How to Stop a Panic Attack: A London Therapist's Evidence-Based Guide

The first time it happens, most of my clients are convinced they are dying. Their heart pounds so hard it feels like it will break a rib. The room narrows. Their hands tingle. They cannot catch their breath, and the fact that they cannot catch their breath makes them certain that something is catastrophically wrong with their body. Many end up in A&E. The ECG is clean, the bloods are normal, and a tired doctor at three in the morning tells them it was “just” a panic attack — as if “just” were an adequate word for an experience that felt like the end of their life.

If this has happened to you, I want to say two things before anything else. First: you are not losing your mind, you are not weak, and your body is not broken. Second: what you experienced is fully understandable, thoroughly researched, and very treatable. In my 14 years of practice in London, panic is one of the conditions I see most often — and, with the right framework, one of the conditions that responds most reliably to therapy. This article will walk you through what is actually happening inside your body during an attack, what to do in the moment, and how to tell when panic attacks have crossed into a disorder that needs structured treatment.

What is actually happening to my body during a panic attack?

A panic attack is not a malfunction. It is your fight-or-flight system firing at full strength when there is no tiger in the room. The mechanism is ancient and superbly designed — for surviving predators on a savanna. It is simply misfiring in a modern context.

Here is the sequence, compressed into seconds. Your amygdala — a pair of almond-shaped structures deep in the brain that scan continuously for threat — interprets something as dangerous. It might be a racing thought, a sensation in your chest, a memory, a crowded Tube carriage, or nothing you can consciously identify. The amygdala signals the hypothalamus, which fires through the autonomic nervous system to your adrenal glands. Your adrenals flood your bloodstream with adrenaline and cortisol.

The effects of that flood are precisely what you feel in a panic attack. Your heart rate surges, because adrenaline instructs it to. Your airways widen and breathing quickens, because your body is preparing to run. Blood drains from your fingers, face, and digestive system toward the large muscle groups you might need to fight or flee — which is why your hands go numb, your lips tingle, and you feel nauseated. Pupils dilate, sweat appears, muscles tense. Every one of these sensations is your sympathetic nervous system working exactly as it was built to.

The cruel part is what happens next. Because the symptoms are so intense, your mind reasonably concludes that something terrible is happening. “My heart is going to give out.” “I can’t breathe — I’m suffocating.” “I’m having a stroke.” These catastrophic interpretations feed back into the amygdala as fresh evidence of danger, which releases more adrenaline, which intensifies the symptoms, which confirms the fear. Clinicians call this the vicious cycle of panic, and it is the single most important thing to understand if you want to learn to interrupt it.

The good news is written into the physiology. Adrenaline has a short half-life. Your body metabolises it within minutes. Panic attacks typically peak within about ten minutes and begin subsiding soon after, because the chemistry physically cannot sustain itself longer than that. No matter how dreadful an attack feels, it will end.

Panic attack or heart attack — how can I tell?

This is the question that brings most first-time attackers to A&E, and it is the right question to ask. Chest pain must always be taken seriously, and if you are in any doubt, call 999 or NHS 111. I would never tell someone to self-diagnose out of a potential cardiac event.

That said, there are patterns clinicians use to differentiate the two, and knowing them can reduce fear during subsequent attacks.

Heart attack pain tends to build gradually over minutes to hours, feels like crushing or squeezing pressure, and typically radiates to the jaw, left arm, back, or neck. It is often triggered by physical exertion. It does not resolve with rest, and it usually comes with a sense of doom, but not the characteristic surge-and-peak of panic.

Panic attack chest pain tends to peak within about ten minutes, feels sharp or stabbing, stays localised to the chest, and is accompanied by the wider constellation of fight-or-flight symptoms: tingling hands, derealisation, hyperventilation, a fear of going mad or dying. It is often triggered by emotional stress, a thought, or nothing identifiable.

After a first episode, it is sensible to see your GP and request a basic cardiac workup — ECG and bloods. A clean result is not dismissive; it is useful clinical information that, for many people, significantly reduces the fear that fuels future attacks.

What is the difference between a panic attack, panic disorder, and generalised anxiety?

These terms get used interchangeably in everyday conversation and that causes real confusion, so it is worth being precise.

A panic attack is a single episode — the discrete surge of fight-or-flight I described above. Research suggests that roughly a third of adults will have at least one panic attack at some point in their lives, often during a stressful period, and then never again. One panic attack is not a disorder.

Panic disorder is a clinical diagnosis with specific criteria. It requires recurrent, unexpected panic attacks — attacks that come out of the blue rather than being triggered by an obvious feared situation — followed by at least a month of persistent worry about having more attacks, or a significant change in behaviour to avoid them. According to the Adult Psychiatric Morbidity Survey 2023/24, around 1.0% of adults in England meet the criteria for panic disorder. This figure refers to the clinical disorder, not to the much larger group of people who experience an occasional panic attack.

