What to do when someone beside you is having a panic attack

“We were standing in the car park outside the shop and I did not know whether to hug her or call an ambulance. I managed to get both wrong.”

That is what a man told me who came to see me on his own, without his partner, because he wanted to know what to do next time. That strikes me as one of the better reasons for a first appointment. It is also one of the rarer ones – the people closest to us usually assume panic is the business of the person having it, and that their own job is simply to wait.

It is not. What the person beside someone does during a panic attack meaningfully affects how long the attack lasts, and even more what the nervous system of the person having it learns from it. That is good news and bad news at once: it means you can help, and it means you can also do harm by accident.

The first thing that happens to you

Before we talk about them, I have to say something about you.

When someone beside you goes pale, starts shaking and says they are dying, your body responds exactly as it would to real danger. Your heart speeds up, your palms cool, your voice rises half a tone. This is normal and it is not a fault. It is a problem, though, because a person in panic reads your state faster and more accurately than your words.

People in high arousal are extremely sensitive to the face and voice of someone close. If you say calm sentences with a tense face and a fast voice, they will hear the tension, not the sentences. So the first thing you do for yourself is also the first thing you do for them: slow yourself down. Sit or stand beside them, do not loom over them. Reduce the speed of your movements. Let your pitch drop, not your volume.

This is not a technique that needs practising with a stopwatch. It is simply the awareness that in that moment you are two nervous systems in one room, and one of them will adjust to the other.

Sentences that help

People often ask me for exact words, and they are right to – in the middle of an event you cannot invent anything.

“I am here. I am not going anywhere.”

“I know what this is. It is a panic attack. It passes.”

“You do not have to do anything. I am here until it passes.”

“Breathe with me if you want. Slowly out.” – and then breathe out slowly yourself, so they can hear it.

“You do not have to talk.”

“Shall we move away from the crowd?” – a question, not an instruction.

You will notice they are all short. That is not style, it is necessity: during an attack working memory narrows and a long sentence cannot be processed. If you say “listen, you know this isn’t dangerous, remember what your therapist told you when you talked about how your body”, you lost them on the third word.

Sentences better left unsaid

“Calm down.” Nobody has ever calmed down because they were told to. The sentence only says that their state is bothering you too.

“It is nothing, really.” To them, in that moment, it is a great deal. When you deny it, they feel alone.

“Take a deep breath.” During panic a person is already breathing too much. A deep breath blows off even more carbon dioxide and worsens the dizziness and tingling. The opposite helps: a slow, long exhale. I explained this in detail in the piece on what happens in the brain during anxiety.

“Why is this happening again?” The question demands an explanation the person does not have. It adds shame.

“Don’t be silly, people are watching.” I will not comment on this one.

And one that looks kind: “We are going home right now.” More on that two sections below.

What about physical contact

Ask. Always ask. “Is it all right if I hold your hand?”

For some people touch helps markedly. Experiments in which brain responses were measured during an announced unpleasant stimulus showed that holding the hand of a close person noticeably lowers activity in threat-related regions – and that the effect is largest in couples who are close. So a hand is not merely symbolic.

For other people touch during an attack is unbearable. The skin is oversensitive, the sense of being trapped increases, an embrace registers as restriction of movement. That difference is not a matter of love but of physiology, and you cannot guess it. So you ask. If they cannot answer, put a palm on their back or shoulder and watch: if the body pulls away, take your hand away without taking offence.

When to call an ambulance

This is the question that torments people closest most, so let it be clear.

Call if this is the first such event and you do not know what it is. Call if the chest pain is crushing, if it spreads into the arm, neck or jaw, if the person is older, has known heart disease, diabetes or high blood pressure. Call for sudden severe breathlessness that does not ease, for loss of consciousness, for sudden weakness on one side of the body, slurred speech or a drooping face. Call if it followed a head injury or drug use.

Do not call because the attack is long and frightening, if you know what it is and none of the above signs are present. Emergency services will not cure a person with panic, and a trip to A&E often entrenches the belief “I nearly died”, which will lengthen the next attack.

The middle ground between the two is probably the most useful: do not call an ambulance, but do arrange a check-up with a doctor next week. What a doctor should look at I described in the piece on when to see a psychiatrist first.

