What advice should be given to a patient experiencing possible anxiety or panic attacks?

Information for Patients Experiencing Anxiety or Panic Attacks

If you are experiencing symptoms that could be a panic attack, the most important first step is to rule out a medical emergency—particularly a heart attack—by seeking immediate professional medical evaluation if you have severe chest pain, especially if you are over 30 years old or have cardiac risk factors. 1, 2

Recognizing a Panic Attack vs. Medical Emergency

Signs That Suggest Panic Attack (Not Heart Attack)

• Symptoms build rapidly to a peak within 10 minutes 3
• Pain changes with breathing, body position, or is well-localized on the chest wall 1
• Accompanied by trembling, dizziness, feeling of unreality (derealisation), tingling sensations (paresthesias), and chills or hot flushes 1, 2
• Multiple body locations of discomfort rather than focused chest pressure 1

Warning Signs That Require Emergency Medical Care

• Severe prolonged chest pain that interrupts normal activity 1
• Pain accompanied by cold sweats, nausea, vomiting, or fainting 1
• You are male over age 30 or female over age 40 with cardiac risk factors (the likelihood of actual heart disease increases dramatically with age: 67% in men aged 30-39 to 94% in men aged 60-69) 2
• Do not wait for symptoms to disappear—these are poor indicators of risk 1

If you suspect a heart attack: call emergency services immediately, take a fast-acting aspirin tablet (250-500 mg), and do not drive yourself to the hospital. 1

Immediate Self-Management During a Panic Attack

Breathing Techniques

• Practice slow diaphragmatic breathing: breathe in slowly through your nose for 4 counts, hold briefly, then exhale slowly through pursed lips for 6-8 counts 2
• This interrupts the catastrophic thinking cycle and reduces physical arousal 2

Physical Positioning

• Sit in a comfortable position with your upper body elevated 2
• Apply something cool to your face (cold compress or cool air from a fan) to help reduce physiological arousal 2

Grounding Techniques to Prevent Escalation

If you notice early warning signs (racing heart, tight chest, sense of impending doom), immediately use sensory grounding strategies: 2

• Notice environmental details around you: name 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, 1 thing you can taste 1, 2
• Use cognitive distractions: count backwards from 100 by 7s, name all the states alphabetically, or play word games 1, 2
• Apply sensory-based distractors: snap a rubber band on your wrist, hold ice cubes, or feel a textured object 1, 2

Critical Reassurance

Understand that panic attacks, while terrifying, are not dangerous and cannot cause you to die, go crazy, or lose control—the symptoms peak within 10 minutes and then subside. 2, 3

What NOT to Do

• Do not consume alcohol to calm yourself, as this can worsen anxiety and lead to dependence 4, 5, 6
• Eliminate or drastically reduce caffeine, as it commonly triggers or worsens panic attacks 4
• Avoid isolation—staying completely alone at home can worsen agoraphobia and avoidance patterns 7
• Do not drive or operate machinery during an acute panic attack 5, 6

Developing Your Personal Action Plan

Create a written plan for managing future episodes that you can reference when symptoms begin: 2

Identify Your Personal Warning Signs

• Racing heartbeat
• Chest tightness
• Shortness of breath
• Dizziness or lightheadedness
• Sense of unreality
• Fear of losing control 2

List Your Effective Coping Strategies

• Which breathing technique works best for you
• Your preferred grounding technique
• A safe person you can call
• A safe location you can go to 2

Share This Plan

Give a copy to family members or close friends so they know how to support you during an episode—advise them to behave as they would if someone is having a panic attack, providing calm reassurance without constant questioning or physical restraint. 1

When to Seek Professional Help

You should contact a healthcare provider if: 2, 8

• Panic attacks are recurring (more than one episode) 9
• You are avoiding places or situations due to fear of having another attack (agoraphobia) 7, 8
• The attacks are interfering with your work, relationships, or daily activities 8
• You are experiencing depression, suicidal thoughts, or using substances to cope 7, 10

Evidence-Based Treatment Options

Cognitive Behavioral Therapy (CBT)

CBT is highly effective for panic disorder and works by helping you understand the connection between catastrophic thoughts and physical symptoms. 2, 9, 3 This therapy teaches you to reinterpret benign physical sensations (like increased heart rate) as non-dangerous rather than catastrophic. 11

Medication Options (Require Prescription)

If professional treatment is needed, first-line medications include: 4, 3

• SSRIs (such as paroxetine, sertraline, or fluoxetine) are the preferred long-term treatment 4, 9, 3
• These medications take 4-8 weeks to reach full effectiveness but have strong evidence for eliminating panic attacks 4, 9
• Benzodiazepines (such as alprazolam or clonazepam) work immediately but carry significant risks of dependence and cognitive impairment, so should only be used short-term during SSRI initiation 4, 10, 3

The combination of CBT plus medication is more effective than either treatment alone. 4, 9

Important Lifestyle Modifications

• Eliminate caffeine completely (coffee, energy drinks, tea, chocolate) 4
• Avoid alcohol and nicotine, which trigger or worsen panic symptoms 4
• Engage in regular cardiovascular exercise, which reduces anxiety 1
• Maintain regular sleep schedules 1
• Practice daily relaxation techniques even when not having panic attacks 1

Common Pitfalls to Avoid

• Do not repeatedly seek emergency care for the same symptoms once cardiac causes have been ruled out—this reinforces the belief that symptoms are dangerous 11
• Do not avoid all situations where panic has occurred, as this leads to progressive agoraphobia 7
• Do not stop prescribed medications abruptly, especially benzodiazepines, as this can cause dangerous withdrawal including seizures 4, 10
• Do not expect immediate results from antidepressants—they require 4-8 weeks to work 4