Panic attacks: what to do in the moment, how to tell them from a heart problem, and treatment

A panic attack is a sudden rush of intense fear that comes with several physical symptoms at once, such as a pounding heart, shortness of breath, dizziness or chest pain. It usually peaks within minutes, often within 10 minutes, and most attacks ease within 5 to 20 minutes. Occasionally one lasts close to an hour, or attacks come one after another (NHS, 2023a; Mind, 2021; APA, 2022). The US National Institute of Mental Health (NIMH) notes that some researchers see panic attacks as “false alarms”: the body’s survival instincts firing too often or too strongly when there is no real danger (NIMH, 2025). The UK’s National Health Service (NHS) says attacks are frightening but not dangerous and do not cause physical harm (NHS, 2023a). Even so, chest pain you have never had before, or symptoms that feel different from usual, need checking for a heart problem first. This guide is written for adults; if a child has these symptoms, see a doctor first.

One attack does not mean panic disorder. In a survey of adults in 25 countries, 66.5% of people who had ever had a panic attack had more than one. Repeated attacks were linked to the later onset of other mental disorders (odds ratio 2.0), while single attacks were not (de Jonge et al., 2016). Panic disorder means unexpected attacks that keep coming back, followed by at least a month of persistent worry about further attacks or marked changes in behaviour to avoid them (NHS, 2023a; National Mental Health Information Portal, 2020). The symptom list and how common it is are covered in anxiety symptoms.

In Korean health-insurance statistics, the number of people treated with panic disorder (F41.0) as the main diagnosis rose from 50,814 in 2010 to 217,297 in 2025. In 2025, 55.7% were women, and people in their 40s were the largest age group. These figures count people treated, not how many people live with panic disorder, and the rise may partly reflect more people seeking help (Health Insurance Review and Assessment Service, 2026). mind.io does not offer a panic test. This guide covers what to do during an attack, how to tell it from a heart problem, why panic keeps coming back, and the treatments and help that have evidence behind them.

Panic attacks and heart problems share many symptoms. Chest pain, shortness of breath, sweating, nausea and dizziness can appear in both (NHS, 2023a, 2023b), and Korea’s disease control agency notes that people having a heart attack can also become extremely anxious and restless (National Health Information Portal, n.d.). In an Australian emergency department, among 338 chest-pain patients assessed for possible acute coronary syndrome, 5.6% were diagnosed with panic disorder and 7.7% had a major cardiac event, such as a heart attack, within 30 days. The researchers concluded that the symptoms and signs routinely checked for chest pain cannot tell people with panic disorder from those without it (Greenslade et al., 2017). That is why you should not brush it off as “just panic” based on how it feels.

Call your local emergency number at once (119 in Korea), rather than assuming it is panic, if chest pain or tightness comes on suddenly and does not go away, if the pain spreads to your arm, neck, jaw or back, or if chest pain comes with sweating, nausea, light-headedness or shortness of breath (NHS, 2023b). This applies even if you have had panic attacks before, and all the more if you are older or have risk factors such as smoking, high blood pressure, diabetes, high cholesterol or a family history of early heart disease (NHS, 2023b; National Health Information Portal, n.d.). Do not drive yourself to hospital (NHS, 2026b), and do not wait in the hope that it will settle (National Health Information Portal, n.d.). Whether it is a heart attack is confirmed with an ECG and blood tests, not by how it feels (NHS, 2026b).

See a doctor first after a first attack, an attack that feels different from usual, or if you actually lose consciousness. Korea’s National Mental Health Information Portal says that even when panic disorder is suspected, a medical assessment may be needed to rule out heart, lung, neurological and hormonal conditions (National Mental Health Information Portal, 2020), and Japan’s National Center of Neurology and Psychiatry advises seeing an internist first for palpitations or breathlessness, because an overactive thyroid, an irregular heartbeat or anaemia can also cause anxiety (National Center of Neurology and Psychiatry, n.d.). Guidance from the UK’s National Institute for Health and Care Excellence (NICE) says people who come to an emergency department with a panic attack should have the minimum tests needed to rule out an acute physical problem, and then be referred to primary care for follow-up (NICE, 2011).

