Five Practical Evidence-Based Steps to Better Manage Panic
Five Practical Evidence-Based Steps to Better Manage Panic
Introduction: Understanding Your Experience
You find yourself sitting in a meeting, driving your car, being on public transport, or being in a shopping mall. Your heart starts to race uncontrollably. Your breathing becomes shallow and rapid. Your hands tingle or go numb. You start sweating profusely. The world suddenly feels unreal as though you’re watching your self from outside your body. You have this overwhelming sense of dread, just needing to get away. If this sounds familiar, these five practical steps to manage a panic attack could be just what you need.
You Are Not Alone
You are not alone in this experience.
Panic can be one of the most frightening and disorienting experiences a person can endure.
>Research suggests that approximately 11% of the population experiences a panic attack in any given year, and around 2-3% of people will develop panic disorder at some point in their lives (Kessler et al., 2006).
<p>If you’ve had even one panic attack, you understand how profoundly it can shake your confidence and alter your daily life.<p>Many people find themselves reorganizing their entire existence around the fear of having another attack—avoiding certain places, activities, or situations where they worry panic might strike.
The Good News
The good news is this: panic is treatable.
While panic attacks feel utterly real and genuinely distressing in the moment, they are not dangerous. Your body is not failing you. Your mind is not breaking down. What’s happening is a misalignment between your threat-detection system and actual threats in your environment—and this misalignment can be corrected.
This blog post is written for anyone who has experienced panic and wants to understand it better. More importantly, it’s designed to provide you with five practical, evidence-based strategies that you can implement immediately to regain control, reduce the frequency and intensity of panic attacks, and rebuild your confidence.
<p>These strategies are grounded in decades of being in clinical practice, supported by psychological research, and have helped countless people move from a life controlled by panic to a life where panic no longer calls the shots.
What Is Panic, Really?
<p>Before we discuss management strategies, we need to understand what panic actually is—because what you believe about your panic significantly influences how you respond to it, and your response significantly influences whether panic persists or resolves.
Panic vs. Anxiety: Understanding the Difference
First, it’s important to distinguish between anxiety and panic, as they’re often confused.
Anxiety is a future-focused emotional state characterized by worry about potential threats. It’s often mild to moderate in intensity and can actually be adaptive—it helps us prepare for challenges and stay alert to genuine dangers.
Panic, by contrast, is sudden, intense, and overwhelming. It’s a full-system alarm response triggered by your nervous system’s threat-detection mechanisms. During a panic attack, your body enters the “fight-or-flight” response—a physiological state designed to help us survive immediate physical threats.
The Neurobiology of Panic
When you experience a panic attack, your amygdala—the brain’s alarm centre—activates rapidly in response to perceived threat signals.
The amygdala then triggers the sympathetic nervous system, flooding your body with stress hormones including adrenaline and cortisol. Your heart rate increases, blood vessels constrict, blood is redirected to major muscle groups, your breathing becomes rapid and shallow, and your senses sharpen.
In the context of facing a predator or immediate physical danger, these changes are perfectly calibrated to help you survive.
<p>The problem, as David Clark outlined in his influential cognitive model of panic (Clark, 1986), is that when you experience panic symptoms—racing heart, dizziness, breathlessness, tingling sensations—your mind can misinterpret these normal (if uncomfortable) bodily sensations as signs of immediate catastrophe.<p>You might think, “My heart is racing uncontrollably—I’m having a heart attack,” or “I can’t catch my breath—I’m suffocating,” or “The world feels unreal—I’m losing my mind.”
These catastrophic interpretations then trigger further anxiety, which intensifies the physical symptoms, which further confirms your catastrophic thoughts. This creates a vicious cycle referred to as “panic spiralling.”
What Panic Is Not
This is crucial: panic attacks are not dangerous.
They feel dangerous, tremendously so, but they are not.
>Medical research consistently demonstrates that panic attacks, while deeply unpleasant, do not cause heart attacks, strokes, fainting, suffocation, or loss of control.
Your body is not in danger during a panic attack. Your mind is functioning normally, even though it doesn’t feel that way.
<p>Understanding this distinction—between the subjective experience of danger and the objective reality of safety—is foundational to managing panic effectively.
