How do you stop an anxiety attack?

If this is happening right now, skip to the breathing instructions below and come back to the rest afterward. Everything else on this page is useful later. The breathing is useful in the next sixty seconds.

The breathing, specifically

Vague advice to “breathe deeply” tends to make things worse, because most people respond by taking large fast breaths, which increases the same sensations they are trying to reduce. The mechanism that helps is a longer exhale than inhale. That is the part that matters.

Do this:

1. Breathe in through your nose for a count of four.
2. Breathe out through your mouth, slowly, for a count of six, as if breathing through a straw.
3. Do not pause or hold at the top. Go straight from in to out.
4. Repeat for ten cycles, roughly two minutes.

Keep the breaths ordinary in size. You are not trying to fill your lungs. If four and six feel impossible, use three and five, and lengthen once the rhythm settles. Put one hand on your stomach so you can feel the movement lower than your chest.

Ten cycles is the instruction because most people abandon this after three, decide it did not work, and go back to fighting the sensation. The shift usually arrives somewhere between the sixth and tenth breath.

While you are breathing, do one grounding task

Give your attention a small concrete job. Name five things you can see, working around the room. Then four things you can hear, including quiet ones like a fan or traffic. Then three things you can feel, such as your feet on the floor or the chair against your back.

Name them silently in full sentences rather than as a list. The slower pace is the point.

Cold helps too, and works fast for many people. Hold something cold, run cold water over your wrists, or press a cold can against your neck.

The one instruction that changes everything

The instinct during an attack is to make it stop immediately. That instinct is what extends it.

Watch what happens internally: the heart rate climbs, you notice it, you think something is wrong with me, and the alarm response reads that thought as confirmation of danger and fires harder. Fear of the sensation produces more of the sensation. That is the loop.

The way out is to stop fighting. Silently label it: this is anxiety, it is peaking, it will come down. Then let it. An anxiety attack is a wave. It rises, it peaks, and it falls on its own, and it does that whether or not you struggle against it. Your only job is to breathe slowly and wait it out.

Two things not to do. Do not leave the situation the instant the fear appears, if you can manage staying, because escaping at the peak teaches your brain that escape was what saved you and makes the next one more likely. And do not check your pulse repeatedly. Monitoring is a form of scanning, and scanning keeps the alarm active.

Afterward, and why the next one is easier if you note it

Once it passes you will probably feel wrung out and want to never think about it again. Five minutes of noting is worth more than that avoidance.

Write down where you were, what you were doing in the hour before, how you slept, caffeine and alcohol in the previous day, and what the first physical sensation was. Rate the peak intensity from 0 to 10, and note how long it took to come down.

Two things emerge from a few weeks of this. Patterns become visible that are invisible day to day, particularly around sleep, caffeine, and skipped meals. And the recorded duration undercuts the belief that an attack could go on indefinitely, because it never does.

Reducing how often they happen

In-the-moment tools get you through an attack. They do not reduce the frequency, and people often plateau at the coping stage and stay there for years.

Cognitive behavioral therapy targets the mechanism instead. That involves retraining how you interpret body sensations, since attacks run on reading a normal racing heart as a sign of catastrophe, and gradually returning to the places and situations you have been avoiding. Avoidance is what quietly shrinks a life around this, one skipped subway ride or declined meeting at a time.

Your therapist tracks intensity ratings with you month to month using standardized measures, so progress is based on the trend rather than on how a single bad week felt. See how we help with anxiety, and if the attacks come on suddenly and peak within minutes, read about panic attacks and panic disorder.

One medical note, then how to reach us

If this is your first episode, or if the symptoms include chest pain, fainting, or anything that seems physically off, get evaluated by a doctor. Confirming there is nothing medical going on is genuinely useful, and it is worth doing once rather than repeatedly.

MindView works with adults 18 and over. Book at choose your therapist or call (646) 493-4007.

If you are having thoughts of harming yourself, call or text 988 for the Suicide and Crisis Lifeline. MindView is not a crisis service.