What to Do When You Have a Panic Attack

Written By Cora Taylor

DISCLAIMER: The information provided in this blog is for educational and informational purposes only and is not intended as medical or psychological advice, diagnosis, or treatment. Reading this does not create a therapist–client relationship. If you are in crisis or need immediate help, contact 988.

(Editor's Note: Welcome to Part 2 of our Active Exposure Series! In Part 1, we explored social anxiety. Today, we are shifting to physical anxiety and panic. When panic strikes, your first instinct is to fight it or force it to stop. In this post, we explain what is actually happening in your body during a panic attack—and why we need to stop fighting it.)

It’s 1:15 PM on a Tuesday. You are in the middle of a busy afternoon in Roseville—maybe working through a packed schedule, running errands, or managing your family's daily tasks. Out of nowhere, your chest tightens. Your heart starts hammering against your ribs, your vision feels slightly tunneled, and the air in the room suddenly feels too thin to breathe.

Your brain instantly hits the emergency button: “What is happening to me? I need to stop this right now.”

If you just typed "what to do when you have a panic attack" into Google while feeling that sudden surge of adrenaline, take a deep breath—not to force yourself to calm down, but to anchor yourself right here. You are physically safe, your body is not breaking, and this wave will pass.

When panic strikes a capable adult who holds themselves to high standards, the default reaction is to treat it like any other urgent problem: fight it, fix it, or force it to stop. But when it comes to panic, those standard instincts will trick you. Here is the evidence-based guide on what to actually do when panic hits—and why stopping the fight is the fastest way out.

Why "Trying to Calm Down" Backfires

If you search the internet during a panic wave, most generic articles will give you a list of quick distraction tricks: count five blue objects in the room, splash freezing water on your face, or force yourself to do box breathing.

While these tools are well-intentioned, and can be helpful in the sort-term, they have a fatal flaw: they treat the panic like an actual threat.

When you panic, your sympathetic nervous system fires off a surge of adrenaline. If you are sitting safely at a desk and immediately execute a frantic "rescue mission"—grabbing a water bottle, clutching your chest, or hyper-focusing on forcing your breath to slow down—your brain draws a logical conclusion: "We must be in mortal danger, because look at how hard we are fighting to survive!"

Psychologist Dr. David Clark identified this cycle as the Catastrophic Misinterpretation of Bodily Sensations (Clark). Panic isn't caused by your racing heart; it is caused by your brain interpreting that racing heart as proof of an impending collapse.

Furthermore, leading exposure researcher Dr. Michelle Craske introduced Inhibitory Learning Theory (Craske et al.). Her research shows that to overcome panic, we don't actually need to "calm down" during an attack. Instead, we need to teach our brains a new piece of data: that these physical sensations are uncomfortable, but fundamentally safe. When we use "safety behaviors" (like gripping tables, splashing water, or forcing deep breaths) to escape the feeling, we accidentally teach our brain that the feelings are dangerous and that we only survived because we fought them off.

To break this loop, we don't need better distraction tools. We need to teach your brain that the physical alarm, while deeply uncomfortable, is fundamentally harmless.

THE ANATOMY OF A PANIC LOOP How fighting normal body sensations creates a cycle of panic THE PANIC LOOP 1. Normal Physical Sensation Slightly elevated pulse, tight chest, or dizziness (Triggered by stress, fatigue, coffee, or heat) 2. Catastrophic Thought "Something is wrong!" "I'm going to pass out or lose control." 3. Brain Registers Threat Amygdala fires the fight-or-flight alarm Releases a surge of adrenaline & cortisol 4. Symptom Escalation Physical sensations multiply Heart pounds faster, vision tunnels EVIDENCE-BASED EXPOSURE THERAPY PROTOCOL


3 Actionable Steps to Handle Panic in Real-Time

Instead of white-knuckling your way through the wave, use these three evidence-based steps during your next panic surge:

Drop the "Rescue Mission" (Ditch Safety Behaviors)

The moment you feel panic rising, resist the urge to deploy a safety crutch. Don't run to the restroom, don't check your pulse, google your symptoms for reassurance, and don't try to force your body to relax. It’s easy to fall into these traps of “I have to have my water bottle/fidget toy/best friend on the phone/ etc. or else I can’t handle it”. But giving into the belief just reinforces the idea that we aren’t capable on our own. According to research by Dr. Michelle Craske at UCLA, dropping these "safety behaviors" allows your brain to experience inhibitory learning—the realization that you survived the surge without needing to be saved (Craske et al.). Things will be uncomfortable, but there is no need to be afraid.