The Paradox of Avoidance in Panic Management: Why Fighting Panic Intensifies It
<p>One of the most counterintuitive yet well-documented findings in anxiety research is that the very act of struggling against panic—attempting to escape, suppress, or eliminate the uncomfortable sensations—paradoxically strengthens anxiety’s grip and escalates panic symptoms.<p>This phenomenon, known as “experiential avoidance,” creates a psychological tug-of-war wherein each effort to push away the feeling generates increased focus on it, resistance to it, and ultimately amplification of it.<p>When an individual experiences heart palpitations during a panic attack and thinks “I must stop this feeling” or “I need to get away from this sensation,” they inadvertently shift into a defensive posture that activates the sympathetic nervous system further, intensifying the very physiological responses they’re trying to escape.<p>This struggle itself becomes a safety behaviour—a form of mental avoidance that, like physical avoidance behaviours, maintains the panic disorder cycle (<a href=”https://www.sciencedirect.com/science/article/abs/pii/S0005796798001533?via%3Dihub”>Salkovskis et al., 1999). According to Acceptance and Commitment Therapy (ACT) research, the solution lies not in victory against panic but in fundamentally changing one’s relationship with it. Adopting a stance of observation, acceptance, and willingness to experience uncomfortable sensations without judgment or resistance (Arch & Craske, 2008).<p>By releasing the tug-of-war rope—by ceasing the struggle and instead allowing sensations to exist—individuals paradoxically reduce their power and duration, as anxiety naturally dissipates when no longer met with internal resistance.
Five Practical Evidence-Based Steps to Better Manage Panic
Step 1: Master Your Breathing with the Physiological Sigh
Why This Matters
One of the most immediately distressing symptoms during a panic attack is the sensation of not being able to breathe. Your breathing becomes rapid and shallow—a pattern called hyperventilation.
<p>This rapid breathing causes you to expel too much carbon dioxide from your bloodstream, which leads to a cascade of unpleasant symptoms: dizziness, tingling in your extremities, chest tightness, and a heightened sense of unreality (depersonalization/derealisation). Ironically, the very symptom—rapid breathing—that you’re trying to correct is often making things worse.
Research has consistently demonstrated the power of controlled breathing techniques in reducing panic symptoms. A meta-analysis by Meuret and colleagues (2013) examining over 30 studies found that slow breathing techniques significantly reduced panic symptoms and were particularly effective when combined with cognitive strategies.
<p>However, traditional advice to “breathe slowly and deeply” during panic often doesn’t work because it’s difficult to execute when you’re in acute distress.<p>Moreover, research by Balban and colleagues has identified a particularly effective breathing pattern that works with your physiology rather than against it: the physiological sigh.
The Physiological Sigh
The physiological sigh involves two inhales followed by one extended exhale:
1. Inhale through your nose for a count of four, allowing your belly to expand (diaphragmatic breathing)
2. Immediately inhale again through your nose for another count of two, filling your chest
3. Exhale slowly and completely through your mouth for a count of six to eight, making this exhale longer than your inhales
The key is that extended exhale. This activates the parasympathetic nervous system—your body’s natural “calming” system. It signals safety to your nervous system and helps restore equilibrium.
Practical Application During Panic
Practice this breathing pattern for just 5-10 minutes daily when you’re calm, so it becomes familiar and automatic.
<p>The goal is that when you feel panic beginning to rise, you can access this technique without having to think about it.
Research shows that pre-practicing breathing techniques makes them substantially more effective when you need them (Meuret et al., 2010).
During a panic attack itself, aim for 5-10 cycles of this breath pattern. You might not be able to control your breathing perfectly while panicking, and that’s okay. The act of deliberately engaging with your breath—shifting your focus from catastrophic thoughts to the physical sensation of breathing—is itself therapeutic.
Step 2: Challenge Catastrophic Thoughts Through Cognitive Restructuring
Why This Matters
<p>Cognitive therapy for panic disorder, pioneered by David Clark and extensively researched since, demonstrates that the relationship between your thoughts and panic is bidirectional.
