Management of Panic Attacks
The best course of treatment for someone experiencing an acute panic attack is cognitive-behavioral techniques including controlled breathing exercises, grounding techniques, and reassurance, followed by consideration of medication and longer-term therapy for recurrent episodes. 1
Immediate Management of an Acute Panic Attack
First-Line Interventions
Breathing Techniques:
- Implement diaphragmatic breathing (slow, deep breaths)
- Guide the person to breathe in for 4 counts, hold for 2, and exhale for 6 counts
- Avoid hyperventilation which can worsen symptoms 1
Grounding Techniques:
- Sensory grounding: Have the person identify 5 things they can see, 4 things they can touch, 3 things they can hear, 2 things they can smell, and 1 thing they can taste
- Cognitive distractions such as counting backwards or word games
- Use of sensory-based distractors (e.g., feeling a textured item) 1
Reassurance and Education:
- Explain that symptoms are not life-threatening
- Inform that panic attacks typically peak within 10 minutes and then subside
- Validate their experience while providing realistic reassurance 1
Environmental Modifications
- Move to a quiet, safe space if possible
- Reduce environmental stimuli (bright lights, loud noises)
- Have the person sit or lie down to prevent injury if dizziness occurs 1
Pharmacological Interventions
Acute Management
- Benzodiazepines may be considered for rapid symptom relief in severe cases:
Long-Term Management for Recurrent Panic Attacks
First-line pharmacotherapy: SSRIs
Second-line options:
- SNRIs (e.g., venlafaxine)
- TCAs (e.g., clomipramine, imipramine)
- Note: TCAs may be more effective but have more side effects than SSRIs 5
Psychological Interventions
Cognitive-Behavioral Therapy (CBT)
- Most effective psychological treatment for panic disorder, typically requiring 12-15 sessions 7
- Key components:
Other Effective Approaches
- Mindfulness-based techniques: Particularly effective for those with recurring panic attacks
- Relaxation training: Progressive muscle relaxation can reduce overall anxiety levels
- Addressing avoidance behaviors: Crucial for preventing development of agoraphobia 8
Follow-Up and Maintenance
When to Seek Professional Help
- For recurrent panic attacks (more than one episode)
- When panic attacks significantly impact daily functioning
- If there's development of avoidance behaviors (potential agoraphobia) 8
Treatment Course
- Short-term CBT (12-15 sessions) is typically sufficient for significant improvement 7
- For medication, continue treatment for 6-12 months after symptom resolution
- Gradual tapering of medication is essential to prevent withdrawal symptoms 2, 4
Special Considerations
Common Pitfalls to Avoid
- Misdiagnosis: Panic symptoms can mimic cardiac conditions; rule out medical causes when appropriate
- Over-reliance on medication: Benzodiazepines should not be the sole treatment strategy due to dependence risk 3, 5
- Reinforcing avoidance: Encouraging avoidance of feared situations can worsen long-term outcomes 8
- Ignoring comorbidities: Panic disorder often co-occurs with depression and other anxiety disorders 6
Cultural Considerations
- Symptom presentation may vary across cultures (e.g., somatic vs. cognitive focus)
- Treatment approaches may need cultural adaptation, as demonstrated in studies with Asian populations 1
By combining immediate management strategies with appropriate long-term interventions, most individuals with panic attacks can achieve significant symptom reduction and improved quality of life.