A single attack does not harm the body, but the link between long-lasting panic disorder and heart disease is a separate question. A meta-analysis of 12 cohort studies found that people with panic disorder had 1.47 times the risk of later coronary heart disease, but it could not rule out reverse causation, such as early heart disease being taken for panic (Tully et al., 2015). Panic disorder is no reason to skip ordinary heart care such as checking blood pressure and cholesterol, and new or changed chest symptoms deserve another check. A study at a cardiac hospital’s emergency department also found that many people with panic disorder had coronary artery disease as well (Fleet et al., 1996); see anxiety symptoms for details.

First: if sudden chest pain does not go away, spreads to your arm, neck, jaw or back, or comes with sweating, nausea, light-headedness or shortness of breath, do not assume it is panic: call your local emergency number at once (119 in Korea) (NHS, 2023b). If none of these signs is present, stay where you are if you can and remind yourself that the feeling will peak and pass (NHS, 2023a). Rather than forcing big breaths, breathe in gently through your nose and out slowly and long through your mouth (National Mental Health Information Portal, 2020; NHS, 2026c). You can also breathe slowly while counting to five, or focus on your senses, for example by eating a mint or touching something soft (Mind, 2021). Breathing exercises help most when practised regularly as part of your daily routine (NHS, 2026c). If this was your first attack, see a doctor afterwards to rule out other causes. The evidence on slow breathing and grounding is in how to relieve stress.

Slow breathing is a tool for riding out an attack, not the core of treating panic. Adding breathing retraining to cognitive behavioural therapy (CBT) did not clearly add benefit (Schmidt et al., 2000), and an analysis of 72 trials with 4,064 participants found that breathing retraining made treatment easier to accept but had little effect on outcomes (Pompoli et al., 2018). There is no need to cling to getting your breathing “right” as if something terrible will happen otherwise.

Breathing into a paper bag is not recommended. The UK first-aid charity St John Ambulance warns that it could make things worse (St John Ambulance, 2025), and deaths have been reported when it was wrongly used on patients who were short of oxygen or had a heart problem (Callaham, 1989). Experiments also suggest that expectation and suggestion play a part in the relief it seems to bring (van den Hout et al., 1988).

Once the attack has passed, rest somewhere quiet or have a drink to look after yourself (Mind, 2021), and go back to what you were doing if you can. Building up the time you spend in situations that worry you, little by little, reduces anxiety better than avoiding them (NHS, 2026a). If it happens while you are driving, pull over somewhere safe and wait for it to pass. If chest pain does not go away or feels different from usual, follow the emergency advice above at once.

According to the cognitive theory of panic, attacks arise from a tendency to misread bodily sensations, such as a racing heart or dizziness, as a sign of imminent catastrophe such as a heart attack (Salkovskis et al., 1996). Fear then makes the sensations stronger, which in turn seems to confirm the misreading: a vicious cycle (NIMH, 2025). The WHO’s International Classification of Diseases (ICD-11) lists fear of losing control or going mad as a symptom of a panic attack (WHO, 2025). It is a fear felt during the attack, not something that actually happens.

People with high anxiety sensitivity, a strong fear of bodily sensations, were more likely to have panic attacks under stress. In a study that followed 1,401 young adults through 5 weeks of highly stressful basic training, about 20% of those in the top 10% for anxiety sensitivity had a panic attack during that time, compared with 6% of the rest (Schmidt et al., 1997). Avoiding situations for fear of another attack can create a cycle of living “in fear of fear”, which may bring on more attacks (NHS, 2023a).