Not only do panic symptoms trigger catastrophic thoughts, but catastrophic thoughts intensify panic symptoms.</p>
>Arch and Craske (2011) in their article on the efficacy of cognitive behavioural therapy for panic disorder stated that cognitive restructuring—th
e process of identifying and challenging catastrophic thoughts—is one of the most effective components of treatment, with success rates of 60-80% in reducing or eliminating panic symptoms.
<p>During a panic attack, your mind generates thoughts like:
• “I’m having a heart attack”
• “I’m losing control”
• “I’m going to faint”
• “This will never end”
• “Everyone can see I’m panicking”
These thoughts feel absolutely true in the moment. But they’re predictions made by an anxious mind, not facts.
How to Practice Cognitive Restructuring
The process of cognitive restructuring involves:
Recognition
Notice the catastrophic thought as it occurs. You might say to yourself, “I’m having the thought that I’m having a heart attack” rather than “I am having a heart attack.”
Evaluation
Ask yourself:
What evidence supports this thought?
What evidence contradicts it?
Have I had this thought many times before?
Did the catastrophe actually occur?
Replacement
Generate a more balanced, realistic thought. This isn’t positive thinking or denial—it’s accurate thinking. For example:
<p>o Instead of: “I’m having a heart attack”
o Try: “I’m experiencing uncomfortable physical sensations, but I’ve been checked by a doctor and my heart is healthy. These sensations are unpleasant but not dangerous.”
Practice
Write down your panic-related thoughts, then work through them using this process. This externalizes your anxious thoughts and makes them easier to examine objectively.
An Important Caveat
Cognitive restructuring is most effective when practiced regularly during calm periods, not just during panic attacks.
>Research indicates that people who regularly challenge their anxious thoughts develop new neural pathways that gradually reduce automatic catastrophic thinking (Cristea et al., 2015). The goal is that catastrophic thoughts become less automatic and less believable over time.
Step 3: Implement Interoceptive Exposure to Desensitize Your Threat System
Why This Matters
<p>Here’s a paradox: one of the most effective ways to overcome panic is to intentionally create mild versions of the physical sensations you fear.
This might sound counterintuitive, but it’s grounded in solid neuroscience and extensive research evidence.
The principle behind this approach is called habituation. When you repeatedly experience a stimulus without the feared consequence occurring, your threat-detection system gradually “learns” that the stimulus isn’t actually dangerous. Your amygdala’s alarm response weakens.
<p>Research by Barlow and colleagues (1989) demonstrated that interoceptive exposure—deliberate exposure to bodily sensations associated with panic—is significantly more effective than standard relaxation techniques in reducing panic disorder.<p>A meta-analysis by Norton and Price (2007) found that interoceptive exposure components in cognitive-behavioural therapy for panic were particularly predictive of treatment success.
How to Practice Interoceptive Exposure
The process involves systematically and deliberately creating mild versions of the sensations you fear:
For Racing Heartbeat
<p>• Jump up and down, do jumping jacks, or run in place for 30-60 seconds until your heart is pounding
• Notice the sensation: your heart racing is uncomfortable but not dangerous
• Sit down and observe your heart rate return to normal over the next few minutes
• Repeat this exercise several times until the sensation becomes less frightening
For Dizziness
<p>• Spin around slowly for 30-60 seconds until you feel dizzy
• Sit down and observe the dizziness dissipate
• Notice that dizziness doesn’t lead to fainting
For Breathlessness
<p>• Hold your breath for 30 seconds, or breathe through a straw, or hold a pillow over your face for a few seconds (safely)
• Notice that your breathing automatically returns to normal when you stop<br />• Repeat until the sensation feels more manageable
For Unreality (Depersonalization/Derealisation)
<p>• Shake your head back and forth while looking at your reflection for 30-60 seconds
• Notice that the strange sensation of unreality naturally resolves<p>The crucial element is that you must allow yourself to experience these sensations fully, without immediately trying to escape or neutralize them. This teaches your nervous system: “I can experience this sensation, it’s uncomfortable, but I’m safe.”
A Gradual Approach
Start with sensations that are lower on your fear hierarchy. If your worst fear is fainting, don’t start there; start with heart racing or dizziness. As you build confidence and your nervous system learns that these sensations aren’t dangerous, you can work your way up to more challenging exposures.
<p>Research indicates that interoceptive exposure is most effective when practiced regularly—ideally several times per week—rather than sporadically (Craske et al., 2008).
