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To a bystander, a panic attack can look like a full-body exorcism. The only time I’ve had one myself, as a teenager, I hyperventilated so violently that someone called an ambulance, which was understandable but mortifying (high school!). In other cases, panic attacks are less obvious. When a friend of mine had an episode at a restaurant a few years ago, she managed to excuse herself to the bathroom without anyone noticing that something was wrong. (Or if they did, they didn’t say anything.)
Panic attacks are a result of the brain being hijacked by fear or stress — often without warning or any discernible triggers. “It usually escalates within a few minutes, peaks, and then de-escalates a few minutes later,” says Dr. Leah Katz, a psychologist who specializes in anxiety. “You get short of breath, dizzy, tingly, and sweaty. Your heart pounds. You might feel like you’re losing control or going crazy.” (Or, as my friend put it, “I thought I was dying.”)
A witness to a panic attack may not know what’s happening, but even if you do, you’re helpless to stop it. Which is awful when a loved one — or anyone — is shaking and sobbing in front of you. I talked to several mental-health professionals about what they would do to help (or have done in clinical situations). Is there a way to make it better or at least not worse?
Everyone said that the most important thing is to stay calm. “As a support person, you need to find your own stillness, so that the other person’s fear can find a resting point,” says Satya Doyle Byock, a psychotherapist and author of Quarterlife: The Search for Self in Early Adulthood. She recommends taking deep breaths and focusing on physical sensations (your feet on the floor, the temperature in the room) to stay present. Your ability to keep a cool head signals to the other person that they are safe and cared for.
It may help to identify what’s going on, but make sure not to minimize it. “Calling it ‘just a panic attack’ might make the person feel judged or dismissed,” says Byock. “It’s better to say, ‘I think you’re having a panic attack’ in a nonjudgmental way.” You could reassure them that what they’re going through will pass, she adds. “Trying to get them to ‘just stop’ or ‘calm down’ is threatening and makes everything worse.”
Your next step is to ask very simple questions about what you can do. “They might not know what they need, so be patient,” says Dr. Katz. “Keep the questions simple and short. When someone’s having a panic attack, they’re not able to articulate themselves or even speak sometimes.” Some suggestions: Do you want me to talk to you? Do you want me to stay close to you right now? Do you need space? Do you want to hold my hand?
You can offer physical comforts, but don’t be forceful. “You might get a cup of water and just hold it — don’t try to put it in their hand or make them drink it. Maybe get a blanket. Gently provide things without being too persistent or aggressive,” adds Dr. Katz. Different sensations can be soothing too. “Drinking something cold or hot, or taking a warm shower, or holding an ice cube can bring people back into their bodies.” (In my own panic-attack experience, I remember ice water feeling wonderful, probably because I was sweating so profusely.)
You may have heard (or seen in movies) that breathing into a paper bag can stop hyperventilation. This might work for some people, but it can be dangerous for others. And shoving a bag in someone’s face when they’re in distress probably isn’t a great idea unless they explicitly request it.
A panic attack is not dangerous or harmful on its own and doesn’t usually require emergency medical attention. However, it’s quite common for people to mistake their panic attack for a heart attack (I know someone who did this and called 911). If you’re truly worried, it’s not wrong to seek medical help, but it’s usually not necessary.
The next steps come after the panic attack has subsided. In most cases, the person will feel depleted and want to rest. Fluids and electrolytes are a good idea. (A shot of bourbon, which my friend at the restaurant took to “settle her nerves,” is not: “When you’re experiencing major anxiety, turning to substances can encourage dependency and reinforce escape behavior,” says Dr. Katz.) After I had a panic attack, I went home and took a nap. Again, it helps to ask the person what they need — space, or company, or a Netflix coma with a double order of fries from Shake Shack?
Finally, depending on your relationship with the person, you may want to follow up with them about what happened. “Once you’ve both recovered, it’s beneficial to check in and see how they’re doing and also have a conversation about what feels supportive to them,” says Dr. Katz. “That’s a good chance to say, ‘Is there something different I can do for you next time?’” Even if they can’t answer, just knowing that you care enough to ask can be a comfort.