Panic Attack: What to Do in the Moment

You're at work, in a meeting, or simply out shopping. Suddenly your heart races, your hands tremble, and you feel like the air is running out. Your mind screams at you: "This is serious! I'm going to pass out! I'm having a heart attack!"

In the article that follows, I explore anxiety and chronic worry. If you recognise yourself in this theme, I designed a generalized anxiety test that helps you take stock of your everyday anxiety level. It comes with a guide to extend your reflection beyond the results.

This is a panic attack. And in those few seconds that follow, everything becomes confusing, terrifying, uncontrollable.

Over my years of practice in cognitive behavioral therapy (CBT) in Nantes, I've supported hundreds of people going through these moments of extreme intensity. The good news? There are proven techniques for regaining control in the moment.

Understanding what's happening in your body

Before you act, you need to understand. A panic attack is not a real threat — it's a false alarm from the sympathetic nervous system.

Your amygdala (the brain's fear center) detects a perceived threat and triggers the "fight-flight-freeze" response. Your body releases adrenaline and cortisol. Your breathing quickens. Blood rushes toward your muscles. You're in a state of hypervigilance.

The problem? This response is useful if a lion is charging at you. It isn't if you're standing at the supermarket checkout.

And here's the cognitive trap: you interpret the physical symptoms as proof that something horrible is happening. Your heart races → you think "I'm having a heart attack" → you panic more → your heart races even faster. It's a negative feedback loop.

Albert Ellis, founder of rational emotive therapy, called this "awfulizing": turning discomfort into catastrophe. Aaron Beck, the father of CBT, showed how this misinterpretation of sensations reinforces anxiety.

The 4 Pillars of In-the-Moment Intervention

1. Stopping rapid breathing: the abdominal breathing technique

Your breathing is the fastest lever for calming your nervous system. When you panic, you breathe from the chest — short, jerky, shallow. This increases anxiety.

The exercise: 4-6-8 breathing

• Inhale slowly through your nose for 4 seconds
• Hold your breath for 6 seconds
• Exhale slowly through your mouth for 8 seconds
• Repeat 5 to 10 times

Why does it work? The prolonged exhale activates your parasympathetic system (the body's brake). It's the branch that tells your heart: "Slow down. Everything's fine."

Jon Kabat-Zinn, creator of Mindfulness-Based Stress Reduction (MBSR), demonstrated that this conscious breathing reduces amygdala activation in less than 2 minutes.

Practical tip: Practice this exercise every day, outside of crises, so that your body already knows it. During a panic attack, you don't have the energy to learn something new.

2. Interrupting the catastrophic spiral: the "re-anchoring" technique

During panic, your mind generates automatic catastrophic thoughts: "I'm going to faint," "I'm losing control," "I'm going crazy."

These thoughts are not facts. They're hypotheses generated by a brain in fear.

The exercise: the 5 senses

Bring your attention back to the immediate present. Name:

• 5 things you can see (a door, a face, a plant)
• 4 things you can touch (the fabric of your shirt, a table)
• 3 things you can hear (a noise, a voice, the silence)
• 2 things you can smell (a scent)
• 1 thing you can taste (your saliva, a sweet)

This exercise, called "grounding" or "anchoring," short-circuits rumination by forcing your prefrontal cortex (the area of reason) to process real sensory information, rather than imagined catastrophic scenarios.

You are not in immediate danger. You are here, now, safe.

3. Accepting the sensations rather than fighting them: the exposure paradox

Here's a counterintuitive paradox that CBT has validated: the more you resist panic, the more it persists.

Why? Because the resistance itself generates anxiety. You tell yourself: "No, not now, not here!" — and that refusal creates additional tension.

Exposure therapy, developed by Joseph Wolpe and refined by David Clark, shows that accepting the symptoms disarms them.

The exercise: neutral observation

During a panic attack, instead of fighting the sensations, observe them like a scientist:

• "My heart is racing. That's normal under stress."
• "My hands are sweaty. That's a physiological reaction."
• "I feel dizzy. That's a sensation, not a danger."