Step 4: Practice Mindfulness and Acceptance to Change Your Relationship with Panic
Why This Matters
Traditional approaches to panic management focus on reducing symptoms—making the physical sensations go away, eliminating the anxious thoughts.
<p>But research in Acceptance and Commitment Therapy (ACT) and mindfulness-based interventions suggests that another powerful approach is to change your relationship with panic sensations, accepting them as present without fighting them.
This might sound passive or resigned, but it’s quite the opposite. Research by Arch and Craske (2008) found that individuals who accepted their anxiety symptoms (rather than struggling against them) experienced better long-term outcomes and lower rates of panic relapse.
<p>A meta-analysis by A-Tjak and colleagues (2015) examined 18 randomized controlled trials of ACT for anxiety disorders and found it significantly effective, with effects comparable to or exceeding cognitive-behavioural therapy in some cases.<p>The fundamental principle is this: the struggle against panic—the attempt to suppress, avoid, or escape the experience—is often what perpetuates panic. The physical sensations of panic are unpleasant, but they become unbearable when you resist them.
How to Practice Mindfulness and Acceptance
Mindfulness involves observing your experience—thoughts, sensations, emotions—with curiosity and non-judgment, like a scientist observing phenomena in a laboratory.
A Simple Mindfulness Practice for Panic Sensations
1. Notice without judgment: When you experience panic sensations, pause and observe them. “I notice my heart is racing. I notice my hands are tingling. I notice I’m having the thought that something bad will happen.”
2. Observe the sensations as separate from yourself: Rather than “I am panicking,” think “Panic sensations are occurring in my body.” This creates distance between you and the experience.
3. Describe in sensory detail: Instead of global evaluation (“I’m panicking”), describe specifically what you observe: “I notice a rapid thumping sensation in my chest. I notice my breathing is shallow. I notice tension in my shoulders.”
4. Allow the sensations to be present: This is the acceptance piece. Instead of fighting the sensations, mentally allow them: “These sensations are here right now. That’s okay. I don’t have to fix them or make them go away immediately. I can observe them and continue with my day.”
5. Redirect attention to values-aligned action: While accepting the panic sensations, redirect your attention to what matters to you. If you’re at work, focus on the task. If you’re with loved ones, focus on the conversation. This demonstrates to your nervous system that the panic sensations, while present, don’t control your behaviour.
Building a Daily Practice
Research demonstrates that mindfulness is most effective as a daily practice, not something you only do during panic.
Consider dedicating 10-15 minutes daily to formal mindfulness meditation. Apps like Insight Timer and Calm offer guided meditations specifically for anxiety.
Hofmann and colleagues (2010) found that mindfulness-based therapies significantly reduce anxiety symptoms. Subsequent research suggests that consistent adherence to mindfulness practice is associated with greater clinical benefits, although the specific threshold of 4–5 practices per week was not reported in the meta-analysis.
Step 5: Modify Your Safety Behaviours and Avoidance Patterns
Why This Matters
<p>After a panic attack, many people develop what researchers call “safety behaviours”—actions taken to prevent panic or to escape from panic situations. These might include:<p>• Holding onto something solid during panic (seeking physical security)
• Carrying medication or having water nearby
• Avoiding certain places where panic occurred
• Staying near exits
>• Avoiding being alone
• Checking your pulse repeatedly to ensure your heart is okay
• Seeking reassurance from others
These behaviours feel protective in the moment, but research consistently demonstrates that safety behaviours actually maintain panic disorder. >Salkovskis and colleagues (1999) found that individuals who relied on safety behaviours showed slower recovery rates and higher relapse rates compared to those who gradually reduced these behaviours.
The mechanism is clear: safety behaviours prevent you from learning that you’re safe without them.
<p>Each time you use a safety behaviour and the feared catastrophe doesn’t occur, your mind attributes this to the safety behaviour: “I didn’t have a heart attack because I stayed near the hospital” or “I didn’t faint because I held onto something.” This means you never learn: “I’m safe in this situation regardless of what I do.”
