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Panic attack action card.

Published July 10, 2026 · Last reviewed July 14, 2026 by Shariq Refai, MD, MBA, FAPA

What's happening, what to do during, what to do after, and when to seek help. Print it. Keep it somewhere you can see when you need it.

Medically reviewed by Shariq Refai, MD, MBA · Last reviewed July 10, 2026

Quick answer

A panic attack is a sudden, intense surge of fear or discomfort that peaks within minutes. It feels dangerous. It rarely is. The pounding heart, chest tightness, shortness of breath, sweating, shakiness, and fear of dying or losing control are the nervous system's fight-or-flight response firing when there's no external threat. Panic attacks are common, they end on their own, and they don't damage your body. What follows are five steps to move through one and how to think about the aftermath.

What's happening.

During a panic attack, the sympathetic nervous system releases a burst of adrenaline and related signaling. That produces a fast heart rate, tingling, chest pressure, breathlessness, sweating, nausea, dizziness, tremor, and the very unsettling feeling that something is deeply wrong. Some people also experience derealization (the world feels unreal) or depersonalization (feeling detached from themselves). These are physiological reactions, not evidence of danger. Most attacks peak within 10 minutes and largely resolve within 20 to 30.

DSM-5-TR defines a panic attack as an abrupt surge of intense fear or discomfort reaching a peak within minutes, with four or more characteristic symptoms (palpitations, sweating, trembling, shortness of breath, choking sensation, chest pain, nausea, dizziness, chills or heat, paresthesias, derealization or depersonalization, fear of losing control, fear of dying). Panic attacks can occur in panic disorder, other anxiety disorders, post-traumatic stress disorder, and general medical conditions. They can also happen once in a lifetime with no ongoing disorder.

Five steps to move through it.

  1. 1. Stop and name it.

    Say it, out loud if you can: "This is a panic attack. It'll peak in a few minutes and then it'll pass." Naming the experience gives you a small piece of ground to stand on. It also breaks the cycle where the physical sensations are misread as evidence of a heart attack or stroke, which fuels more panic. The sensations are the panic attack. They're not proof of something worse.

  2. 2. Slow the breath.

    Breathe in through your nose for 4 seconds. Hold for 4. Breathe out through your mouth for 6 to 8. Repeat for four to six cycles. Don't try to breathe deeply, try to breathe slowly. Hyperventilation is a major driver of panic symptoms; slowing the breath, especially the exhale, reduces sympathetic activation via the vagus nerve and helps the physical sensations settle.

  3. 3. Ground with your senses.

    Look around and name five things you can see, four you can feel touching your skin, three you can hear, two you can smell, and one you can taste. Or press your feet firmly into the floor and notice the pressure. Or hold something cold. The goal is to shift attention from internal alarm signals to concrete external information. See our grounding techniques reference for more options.

  4. 4. Ride the wave.

    Don't try to stop the attack. Don't run from it. Panic attacks peak, then they fade. Fighting or fleeing extends them and teaches the nervous system that the situation was actually dangerous. Instead: keep breathing slowly, keep noticing your surroundings, and let the wave rise and fall. It always falls. Twenty minutes from now, this will be over.

  5. 5. Aftercare.

    Once the wave passes, most people feel drained. Drink some water. Eat something small. Take a short walk if you can. Notice what your body actually feels like now that the sympathetic surge has ended, a little tired, a little sore, mostly okay. That evidence is worth collecting. It's what makes the next attack less frightening.

Try this next. This card is the short version. For the full, psychiatrist-designed version, see the Panic Reset, a step-by-step guide to stopping a panic attack. shrinkMD is part of The Shrink Network, founded by Shariq Refai, MD.

What not to do.

  • Don't hyperventilate on purpose. Rapid deep breaths make panic symptoms worse.
  • Don't take a benzodiazepine without a plan. Benzodiazepines feel effective in the moment, but taken as needed during every attack they can reinforce panic disorder rather than treating it. If you're already prescribed one, follow your prescriber's guidance. If you're not, this is a conversation for your prescriber.
  • Don't check your pulse compulsively. Repeatedly checking the body for signs of danger fuels the attack.
  • Don't avoid the place it happened. Avoidance shrinks your life and strengthens panic disorder over time. If avoidance is already limiting where you go and what you do, that's a signal to work with a therapist who does exposure-based treatment for panic.