Avoiding places where attacks have happened brings relief in the moment, but the belief that “something terrible will happen there” stays intact. So-called safety behaviours, for example always carrying water or medicine, sitting near the exit, or going out only with someone else, also block the chance to learn that the feared catastrophe does not happen (Salkovskis et al., 1996). In one experiment, patients who dropped their safety behaviours during 15 minutes of exposure showed a greater fall in catastrophic beliefs and anxiety when retested within two days than those who kept them up (Salkovskis et al., 1999). These habits have helped you get by, so there is nothing to be ashamed of; it is best to cut them back step by step, ideally with a therapist. Prescribed medicines, though, should not be stopped without talking to your doctor.

When avoidance spreads to many situations where escape or help might be hard, such as public transport, crowds or being out alone, so that you avoid them or can only face them with a trusted companion, and this lasts for at least several months, it is called agoraphobia (WHO, 2025). If it is being apart from someone close to you that you fear, rather than the situations themselves, see also Separation anxiety in children and adults. The diagnosis is made by a professional. Some people also wake from sleep in a state of panic. Nocturnal panic has been reported at least once by 44–71% of people with panic disorder; it is distinct from sleep apnoea and nightmares, but other causes need to be ruled out first (Craske & Tsao, 2005). If you woke unable to move, that is closer to sleep paralysis than to nocturnal panic. If you wake up choking, or are told you stop breathing while snoring, see the sleep apnoea signs in insomnia: what helps and get checked.

Caffeine. A meta-analysis of 9 blinded studies (237 patients) comparing caffeine with placebo in people with panic disorder found that 51.1% had a panic attack after a large dose of caffeine, roughly equal to 5 cups of coffee, while none did after placebo. In the studies that also tested healthy people, 53.9% of patients and 1.7% of healthy people had an attack. Little is known about smaller amounts (Klevebrant & Frick, 2022). The NHS and Korea’s mental health portal also name caffeine as something that can bring on attacks (NHS, 2023a; National Mental Health Information Portal, 2020), and Japan’s National Center of Neurology and Psychiatry suggests cutting down gradually if needed (National Center of Neurology and Psychiatry, n.d.). For caffeine and sleep, see insomnia: what helps.

Alcohol. Alcohol eases anticipatory anxiety in people with panic disorder, which makes it tempting to rely on, but in alcohol use problems it increases sensitivity to carbon dioxide, which may in turn promote panic (Cosci et al., 2007). Alcohol withdrawal symptoms also resemble a panic attack (National Mental Health Information Portal, 2020). The NHS advises against using alcohol, cigarettes or drugs to relieve anxiety (NHS, 2026a), and says untreated panic disorder raises the risk of an alcohol or drug problem (NHS, 2023a). Why drinking to cope with stress backfires is covered in how to relieve stress.

Smoking. Daily smoking was linked to a higher risk of a first panic attack and of panic disorder, and the risk tended to be higher in current than in former smokers. In the other direction, having panic attacks first did not clearly raise the risk of starting to smoke daily (Breslau & Klein, 1999). This was an observational study, so it does not prove cause, but the NHS advises stopping smoking (NHS, 2023a).

Other factors. Stimulants can also trigger panic attacks (National Mental Health Information Portal, 2020). A racing heart from coffee, exercise or certain medicines can be read as the start of an attack and actually bring one on (APA, 2022). The exact cause of panic disorder is not fully understood; very stressful experiences such as bereavement, and having a close relative with panic disorder, are among the factors linked to it (NHS, 2023a). It is not a sign of weak willpower.

Cognitive behavioural therapy. CBT is the most-studied psychological therapy for panic disorder. A 2022 network meta-analysis of 136 trials found that CBT had a moderate effect compared with usual care (effect size 0.67, moderate certainty), and after trials at high risk of bias were removed, CBT was the only therapy still more effective than usual care. Short-term psychodynamic therapy was also named a reasonable first choice, with low certainty (Papola et al., 2022). Against placebo, the effect of CBT for panic disorder was small to moderate (g = 0.39, 5 studies; Carpenter et al., 2018), and a Cochrane review rated the evidence across psychological therapies for panic disorder as low quality (Pompoli et al., 2016). It does not guarantee a cure, but it is the treatment with the most evidence so far. NICE recommends weekly sessions of 1 to 2 hours, 7 to 14 hours in total, completed within 4 months (NICE, 2011).

