An out-of-the-blue panic attack is probably because your brain has detected a stressor or threat before you are even aware of it, but some might also happen as a result of other mental health conditions like post-traumatic stress disorder.

How to survive a panic attack: what are the best coping strategies?

Understand your panic cycle

First, try and understand your panic cycle, says Dr Windgassen, referring to the vicious cycle of anxiety. “Understanding the physiology allows you to ease into the sensations when they come up without severe fears of losing control or being in danger and, in this way, the panic attack will pass quicker.”

There are free resources on the NHS website to help you better understand your panic attacks, she says, or you can unpick your panic cycle and triggers with a qualified cognitive behavioural therapist. “There is lots of good research showing how effective CBT is for panic disorder,” she adds.

Don't try and avoid or fight it

“With panic disorder, we want to stop any avoidance that might be going on because again this only serves to keep the panic cycle going,” she adds. “Finding safe and gradual ways to expose yourself to things that you fear – without the use of ‘safety behaviours’ – will gradually allow you and your nervous system to adjust.”

Your ‘safety behaviours’, explains Dr Windgassen, are designed to keep you safe but actually end up keeping the cycle of symptoms going because they reduce your confidence in functioning without them, she says. “For example, if you always close your eyes and grip the seat on the tube because you worry you will have a panic attack, you inadvertently signal to your nervous system that you are in danger, making it more likely to have a panic attack.”

Methods of distraction like coping visualisation could also fall into the safety behaviour trap, she adds. “Essentially you want to be exposed to the panic attack without distraction; to allow your body to habituate. If you don't, it makes it more likely that your body and psychology will become more hypervigilant and fearful.”

Ground yourself

What you can do, though, is engage in something that is grounding and allows you to stay in the present moment right after, or during, the panic attack. “This helps your body feel safe again,” she adds, citing things like reading your book or listening to music after the panic attack has happened.

“I also help my clients with attentional focus practices, which allow them to gently readjust hypervigilant focus on the body, to be more present and integrated in what is going on,” she adds. “Instead of distracting yourself in some way from what is going on with your body, try and connect with it and work with it.”

Control your breathing

Breathwork, for example, is a great tool to turn to when it comes to panic attacks. To help reduce stress, the NHS recommends counting steadily from 1 to 5 on each in-breath and each out-breath, closing your eyes and focusing on your breathing.

You could also try the 4-2-8 technique, says Dr Windgassen, a breathing sequence that's been touted for its ability to help reduce stress and aid sleep. “The simplest and most effective thing is extending the exhale out longer than the inhale and slowing down breathing,” she shares.

Simply breathe in for 4, pause for 2 and extend the exhale for 8. ‘"This activates that parasympathetic nervous system to help calm things down."

As with all coping strategies, there's never going to be a catch-all cure. The solution to enduring a panic attack and indeed preventing them in the future will differ from person to person.

Remember: what works for somebody might not be the answer for someone else. As Dr Windgassen points out, understanding your panic cycle is a key starting point as is looking for the right solutions that help ground you as opposed to any unhelpful methods of distraction.

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