When to seek immediate medical evaluation.

Panic attacks feel like a heart attack. Sometimes it's a heart attack. Call 911 (or seek immediate care) if any of the following is true:

  • This is your first episode of chest pain, shortness of breath, or fainting and you haven't been medically evaluated.
  • Chest pain that radiates to the jaw, arm, or back, especially with sweating and nausea.
  • Symptoms that do not resolve within 20 to 30 minutes.
  • Fainting, near-fainting, or a level of chest pain you haven't experienced before.
  • You've known heart disease, are older, or have significant risk factors.
  • Symptoms come with sudden severe headache, one-sided weakness, difficulty speaking, or vision loss, possible signs of stroke.

Panic attacks are a diagnosis of exclusion the first time they occur. A medical workup, an EKG at minimum, sometimes labs (thyroid, electrolytes, glucose, drug screen), is standard before assuming symptoms are psychiatric in origin.

When to seek psychiatric evaluation.

Once a medical cause has been ruled out and panic attacks are recurring, consider a psychiatric evaluation if any of the following is true:

  • Panic attacks are happening more than once a month.
  • You're worrying about the next one between attacks.
  • You're avoiding places or situations because of them.
  • Sleep, work, relationships, or day-to-day functioning are being affected.
  • You're using alcohol or other substances to manage the attacks.

Evidence-based treatments for panic disorder work well. First-line options include cognitive behavioral therapy with an exposure component and SSRIs (some SNRIs are also effective). Combining the two often works better than either alone. Benzodiazepines have a limited role in short-term or bridging use under a prescriber's guidance.

What this card isn't.

This page is a general educational reference for what a panic attack is and what to do during one. It isn't a diagnosis, not a treatment plan, and not a substitute for evaluation by a licensed clinician. If your symptoms are new, severe, or not fitting the pattern above, seek medical care.

Care-routing framework

When evaluation may help, care can look like one of five things.

If panic attacks are happening regularly, that's worth talking about. Choose the care setting that fits your situation, your insurance, and your access. There's no requirement to start with a psychiatrist. Full framework and disclosure on the editorial strategy page.

  1. Your primary care doctor.

    The entry point most people already have. PCPs evaluate and treat panic often, and can rule out medical mimics (thyroid, cardiac, others). Often the fastest first conversation.

  2. A therapist trained in CBT for panic.

    Exposure-based CBT for panic disorder has strong evidence. Psychology Today's directory lets you filter for CBT and for panic disorder specialization.

  3. A psychiatrist for prescribing and complex care.

    The right fit when medication is on the table, symptoms are severe, or first-line treatment isn't working. Wait times for in-network psychiatrists in the US are often long, sometimes months.

  4. shrinkMD, one telepsychiatry option.

    shrinkMD is the network's independent telepsychiatry practice, board-certified, currently accepting adult patients in a limited set of US states. Transparently one option among many, not a recommendation above other qualified clinicians.

  5. 988 for crisis. This is a different moment.

    If you're thinking about suicide, in acute crisis, or someone you love is in danger right now, this isn't a "find a psychiatrist" moment. Call or text 988 in the US. Call 911 if someone is in immediate danger.

Full disclosure. The Shrink Network is founded by Shariq Refai, MD, who also owns shrinkMD. This site takes no referral fee, no affiliate commission, and no revenue for care sent to shrinkMD or any other clinician named here. We name shrinkMD because it's transparently one option, not because we recommend it above other qualified clinicians.

Sources.

Related resources.

The card gets you through the attack. These help you understand it afterward.

How to cite this page

APA-style suggested citation:

Refai S. Panic attack action card: what to do during and after. The Shrink Network Toolkit Library. Published July 10, 2026. Accessed [date]. https://shrinknetwork.com/toolkit/panic-attack-action-card/

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Educational reference, not medical advice. This page is general education about panic attacks. It isn't a diagnosis, not a treatment plan, and not a substitute for evaluation by a licensed clinician. If symptoms are new, severe, or unusual for you, seek medical evaluation. If you're in crisis, call or text 988 in the US.