Describe the Data Like an Objective Scientist

When panic hits, your mind generates catastrophic narratives ("I'm going to pass out in front of my team"). Counter this by stripping away the drama and stating cold, physical facts: "I am noticing a sensation of tightness in my throat. My heart rate is currently elevated. My skin feels warm." Describing physical sensations without adding emotional labels activates your prefrontal cortex, helping you observe the physiological wave rather than getting swept away by it.

Use Paradoxical Invitation (TEAM-CBT)

Pioneered in TEAM-CBT by Dr. David Burns, Paradoxical Invitation means leaning into the symptom rather than pushing it away (Burns). When panic whispers, "Your heart is going to explode," talk back to it with quiet defiance: "Okay, heart, beat even faster. Let's see how high we can get this pulse." By demanding more of the sensation, you shatter the illusion of fear that panic relies on. You take the steering wheel back. (This is more advanced, so if you are interested in it but nervous to start, a therapist with experience in exposure can certainly help get you going.)

How to Stop Panic Long-Term, Not Just Manage It

The steps above will help you handle a panic attack when it hits. But if you want to stop panic attacks from coming back in the long run, managing the moment is only the first step. The gold-standard treatment for lasting relief is a technique called Interoceptive Exposure (Barlow and Craske).

In Interoceptive Exposure, we safely recreate the mild physical sensations that trigger your anxiety—like a racing heart, tight chest, or lightheadedness—in a controlled environment. Then, you practice sitting with those feelings without running away, checking your pulse, or trying to force yourself to calm down.

The goal is not to promise that you will never feel anxious again. The goal is to retrain your brain so it learns a simple truth: these physical sensations are uncomfortable, but they are not dangerous.

(Stay tuned for our next post in the Active Exposure Series, where we will pull back the curtain on Interoceptive Exposure and show you exactly what happens inside an in-office session step-by-step!)

A Gentle Reframe

Instead of thinking, "I am losing control and I have to stop this panic attack right now," try shifting to this: "My body’s internal smoke detector is going off for a burnt piece of toast. The alarm is loud and obnoxious, but there is no actual fire. I can let the alarm ring while I stay right here."

About the Author

Cora Taylor, LMFT, is a California licensed therapist dedicated to helping high-functioning adults break free from panic attacks, worry loops, and sleepless nights. Utilizing active, short-term approaches like Exposure Therapy and CBT-I, she helps clients move out of survival mode and expand their comfort zones. She provides convenient virtual therapy throughout California and has limited in-person sessions available at her Roseville office.

Medical Clearance for Exposure Exercises: Before attempting any exposure exercises—especially Interoceptive Exposure exercises that deliberately induce physical sensations (such as elevated heart rate, hyperventilation, or lightheadedness)—you must consult with a licensed medical physician or physician assistant to rule out underlying medical conditions. Interoceptive exposure should not be practiced without prior medical clearance if you have or suspect you have conditions including, but not limited to:

  • Cardiovascular disease, high blood pressure, or heart conditions

  • Asthma, COPD, or other respiratory disorders

  • Seizure disorders or epilepsy

  • Recent surgery, physical injury, or fainting disorders (syncope)

  • Pregnancy

Exposure therapy is most safely and effectively practiced under the direct guidance of a licensed mental health professional. If you experience severe distress, chest pain, shortness of breath, or a medical emergency, stop the exercise immediately and seek emergency medical care.

In Case of Emergency: If you are in crisis or experiencing a mental health emergency, please call or text 988 (the Suicide & Crisis Lifeline in the US) or go to your nearest emergency room.

Keep Reading | Explore the Active Exposure Series

Social exposure is a powerful way to handle social anxiety. But exposure therapy can help with many types of fear. Explore other parts of this skills-building series:


Step Out of the Panic Loop

Conquering panic isn't about learning how to stop an attack from happening; it's about realizing you don't have to stop it to be completely safe.

If you are tired of living in fear of the next sudden adrenaline wave and are ready to reclaim your confidence at work and at home, I’m here to help. I work with driven adults in Roseville, CA, and across California using targeted, evidence-based exposure therapy and CBT protocols.

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References

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Social Exposure | Breaking the Judgment Trap