear.
• Journal triggers: Time, place, thoughts, sensations.
• Schedule “worry time” (15 min/day) to contain rumination.

Long-Term Strategies

• CBT (Cognitive Behavioral Therapy): Gold standard—restructures catastrophic thoughts, exposure to interoceptive cues.
• Medication (if indicated): SSRIs/SNRIs first-line; benzodiazepines only short-term/rescue.
• Lifestyle: Regular sleep, exercise, caffeine/alcohol moderation.
• Mindfulness/MBSR: Reduces reactivity to bodily sensations.

When to Seek Help

• Attacks recurrent (≥2/month) or unpredictable.
• Significant avoidance or functional impairment.
• Co-occurring depression, substance use, or suicidality.

Anxiety is treatable. Start with your primary care provider or a therapist.