What to Do During an Anxiety Attack: A Step-by-Step Guide

Your heart is racing. Your chest feels tight. You cannot catch your breath and you are convinced something is seriously wrong. Maybe you are dying. Maybe you are having a heart attack. Maybe you are losing your mind.

You are not. What you are most likely experiencing is an anxiety attack, sometimes called a panic attack. And while it feels absolutely terrifying in the moment, it is not dangerous. Your body is doing exactly what it was designed to do in the face of a perceived threat. The problem is that the threat is not real, and your nervous system does not know the difference.

I have worked with hundreds of patients who experience anxiety and panic attacks, and the single most helpful thing I can tell you is this: it will pass. Every attack peaks and then fades. No anxiety attack lasts forever, even when it feels like it will.

Here is what you need to know, both for getting through an attack right now and for understanding when it is time to get professional help.

What Is an Anxiety Attack?

First, some clinical clarity. "Panic attack" is the formal diagnostic term used in the DSM-5. It describes a sudden surge of intense fear or discomfort that peaks within minutes. "Anxiety attack" is not an official clinical term, but it is how most people describe the experience, and it is what most people search for when they are looking for help. I will use both terms here because the coping strategies are the same.

The physical symptoms can include:

• Racing or pounding heart (palpitations)
• Chest tightness or pain
• Shortness of breath or feeling like you cannot get enough air
• Dizziness or lightheadedness
• Tingling or numbness in your hands, feet, or face
• Nausea or stomach distress
• Hot flashes or chills
• A sense of unreality or feeling detached from yourself

These symptoms are produced by your autonomic nervous system flooding your body with adrenaline and cortisol. It is your fight-or-flight response activating as though you are in physical danger, even though you are sitting at your desk, lying in bed, or standing in a grocery store checkout line.

The critical thing to understand: anxiety attacks are not dangerous. They cannot cause a heart attack. They cannot make you stop breathing. They cannot make you "go crazy." Your body is doing something uncomfortable but fundamentally safe.

5 Things to Do Right Now During an Anxiety Attack

If you are reading this mid-attack, start here.

1. Ground yourself with the 5-4-3-2-1 technique.

This is one of the most effective grounding exercises for anxiety because it forces your brain to shift from the internal alarm to the external world. It works by engaging your senses, which pulls your attention out of the panic loop.

Do this slowly and deliberately. Say the items out loud if you can. The goal is not to relax instantly. It is to interrupt the spiral.

2. Slow your breathing with the 4-7-8 technique.

During an anxiety attack, your breathing speeds up. This triggers more adrenaline, which makes the symptoms worse, which makes you breathe faster. You need to break that cycle manually.

Breathe in through your nose for 4 seconds. Hold for 7 seconds. Exhale slowly through your mouth for 8 seconds. Repeat four times. If 7 seconds of holding feels too long, try 4-4-6. The specific numbers matter less than the pattern: slow inhale, pause, longer exhale. A longer exhale activates your parasympathetic nervous system, which is the brake pedal that counteracts fight-or-flight.

3. Tell yourself: "This is anxiety. It will pass. I am safe."

This is not positive thinking. It is accurate thinking. Your brain is telling you that you are in danger. You need to correct that message, clearly and repeatedly. Say it out loud if possible. "This is anxiety. I have felt this before. It always passes. I am safe." Labeling the experience as anxiety reduces the amygdala's threat response. Research on affect labeling shows that naming an emotion decreases its intensity.

4. Do not fight it. Let the wave pass.

This is counterintuitive, but resisting an anxiety attack makes it worse. When you clench your jaw, tighten your muscles, and mentally scream at the anxiety to stop, you are telling your nervous system that the threat is real and that you need to fight harder. Instead, try the opposite: acknowledge that the attack is happening, accept that it is uncomfortable, and let your body move through it. Think of it like a wave. It will crest and it will recede. Fighting the ocean does not stop the wave.