Why rescuing feeds panic

Now for the part that may sound harsh.

If every time panic appears you leave the shop immediately, if you take over the driving, if you make the phone call they dread, if you go everywhere they would not go alone – each of those acts is followed by relief. And relief is a reward. The nervous system learns: it would have been terrible if my partner had not stepped in.

In the literature this is called family accommodation, and in anxiety disorders it is one of the best documented predictors of a poorer outcome. It is not a sign of a bad partner. On the contrary, it appears precisely in those who care most.

The change is not that you stop helping. It is that you help differently: you stay beside them, you do not take over. “I am here, we will wait until it passes, and then we will go to the till” is something other than “leave it, I will do it”. The first says they can; the second says they cannot.

This conversation has to happen while calm, not in the middle of an attack, and it has to be a shared agreement, not your decision. Otherwise it reads as a withdrawal of help. I wrote something about how such boundaries are drawn without leaving anyone alone in the piece on setting boundaries.

What about the people around you

If this happens in public, the shame is often worse than the symptoms. People stop, someone brings a chair, someone suggests water, someone films. Your job is simple: put yourself between them and the audience.

One sentence is enough, said calmly and without explanation: “Thank you, we have everything we need.” Nobody needs to be told what is happening. Your person’s diagnosis is not information for passers-by, and the fear that everyone will see is one of the largest factors keeping panic alive. If you notice them gripping your sleeve and staring at the ground, move them a few metres – not home, just out of sight, to the edge, to a bench, into a corner.

That distinction is small and important at once. Stepping out of view is not fleeing the situation; going home is. The first lowers shame, the second entrenches avoidance. I wrote about how shame works and why it is so hard to shake in the piece on shame.

When the attack passes

For the first ten minutes afterwards a person is exhausted, often embarrassed and sometimes angry. Do not start a conversation about causes. Do not say “see, I told you it would pass”, because that sounds like a victory over them.

Offer water. Sit for a few more minutes. If at all possible, do not leave the place where it happened straight away – five minutes of quiet sitting in the same spot is a small but real exercise for a nervous system that otherwise learns this room must be escaped.

Leave the conversation for the next day. Then ask the question that matters: “What helped yesterday and what did not?” The answer will be more useful than anything you have read, including this piece.

If it is your child

With a child or adolescent the same applies, with two additions.

First, a child reads your face even more than an adult does. If you become frightened, they will learn that the thing is frightening. If you stay boringly calm, they will learn something else.

Second, with children the temptation to accommodate is even greater – writing a note for school, allowing them to stay home, taking over the phone call. It relieves in the short term and builds avoidance that is harder to dismantle later. If the attacks recur, it is worth involving a professional sooner rather than later.

Where this advice does not hold

Now the section that argues against itself, and I think it is the most important one here.

All of the above assumes you are a calm, available person with enough room to lend someone else your nervous system. Often you are not. If you have an anxiety disorder yourself, if you are exhausted, if the attacks have been happening four times a week for a year, you will not manage this – and that is not a flaw of character.

People close to someone with panic disorder often develop anxiety of their own; monitoring a partner’s state becomes a job, and the relationship slowly reshapes itself around the symptom. If you recognise yourself in that, the right next step is for you, not for them: someone to talk to about your own part in this relationship. I wrote about how support wears a person down in the piece on the signs of burnout.

And one more thing that sometimes disappoints: you are not your person’s therapist and you cannot be. You can be the one who stays. That is in fact the bigger thing, only quieter.

What to remember

During an attack do little, and do it slowly. Sit beside them, speak briefly, ask before touching, demonstrate a slow exhale instead of instructing “take a deep breath”.

Do not tell them to calm down, do not deny it, do not demand an explanation. Name what is happening and say that you are staying.

Call emergency services for a first attack, for crushing chest pain, for signs of a stroke, or whenever you have serious doubt. Otherwise do not – A&E does not treat panic.

And take care that helping does not become taking over. Stay beside them, do not step in for them. If this is beginning to cost you too much, you need help as well; that is not a betrayal, it is the condition for being able to stay.