Generalised anxiety disorder (GAD) is different in texture. GAD is not about discrete attacks; it is about pervasive, difficult-to-control worry across multiple areas of life — health, money, work, family, the future — present more days than not for at least six months, with physical symptoms like muscle tension, poor sleep, and fatigue. APMS 2023/24 puts GAD prevalence in England at 7.5% of adults, with women (8.9%) affected more often than men (5.7%). GAD is the background hum of anxiety; panic disorder is the sudden thunderclap.

It is entirely possible to have both, and in my practice the overlap is common. A person lives with chronic, low-grade worry for years, and then something — a life event, a period of overwork, a relationship rupture — tips the system into full panic. If this resonates, you might find my earlier article on recognising when anxiety needs professional help useful, though it is written in Russian.

What can I do the moment a panic attack starts?

The general principle is this: you cannot stop an attack by arguing with it, and you cannot stop it by “just relaxing.” What you can do is give your parasympathetic nervous system — the brake pedal to your sympathetic accelerator — a clear signal to engage. Several techniques do this reliably. They work because they target physiology, not cognition.

Paced breathing (the extended exhale)

The single most evidence-supported technique is slow, paced breathing with the exhale longer than the inhale. This is not a mystical practice. The vagus nerve, which governs your parasympathetic system, responds to the mechanics of long, slow exhales by slowing the heart. Inhale for a count of four, hold for one, exhale for a count of six or seven. Repeat for several minutes.

The instinct during panic is to gulp air. Hyperventilation actually worsens the physical symptoms — it drops carbon dioxide levels, which causes the tingling, dizziness, and chest tightness that frighten you. Slowing the breath, and especially lengthening the exhale, is the direct physiological antidote.

The 5-4-3-2-1 grounding technique

Panic pulls your attention inward toward the body’s alarm signals. Grounding pulls it back outward into the present. Name, silently or aloud, five things you can see, four things you can feel touching your body, three things you can hear, two things you can smell, and one thing you can taste. Take your time; the slowness is part of the point.

This technique, used in both CBT and dialectical behaviour therapy (DBT), works because sustained attention to external sensory detail recruits the prefrontal cortex and competes with the amygdala’s alarm signal. You cannot catalogue the texture of your jumper and simultaneously maintain catastrophic thinking at full volume.

TIPP skills — for when nothing else is cutting through

TIPP is a DBT distress-tolerance protocol designed for moments when emotional intensity is so high that subtler techniques are not reaching you. It stands for Temperature, Intense exercise, Paced breathing, and Paired muscle relaxation.

The most striking component is temperature. Splashing very cold water on your face, or holding an ice pack against your eyes and upper cheeks for about 30 seconds, triggers the mammalian dive reflex — a hardwired response that slows the heart and shifts the autonomic nervous system toward parasympathetic dominance. It is one of the fastest physiological interventions available. I have had clients keep an ice pack in the office fridge for this reason.

Intense exercise — sprinting up a flight of stairs, a minute of star jumps — also works, counter-intuitively, because it burns off adrenaline in the way it was designed to be burned off. Your body produced the stress chemistry to power a fight or a flight; giving it the movement releases the charge.

What to say to yourself

Coping self-statements are not positive thinking. They are accurate thinking, spoken in the moments when accurate thinking is hardest. Useful ones include: This is a panic attack. It is not dangerous. It will peak and pass within minutes. My body is doing what it is designed to do. I have survived every single one of these before.

Notice these statements do not deny the experience. They do not say “you’re fine” or “calm down.” They name the reality: this is uncomfortable, it is not harmful, it has a shape with a beginning and an end.

Why fighting a panic attack makes it worse

This is the single most counter-intuitive thing I teach my clients, and it is the piece that tends to change everything.

Panic attacks run on fear of panic. Every time you brace, clench, try to shove the attack down, or flee the situation, you tell your amygdala that this was indeed dangerous — otherwise why would you have fought so hard? The alarm system updates its records: “last time we were on the Tube, this happened; avoid the Tube.” Avoidance is the engine of panic disorder. It is also what converts one-off attacks into a life-constraining condition.

The therapeutic principle that contradicts this instinct is sometimes phrased, memorably, as: ride the wave. Rather than fighting the attack, you let it rise, peak, and pass. You stay where you are if it is safe to do so. You name it as what it is, you use a technique to ease the physiology, and you let time — about ten minutes — do the rest. Every attack you survive without running from reduces the next attack’s power.

When has it become panic disorder, and what does treatment look like?

If panic attacks are happening repeatedly, if you have begun avoiding places or activities because of them, if your life has narrowed, or if you are living in constant anticipatory fear of the next one — you are likely in the territory of panic disorder and you should see your GP or a psychologist. Panic disorder is one of the most treatable conditions in mental health, but it very rarely resolves on its own without intervention, because the avoidance that sustains it is self-reinforcing.