5. Move your body.

Your fight-or-flight system has dumped a massive amount of adrenaline and cortisol into your bloodstream. Physical movement helps burn through those stress chemicals. Walk around the room. Shake your hands out. Do jumping jacks. Splash cold water on your face (cold water triggers the dive reflex, which slows your heart rate). You do not need to do a workout. You just need to give your body a physical outlet for the chemical storm it is going through.

Why Do Anxiety Attacks Happen?

Understanding the "why" can take some of the fear out of future episodes. Anxiety attacks happen when your nervous system's threat detection system misfires. Think of it as a smoke alarm going off when there is no fire. The alarm is loud and alarming, but the house is not burning down.

Common triggers include:

• Chronic stress: prolonged work pressure, financial strain, relationship conflict, or caregiving burden
• Sleep deprivation: insufficient sleep dysregulates the amygdala and makes you more reactive to perceived threats
• Caffeine: stimulates the same nervous system pathways that produce anxiety symptoms
• Trauma: past traumatic experiences can sensitize your nervous system to trigger panic in situations that feel similar, even unconsciously
• Medical factors: thyroid dysfunction, hormonal changes (perimenopause, postpartum), and certain medications can increase anxiety

Anxiety and panic attacks also frequently co-occur with other conditions. Many of my patients with ADHD experience anxiety attacks because their executive function difficulties create chronic stress and overwhelm. Depression and anxiety share overlapping neurobiology, and it is common to have both simultaneously.

When to See a Provider About Anxiety

Occasional anxiety is part of being human. But there is a line between normal stress responses and a clinical anxiety disorder that warrants treatment. You should see a psychiatric provider if:

• Anxiety attacks happen weekly or more. Frequent attacks suggest your nervous system is stuck in a heightened state that self-help techniques alone cannot resolve.
• You are avoiding situations because of fear. Skipping social events, avoiding driving, not going to the grocery store, or refusing to fly because you are afraid of having an attack. Avoidance reinforces the anxiety cycle and shrinks your world over time.
• Anxiety is affecting your work, sleep, or relationships. If you are calling out of work, lying awake with racing thoughts, or withdrawing from people you care about, these are signs that anxiety has crossed from uncomfortable to impairing.
• You are relying on alcohol, cannabis, or other substances to manage anxiety. Self-medication provides temporary relief but worsens anxiety in the long run.

Treatment for Anxiety and Panic Disorder

Anxiety disorders are among the most treatable conditions in psychiatry. Treatment typically involves a combination of approaches, tailored to the severity and nature of your symptoms.

• Psychiatric evaluation: A comprehensive assessment to understand the full picture of your symptoms, including whether anxiety is occurring on its own or alongside other conditions like ADHD, depression, or PTSD.
• Medication: SSRIs and SNRIs are the first-line medications for generalized anxiety disorder and panic disorder. They work by modulating serotonin and norepinephrine, which helps stabilize your nervous system's baseline reactivity. Buspirone is another option for generalized anxiety. For acute panic, short-term or as-needed benzodiazepines may be considered in specific clinical situations, though they are not appropriate for long-term management.
• Therapy: Cognitive behavioral therapy (CBT) has the strongest evidence base for anxiety disorders. Exposure-based therapy is particularly effective for panic disorder and phobia-related anxiety. I can refer you to a therapist who specializes in anxiety to work alongside your psychiatric care.
• Lifestyle modifications: Reducing caffeine, improving sleep hygiene, regular physical exercise, and stress management techniques all support treatment outcomes.

All appointments at Dynamic Mental Health Services are conducted via secure telehealth video. You do not need to leave your home, which is especially important for patients whose anxiety makes it difficult to travel. I see patients across New Jersey, New York, and Connecticut, and most major insurance plans are accepted, including Aetna, Cigna, BlueCross BlueShield, UnitedHealthcare, Oxford, Oscar, Anthem, Humana, Emblem Health, Carelon, and Medicare Advantage.