You're no longer fighting. You're observing. And paradoxically, this acceptance reduces the intensity of the panic within a few minutes.

This is what we call "tolerance of uncertainty" — a key skill in CBT.

4. Moving: immediate behavioral activation

Your body is flooded with adrenaline. It was released to prepare you for action. But you're not moving — you stay seated or standing, tense, which prolongs the activation.

The exercise: intentional movement

• Stand up and walk, even on the spot
• Contract your muscles for 5 seconds, then release
• Climb a few stairs
• Do 10 push-ups or squats

Movement burns off the adrenaline and signals to your body: "We've acted. The danger has passed."

Herbert Freudenberger and other researchers have shown that behavioral activation is one of the most powerful CBT interventions against anxiety.

Clinical Example: The Case of Marc

Marc, 38, a sales director, had his first panic attack during an important meeting. His heart raced, he felt a sense of unreality, and he thought: "I'm going crazy."

He left the meeting abruptly. Ever since, he dreaded meetings, then open-plan offices, then eventually leaving home. It had turned into agoraphobia.

We worked together in CBT. First I validated his experience — panic is real and terrifying. Then we:

Identified his cognitive loop: physical symptom → catastrophic interpretation → more panic

Practiced 4-6-8 breathing in session, then at home

Tested gradual exposure: first staying 5 minutes in the open-plan office, then 10, then a short meeting

Worked on acceptance: "Panic doesn't kill. It's uncomfortable, but it passes."

After 12 sessions, Marc regained confidence. He didn't eliminate the anxiety — it's normal to be a little stressed before a meeting — but he stopped catastrophizing it.

The Role of Cognitive Distortions

During a panic attack, your mind uses cognitive distortions — systematic errors of thinking. As we explored in our article on the cognitive distortions that undermine your life, these biased thought patterns reinforce anxiety.

The most common ones during panic are:

• Catastrophizing: "My heart is racing = heart attack"
• Overgeneralization: "I panicked once = I'll always panic"
• Mind reading: "Everyone thinks I'm crazy"
• Emotional reasoning: "I feel in danger = I am in danger"

Identifying these distortions already weakens them.

After the Attack: Prevention and Consolidation

A panic attack is like a fire. First you have to put it out (the techniques above). Then you have to prevent it from reigniting.

Three essential actions:

Practice breathing regularly — even without panic. Your nervous system needs to "learn" relaxation.

Expose yourself gradually to the situations you dread. If you're afraid of public transport, take the bus for 5 minutes. The following week, 10 minutes. This repeated exposure shows your amygdala that there's no real danger.

See a CBT therapist if the attacks persist. Studies show that CBT has a remission rate of 60-80% for panic disorder — far higher than other approaches.

If you're going through periods of stress or generalized anxiety, our article on 7 daily habits to soothe your anxious brain offers you long-term strategies.

Assessing Your Situation

Are you wondering whether what you're experiencing is really a panic attack? Or simply anxiety? The articles Panic attack vs. anxiety: 3 keys to telling them apart and Panic attack or anxiety attack: why tell the difference will help you clarify.

You can also take our psychological tests to objectively assess your level of anxiety and panic.

Key Takeaways

✓ A panic attack is a false alarm from the nervous system, not a real danger.

✓ Abdominal breathing (4-6-8) is your fastest tool for calming your body.

✓ Catastrophic thoughts are not facts — they're hypotheses generated by fear.

✓ Accepting the sensations (rather than resisting) disarms panic.

✓ Movement burns off adrenaline and signals safety to your brain.

✓ Regular practice and gradual exposure prevent relapses.

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Going Further

If you have recurring panic attacks, you're not alone. About 3% of the population suffers from panic disorder at some point in their life. It's treatable. It's curable.

CBT is the approach with the most scientific evidence. It teaches you to identify your automatic thoughts, to challenge them, and to change your avoidance behaviors.

For personalized support, visit psychologieetserenite.com

Together, we'll build a new relationship with your anxiety — not by fighting it, but by understanding it and mastering it.

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Gildas Garrec, CBT psychotherapist in Nantes