The National Institute for Health and Care Excellence (NICE) guideline on panic disorder sets out a clear stepped-care approach. For most adults with panic disorder, the first-line psychological treatment is cognitive behavioural therapy (CBT), typically 7–14 hours over up to four months. This is not the generic “change your thinking” CBT people imagine; it is a specific protocol involving psychoeducation about the fight-or-flight cycle, interoceptive exposure (deliberately inducing mild versions of feared sensations so they lose their power), and the dismantling of avoidance behaviours.

For those who prefer or need medication, NICE recommends an SSRI licensed for panic disorder — escitalopram, sertraline, citalopram, or paroxetine are the main options, with venlafaxine as an alternative. SSRIs for panic typically take four to six weeks to show full effect, sometimes worsen anxiety slightly in the first fortnight, and are usually continued for at least six months after remission. Prescribing and review belong to your GP or a psychiatrist, not to a therapist; this is a medical decision and should be made with proper clinical oversight.

NICE is specific about one thing: benzodiazepines should not be prescribed for long-term panic disorder management. They can relieve acute anxiety quickly, but they are associated with worse long-term outcomes, tolerance, and dependence. If a GP has offered you a long-term benzodiazepine prescription for panic, it is reasonable to ask about alternatives.

Other approaches — mindfulness-based interventions, acceptance and commitment therapy, and psychodynamic work on the meaning of what the panic is protecting against — have evidence behind them too, and for some people these fit better than classical CBT. In my own practice I work integratively, with a relational and gestalt orientation, which often proves useful once the immediate panic is contained and deeper themes — perfectionism, control, suppressed grief, fear of losing oneself — emerge. If you are still weighing what kind of therapy to choose, my article on how to choose a therapist may help.

What role does lifestyle play?

I am cautious about lifestyle advice, because it is usually dispensed as a substitute for therapy rather than a companion to it. That said, a few physiological facts are worth knowing, because they genuinely affect how often attacks occur.

Caffeine is a direct sympathetic-nervous-system stimulant. For someone with a sensitised panic system, three flat whites a day is pouring petrol on embers. Reducing caffeine — especially in the morning if attacks tend to happen earlier in the day — often reduces frequency noticeably within a fortnight.

Alcohol rebounds. The relaxation you feel in the evening gives way to a heightened sympathetic state in the small hours, and many of the nocturnal panic attacks I hear about follow heavier drinking the night before.

Sleep deprivation lowers the threshold at which the amygdala fires. So does skipping meals — the blood-glucose dip that accompanies a long gap between meals can itself produce sensations (shakiness, lightheadedness) that panic-prone bodies misinterpret as danger.

Regular aerobic exercise is one of the better non-therapeutic interventions for panic and anxiety generally. It appears to regulate the baseline activity of the stress response. “Regular” here means three or four times a week; occasional sporadic bursts do not carry the same benefit.

None of this substitutes for therapy if you have panic disorder. But for someone early in the cycle — one or two attacks, not yet a diagnosis — these adjustments can be the difference between a passing phase and a chronic pattern.

When panic becomes unbearable: getting help safely

Panic can feel, at its worst, genuinely unsurvivable — and some of my clients have described fleeting thoughts that they would rather not exist than go through another attack. If you are in that territory, please treat it as what it is: a sign that you need real human support, now, not later.

If you are in crisis, please contact Samaritans on 116 123 (free, 24/7), or call NHS 111 for urgent non-emergency mental health help. If life is in immediate danger, call 999. These services exist precisely for the moments when you cannot get through it alone.

For ongoing care, your GP is the entry point to both NHS talking therapies (self-referral is also possible in most areas, without a GP) and to medication. Waiting times vary considerably across London; if you cannot wait and can afford private care, seeking a therapist directly is a legitimate route. I have written elsewhere about the practical trade-offs between private therapy and NHS mental health services.

A closing thought

Many of the clients I have seen for panic arrive certain that they are broken in some fundamental, unreachable way. They are not. Their fear system is doing precisely what evolution shaped it to do; it has simply become miscalibrated, usually for reasons that make sense once you look closely. Panic is one of the conditions where therapy has a genuinely strong track record — where people walk out of treatment not simply coping but, often, with their lives meaningfully enlarged, because what the panic was guarding against has been met and metabolised.

If you would like to talk through what is happening for you, I offer a free 15-minute introductory consultation over Zoom. It is a chance to describe what you are experiencing, ask questions, and see whether working together feels right, with no obligation. You can book it from the booking page or reach me through the contact details on my site.

Panic attacks, at their peak, lie about everything. They lie about what is happening, what is about to happen, and what you are capable of surviving. The first real act of therapy is learning to stop believing them.