Exposure. At the heart of CBT is exposure: safely facing the feared sensations and situations again. In interoceptive exposure, you plan with a therapist to bring on the feared sensations on purpose and learn that they do not have to turn into an attack (NIMH, 2025; APA, 2022). Examples include making your heart race by running on the spot or making yourself dizzy by spinning. In vivo exposure means breaking a feared situation into small steps and taking them one at a time (APA, 2022). An analysis comparing the components of CBT found that interoceptive exposure tended to improve results, while muscle relaxation was linked to lower effectiveness (Pompoli et al., 2018). If you have a heart or lung condition or are pregnant, talk to a doctor first, and do exposure work with a therapist rather than pushing yourself alone.

Self-help and online treatment. An analysis of 74 trials (6,699 participants) found no difference in effect between self-help guided by a professional and face-to-face individual or group therapy, and all three did better than usual care. Unguided self-help, however, could not be shown to beat usual care, and none of the formats reached high certainty (Papola et al., 2023). Internet-based CBT showed larger effects than wait-list controls, and a few trials suggest it may work about as well as face-to-face therapy, but study quality varied (Stech et al., 2020). NICE suggests self-help first for mild to moderate panic disorder (NICE, 2011). Rather than struggling on alone with a book or an app, it is better to have a professional’s guidance as well.

Medicines. Medicines are described here by class only. Antidepressants (such as SSRIs) are recommended for longer-term treatment (NICE, 2011; National Mental Health Information Portal, 2020). Pooled placebo-controlled trials suggest that about 1 in 7 people taking an antidepressant improve beyond what placebo achieves, but the evidence is low quality and covers only short-term outcomes (Bighelli et al., 2018). Anxiety can briefly get worse when you start, so know this in advance and talk to your doctor (NICE, 2011). Benzodiazepine anti-anxiety medicines act quickly and did better than placebo in short-term trials, though the evidence is low quality (Breilmann et al., 2019); because tolerance and dependence can develop, they may be prescribed only for brief periods (NIMH, 2025), and NICE advises against using them to treat panic disorder because of poorer long-term outcomes (NICE, 2011). If you already take any of these, do not stop suddenly; talk to the doctor who prescribed it. How long antidepressants take to work and what can happen when you stop are covered in antidepressants and psychiatric medication.

Combining treatments, and exercise. Combining medicine with psychotherapy worked a little better during treatment than either alone. After treatment ended, the combination stayed better than medicine alone and was about as good as psychotherapy alone, so either psychotherapy alone or the combination can be chosen first, depending on what you prefer (Furukawa et al., 2007). Regular exercise reduced general anxiety and depression, but there was no clear evidence that it reduces panic symptoms themselves (Machado et al., 2022); in a small trial of 47 patients, adding aerobic exercise to CBT did better than adding very light exercise on only one measure at 7 months (Gaudlitz et al., 2015). Think of exercise as a habit that goes alongside treatment, not a replacement for it (NICE, 2011).

When to see a professional: when attacks keep coming back; when you spend weeks unable to stop worrying about the next one; when the list of things you avoid grows, such as public transport, driving, exercise, coffee or being alone; when you lean on alcohol or medicines to get through; or when low mood or thoughts of harming yourself come with it. The American Psychological Association (APA) suggests finding a professional who specialises in panic or anxiety if you have had four or more attacks, or keep fearing another one (APA, 2022), and the NIMH says it is time to seek help when anxiety starts causing problems at school, at work or with friends and family (NIMH, 2025). France’s public health information site also stresses starting treatment quickly if attacks keep coming back (Santé.fr, 2026). Left untreated, panic disorder can lead to agoraphobia or alcohol and drug problems, so getting help early is better (NHS, 2023a).

