How to Help Someone Having a Panic Attack: A Calm Guide for Loved Ones

Want to help someone having a panic attack? Learn what to say in the moment, what to avoid, when to call for help and how to offer support in the longer term.

It is the second day of bayram (one of Turkey's religious holidays, when families gather) and you are in a crowded house. Suddenly your spouse turns pale, their hands start shaking, and they turn to you and say, "I can't breathe." The people around you get to their feet; someone opens a window, someone brings water, someone asks, "Should we call an ambulance?" And you freeze, not knowing what to do. Helping someone who is having a panic attack looks simple from the outside, but in the moment people very often feel helpless. The fear of the person you love spreads to you as well. This article was written for people whose spouse, child, mother, friend or colleague has panic attacks: what can be done during an attack, which words do not help, when emergency help should be called, and how support can be given in the longer term?

How to Help Someone Having a Panic Attack: What Should You Understand First?

Before you start helping, knowing briefly what a panic attack is also calms your own fear. A panic attack is the body's alarm system working at full power when there is no real danger. The heart speeds up, breathing tightens, the hands may go numb, and the person feels as if they are going to faint, die or lose their mind. An attack usually peaks within a few minutes and begins to subside on its own.

The point that loved ones find hardest is this: the terror the person is experiencing is real, but the danger is not. Both of these need to be held in mind at the same time. If you belittle the fear, the person is left alone; if you magnify the danger, their fear grows. The essence of helping is finding a calm place between the two.

If you would like to understand the course of panic attacks in more detail, the article do panic attacks come back? can help you make sense of the period after a first attack in particular.

Safety First: When Should You Call 112?

From the outside, a panic attack and some medical emergencies can look very similar. For this reason, call 112 (emergency services) without hesitation in the following situations:

• The person is experiencing an attack like this for the first time and has not had a medical assessment before
• Chest pain feels like pressure or tightness, or spreads to the arm, jaw or back
• The person has fainted, their consciousness is clouded or their speech is affected
• There is blueness of the lips, marked difficulty breathing or wheezing
• The person has a known heart, lung or diabetic condition and the symptoms are unusual
• You or the person are not sure what is happening

Even for someone who has had many panic attacks before and has been assessed by a doctor, calling for help is the right decision if the symptoms change. An ambulance called unnecessarily is always better than help that arrives too late.

What Should You Do During the Attack?

If you know the person has previously been diagnosed with panic attacks and that this attack is similar, the following steps can give you direction.

1. Slow yourself down first. Take a breath, drop your shoulders, lower the tone of your voice. Calm is contagious; so is panic. Your body tells the other person "there is no danger" before your words do.
2. Speak briefly and clearly. Instead of long explanations, choose a few simple sentences: "I'm here." "This is a panic attack; it will pass." "There's no need to hurry."
3. Ask what they want. Some people want their hand held; others are uncomfortable being touched. Questions such as "Would you like me to hold your hand?" or "Shall we move somewhere a bit quieter?" give the person back a sense of control.
4. Simplify the surroundings. If you are somewhere crowded, gently ask the people around to give a little space. Everyone offering suggestions at once overwhelms the person even more.
5. Accompany their breathing; do not force it. Rather than saying "Take a deep breath", breathe out slowly and for a long time yourself, and suggest that they breathe out with you if they wish. Counting along can also help: "Breathe in to four, breathe out to six."
6. Bring their attention to the present moment. You can ask the person to name a few objects they can see around them, or to feel their feet on the floor. You can find different examples of these methods in the article on grounding techniques.
7. Wait for the attack to pass. There is no need to try to force the attack to stop. Your job is to make sure the person does not go through this wave alone.

What Not to Say When You Help Someone Having a Panic Attack

Some well-meant words can unintentionally increase fear or shame. Knowing them makes it easier to choose what to say in the moment.

• "Calm down!" The person already wants to calm down but cannot. These words remind them of something they are failing to do.
• "There's nothing wrong with you, you're exaggerating." The storm in their body is very real. These words deny what the person is going through and leave them alone.
• "Pull yourself together, people are watching." Shame increases anxiety. Especially when visiting, at a wedding or at work, these words can prolong the attack.
• "Not again?" Your tiredness is understandable, but these words make the person feel like a burden.
• "What if you're having a heart attack?" If your worry is genuine, call 112; but voicing catastrophic scenarios out loud multiplies the person's fear.

The sentences you can say instead are simple: "I'm here", "I hear you, I know how frightening this is", "It will pass, let's wait together", "Tell me whatever you need."

In a moment of panic, what helps most is not the right words but an unhurried presence.

Paper Bags, Cologne and Other Habits

In Turkey, someone having a panic attack is often given cologne to smell (a traditional household remedy), sugared water or lemon, and is sometimes told to breathe into a paper bag. Cologne or a sip of water can be harmless and comforting. Breathing into a paper bag, however, is a method that is no longer recommended; it can be risky, particularly if the symptoms actually stem from the heart or lungs. Such objects can also, over time, feed the belief that "I can't get through it without these."

After the Attack Has Passed: The First Few Hours

When the attack ends, the person is usually tired, embarrassed and still a little jumpy. In these hours you can:

• Avoid interrogating them. A flood of questions such as "Why did it happen, what were you thinking, what did you eat this morning?" turns attention back to the body and the attacks. If the person wants to talk, listen.
• Return to the usual flow. If the person wishes, going back to the unfinished meal, the conversation or the walk shows that the attack has not brought life to a halt. Taking them straight home or putting them to bed is not always necessary.
• Acknowledge them. Saying "That was a hard few minutes, but you got through it" helps the person see their own resilience.
• Remind them about a medical assessment. If the attacks are new or becoming more frequent, gently suggest they see a doctor.