How to Gradually Reduce Safety Behaviours
The process involves systematically and gradually reducing reliance on safety behaviours:
1. List your safety behaviours: Write down all the things you do to prevent or manage panic. Be specific.
2. Rank them by difficulty: Order them from easiest to eliminate to hardest.
3. Create a gradual exposure hierarchy: Starting with the easiest, plan to progressively reduce each behaviour. For example:
o Week 1: Go to the grocery store and stay 20 minutes without holding the cart
o Week 2: Go for 30 minutes without the safety behaviour
o Week 3: Go alone without any safety behaviour
4. Expect temporary discomfort: When you first reduce a safety behaviour, anxiety may increase. This is normal and expected. Research shows that when you stay in the situation without the safety behaviour, anxiety naturally decreases over 20-40 minutes (Craske et al., 2008).
5. Celebrate progress: Each time you successfully navigate a situation without a safety behaviour, you’re rewiring your threat-detection system. You’re teaching your amygdala: “This situation is safe.”
<p>Research by Hoffart and colleagues demonstrated that reductions in safety behaviours are an important mechanism of change in anxiety treatment, while studies of panic disorder specifically have shown that abandoning safety-seeking behaviours is associated with significantly better treatment outcomes and recovery (Salkovskis et al., 1999; Pompoli et al., 2018).
Integrating These Strategies: A Practical Framework
These five strategies work best when integrated into a comprehensive, systematic approach rather than used in isolation. Here’s a practical weekly framework:
<p>Daily Practice (15-20 minutes):
• Morning: Practice physiological sigh breathing (5 minutes) and mindfulness meditation (10-15 minutes)
• Throughout the day: Practice cognitive restructuring on anxious thoughts as they arise<p>Weekly Practice (2-3 times per week):
• Interoceptive exposure exercises (20-30 minutes)
• Reduction of one safety behaviour by 10-20%
• Review and adjust your approach based on what’s working
Monthly Review:<br />• Assess your panic frequency and intensity
• Adjust your exposure hierarchy
• Celebrate successes
When to Seek Professional Help
<p>While the strategies outlined in this blog are evidence-based and can be very effective, it’s important to acknowledge that some people benefit from professional support. Consider working with a mental health professional if:<p>• You’ve experienced panic attacks for more than a few months
• Panic is significantly interfering with your daily life, work, or relationships
• You’ve developed extensive avoidance patterns
• You have difficulty implementing these strategies on your own
• You have co-occurring mental health conditions like depression<p>Cognitive-Behavioural Therapy (CBT) for panic disorder, delivered by a trained therapist, remains the gold standard treatment, with extensive research supporting its efficacy.<p>A meta-analysis by Hofmann and Smits (2008) examining nearly 100 studies found CBT for anxiety disorders, including panic disorder, to be highly effective, with success rates of approximately 50% achieving substantial improvement and many others experiencing meaningful relief.
Conclusion: Your Path Forward
Panic is distressing, but it is not dangerous, and it is treatable. The five strategies outlined in this blog—controlled breathing, cognitive restructuring, interoceptive exposure, mindfulness and acceptance, and reducing safety behaviours—represent decades of clinical experience based on psychological research translated into practical, actionable steps.
Start with one strategy—perhaps the physiological sigh, since it’s immediately practical and useful. Practice it consistently. Once it becomes automatic, add another strategy. Build gradually, be patient with yourself, and trust the process. The research is clear: panic can be overcome. And your recovery starts with the very next conscious breath you take.
About the Author
Hein Roth is a registered Psychologist specialising in PTSD, Complex PTSD, anxiety, and mood disorders. Hein is the Principal Psychologist and owner of The Trauma & Phobia Clinic in Perth, Australia.
<p>Based on his more than 40 years of professional experience in clinical practice, Hein founded RECOVER®, a registered trade marked mental wellness application with one guiding principle in mind: mental wellness resources should feel personal, supportive, practical, and genuinely human.
People who feel overwhelmed do not need more noise. They need a place that helps them pause, reflect, and understand what they are feeling in a more manageable way. RECOVER® offers a carefully curated collection of self-guided wellness resources intended to encourage awareness, calm, and personal reflection.
<p>Readers can connect with the brand through the official RECOVER® website to explore educational articles and updates, or connect with the community on Facebook , Instagram, LinkedIn, or our other blogs at Recover Blog.