If you live outside Korea, start with a family doctor or your local mental health services, and see the crisis lines just below. In Korea, you can see a psychiatrist, or contact your city, county or district mental health welfare centre for counselling and referral to other services. The mental health crisis line 1577-0199 (24 hours) connects you to a nearby centre (Ministry of Health and Welfare, 2025). The conditions for the 2026 counselling voucher are in depression: what helps. mind.io does not offer a panic test; the anxiety check-in (GAD-7) looks at anxiety in general over the past 2 weeks and does not diagnose panic disorder.

In a 1996 study at the emergency department of a Canadian cardiac hospital, 25% of chest-pain patients with panic disorder said they had had thoughts of killing themselves in the week before the visit, compared with 5% of those without it (Fleet et al., 1996). If you have thoughts of harming yourself, please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

Q. Can a panic attack kill me? A. A panic attack is frightening but not dangerous in itself, and it does not cause physical harm (NHS, 2023a). Symptoms alone cannot rule out a heart problem, though, so if sudden chest pain does not go away, spreads to your arm, neck or jaw, or comes with sweating or breathlessness, do not assume it is panic: call your local emergency number at once (119 in Korea) (NHS, 2023b).

Q. I’m scared I’ll faint or go mad. A. Blood pressure usually rises during a panic attack, so actually fainting is unlikely, and panic attacks do not make people go mad (Anxiety Canada, 2018). The fear of going mad is itself one of the symptoms of a panic attack (WHO, 2025). If you do actually lose consciousness, though, there may be another cause, so see a doctor.

Q. My heart tests were normal, but I still get chest pain and palpitations. A. Korea’s National Mental Health Information Portal says that once a physical examination has found no serious problem, trusting that the uncomfortable sensations are not dangerous helps recovery (National Mental Health Information Portal, 2020). In a study that followed 585 people for 2 years after an emergency visit for chest pain judged not to come from the heart, 11.1% developed panic disorder (Foldes-Busque et al., 2022), so consider following up with care for panic. If the pain is different from before or worse, get it checked again.

Q. Doesn’t breathing into a paper bag help? A. It is not recommended. It could make things worse, and it can be dangerous if the real cause is a lack of oxygen or a heart problem (St John Ambulance, 2025; Callaham, 1989). Instead of holding your breath or gulping air, try breathing out slowly and long.

Q. Should I give up coffee? A. Large doses of caffeine set off attacks in about half of people with panic disorder, but little is known about smaller amounts (Klevebrant & Frick, 2022). If needed, cut down gradually (National Center of Neurology and Psychiatry, n.d.).

Q. If I start medicine, will I need it for life? Will I become dependent? A. When and how to stop is decided with your doctor. Antidepressants are stopped by tapering slowly with your doctor; see antidepressants and psychiatric medication for details. Benzodiazepines can lead to tolerance and dependence (NIMH, 2025). Adding psychotherapy to medicine also kept results better after treatment ended than medicine alone (Furukawa et al., 2007).

Q. How can I help a family member or friend having a panic attack? A. Reassure them calmly and, if you can, take them somewhere quiet, ask bystanders to leave and give them space. Do not use a paper bag, and call emergency services if they do not improve or you are worried (St John Ambulance, 2025). It helps to agree in advance how they would like you to help (Mind, 2021). During recovery, going with them into situations they have been avoiding, following a plan agreed with their therapist, can also help (Santé.fr, 2026). The chest-pain warning signs apply here too.

Q. Does mind.io have a panic test? A. No. The anxiety check-in (GAD-7) looks at anxiety in general over the past 2 weeks and does not diagnose panic disorder. You can compare scores in average GAD-7 score.

Q. It’s so hard I’m having thoughts of harming myself. A. Please do not carry them alone. Reach out to a crisis line right away: call or text 988 in the US and Canada, call Samaritans on 116 123 in the UK and Ireland, or find a line at findahelpline.com elsewhere. If you are in immediate danger, contact your local emergency services.

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