How Can You Offer Support in the Longer Term?

The moment of an attack lasts a few minutes, but the real support is given in the days between attacks. Helping someone who has panic attacks is often less about the few sentences you say during an attack than about the patience you show in the weeks that follow. Whether the person takes the metro again, sits down at a crowded table or goes shopping alone is directly affected by how the people around them accompany these steps. The most common trap here is over-accommodation: behaviour carried out with love that nevertheless feeds the fear.

Let us say a mother starts driving her daughter to work every morning after the daughter has an attack on the metro. After a while the daughter stops taking buses and dolmuş minibuses as well. The mother's love is real, but without realising it she is helping to make sure her daughter never returns to the place she fears. Similarly, someone who turns down every social invitation for fear that their spouse will have an attack narrows the world of the relationship too.

The following principles can be helpful for longer-term support:

• Accompany rather than do. Instead of going to the shop on the person's behalf, go with them and encourage them to try on their own next time.
• Notice small steps. When the person does something they have been avoiding for a while, it is a big step, even if it looks small from the outside.
• Do not push. Applying pressure by saying "Come on, get in the lift, nothing will happen" undermines trust. Steps should be taken at the person's own pace.
• Watch out for the reassurance cycle. If the person asks "Do you think there's something wrong with me?" many times a day, reassuring them every time brings brief relief but makes the need grow. It helps to talk about this together at a calm moment and agree on how you want to respond.
• Encourage them to seek support. Saying, without pressure, "It might do you good to talk to someone about this; we can look into it together if you like" opens a door.

Dealing with the Wider Family's Comments

In Turkey, a panic attack is still often interpreted as "nerves", "imagination" or "being spoilt". Comments from a mother-in-law, an aunt or a neighbour such as "We never had things like this in our day" or "Let them put their mind to some work and it'll pass" can lead the person to feel ashamed and to hide what they are going through. As someone close to them, drawing a short, calm boundary in the face of such comments is an important form of support: "This is a health matter, the doctor knows about it, we're dealing with it." It does not have to go into detail or turn into an argument. Protecting the person's privacy and not explaining the situation to people they are not ready to tell are also part of this support.

If Your Child or a Teenager Close to You Has Attacks

Panic attacks can also occur in adolescence; young people often experience bodily symptoms of anxiety, especially in exam periods such as the LGS and YKS (Turkey's national high-school and university entrance exams). Staying calmly beside your child during an attack gives them the message "We can cope with this feeling." If there are signs such as avoiding school or frequently going to the school nurse before exams, it is useful to see a child and adolescent mental health professional.

You May Need Support Too

Witnessing someone you love have panic attacks again and again is exhausting. At times you may jump every time the phone rings, at times you may feel the fear on their behalf, and at times you may blame yourself for getting angry. These are common feelings in people who care for someone over a long period.

Protecting your own sleep, social relationships and spaces for rest is not selfish; it is a condition for being a better supporter in the long run. If you are also feeling intense anxiety, helplessness or burnout, talking to a professional may do you good.

When Should You Suggest Professional Support?

If any of the following applies to your loved one, it is appropriate to gently suggest that they talk to a mental health professional:

• The attacks are recurring and becoming more frequent
• They have started avoiding certain places, forms of transport or social settings for fear of the next attack
• They are finding it difficult to go to work or school, or to be alone
• They are turning to alcohol or other substances to cope with anxiety
• Hopelessness, withdrawal or low mood have begun to accompany the attacks

These signs do not amount to a diagnosis on their own. If the symptoms are intense, an assessment by a psychiatrist may also be needed. If your loved one talks about harming themselves, take it seriously and call 112 (emergency services) or go to the nearest emergency department.

How Are Panic Attacks and the Role of Loved Ones Approached in Therapy?

Cognitive Behavioural Therapy (CBT) is one of the most thoroughly researched approaches for panic attacks and panic disorder. In therapy, the person learns to recognise the panic cycle, to stay with bodily sensations without fear, and to return gradually to the areas they have been avoiding.

Although loved ones are not directly the subject of therapy, they play an important role in the process. With the client's consent, it is possible for loved ones to be given information in some sessions, for how to behave during an attack to be discussed together, and for ways of reducing over-accommodation to be planned. This both makes it easier for the person to apply what they have learned at home and reduces tension within the family.

For more information on work with anxiety and panic, you can take a look at the anxiety and panic page.

Frequently Asked Questions

Do I have to be with my loved one for every attack?

No. Being there is valuable, but if the person comes to believe they can only get through attacks because you are present, this can increase anxiety over time. The goal is for them to experience getting through it on their own too; these steps can be taken together and gradually.

What can I do if they do not want to go to therapy?

Pushing usually increases resistance. Sharing your observations without blame, for example by saying "I can see you've been very worn out lately", and suggesting sources of information keeps the door open. The decision is theirs, but it matters that they know the door is open.

What should I do if a colleague has an attack at work?

Invite them somewhere quieter, away from the crowd, stay calmly with them and ask what they need. After the attack has passed, taking care not to discuss what happened with others is a way of respecting their privacy. If the symptoms are unusual or you are not sure, do not hesitate to call for emergency help; in the longer term, it is reassuring to know that both they and you can get support.

How can I help someone having a panic attack over the phone?

Slow down your voice and speak in short sentences. Find out where the person is and whether they are safe, then suggest that they lengthen their out-breath along with you. If the person is alone, the symptoms are unusual or the place they are in is not safe, do not hesitate to call 112 and give their location.

• #panic attack
• #guide for loved ones
• #family support
• #anxiety

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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