How to assist someone experiencing a panic attack

Understand what they are going through. People with panic disorders often experience sudden and repeated panic attacks, which last from a few minutes to an hour, but rarely go beyond that due to the body's inability to sustain the attack. Panic attacks are characterized by fear of catastrophe or losing control, even when no real danger exists. These attacks can occur unexpectedly and without a clear reason. In severe cases, symptoms may include a terrifying fear of death. Despite the alarming symptoms, panic attacks are not life-threatening.

• Panic attacks push the body to its extreme, causing the sufferer to feel out of control. Their mind prepares for a “fight or flight” response that isn’t real, forcing the body to react to an imagined threat, whether real or not.
• Hormones like cortisol and adrenaline are released into the bloodstream, initiating the panic process. This reaction is the core of the panic attack. The brain cannot distinguish between a real danger and an imagined one. If you believe it’s real, it will seem real in your mind. The person might act as if their life is in danger, and it will feel like it’s actually happening. Try to see it from that perspective, as if someone held a knife to your neck and said, “I’m going to cut your throat, but guess what? I’m not sure when. It might be right now.”
• There have been no reported fatalities due to panic attacks. A person might die only if they have pre-existing conditions, like asthma, or if they engage in extreme actions afterward (such as jumping out of a window).

Monitor the symptoms. If the person has never experienced a panic attack before, it will occur at two different levels – the second level arises from not understanding what's happening. If you can recognize that they are having a panic attack, this will already help alleviate half the stress. Symptoms include:

• Heart palpitations or chest pain
• Rapid heartbeat
• Shallow breathing
• Trembling
• Dizziness/faintness/feeling like you’re about to pass out (usually due to rapid breathing)
• Pins and needles/numbness in fingers or toes
• Temporary hearing loss or ringing in the ears
• Sweating
• Nausea
• Stomach cramps
• Hot flashes or chills
• Dry mouth
• Difficulty swallowing
• Depersonalization (feeling detached from the body)
• Headaches

If this is the first time the person has had a panic attack, you should call emergency services immediately. When in doubt, it's always best to call for help. This is particularly important if they have pre-existing conditions like diabetes, asthma, or other health issues. Be aware that the signs and symptoms of a panic attack can mimic those of a heart attack. Keep this in mind when evaluating the situation.

Identify the cause of the panic attack. Talk to the person and confirm that they are experiencing a panic attack, rather than another medical emergency (such as a heart attack or asthma attack) that requires immediate attention. If the person has had panic attacks before, they may be able to tell you what triggered the episode.

• Many panic attacks occur without a clear cause, or at least the patient may not be aware of what triggered it, so identifying the cause may not always be possible. If the person doesn’t know why, trust them and don't ask further. Not everything has a clear explanation.

Remove the cause and take the patient to a quiet space. The person having a panic attack may want to leave the place they are in. (However, you should not do this unless they request it. Taking them somewhere else could escalate their panic because they will feel unsafe and unable to grasp what is happening around them. So, if you intend to move them, ask them first and let them know where you're taking them). To ensure safety, take them to a place that is quiet and open. Never touch someone experiencing a panic attack without first asking and getting their consent. In some cases, touching the person can make the situation worse.

• Sometimes, those with panic disorders have specific methods or medications to help them get through an attack, so ask if there's anything you can do to assist them. They might just want to be in a different space.

Speak to them with a gentle yet firm attitude. Be prepared for the possibility that the patient may try to flee. Even in a challenging situation, it's crucial for you to stay calm. Instruct the person to remain still, but never grab or restrain them, even gently. If they wish to move, suggest light stretching, jumping in place, or walking briskly with you.

• If the person is at home, suggest they rearrange their wardrobe or tidy up the house. Their body is primed for fight or flight, so redirecting their energy toward a practical task can help them manage physiological effects. Accomplishing something tangible may improve their mood, and focusing on another activity can dissipate the tension.
• If they are not at home, offer another activity to help them concentrate. A simple task like raising and lowering their arms can work. When they begin to tire or feel bored, their focus will shift away from the panic.

Do not dismiss or belittle their fear. Phrases like "There's nothing to be afraid of" or "This is all in your head," or “You're overreacting” will only worsen the situation. Their fear feels very real to them at the moment, and the best thing you can do is help them cope. Dismissing or downplaying their fear may escalate the panic. Simply say "It’s okay" or "You’ll be fine" and keep breathing.

• Emotional fear is just as real as a physical life-threatening threat to the body. It's important to take their fear seriously. If their fear isn’t grounded in the present and they are reacting to something from the past, help them by reminding them of specific real-life instances. "This is Son we're talking about; he would never slap someone in the face for making mistakes like Quan did earlier. He’s just reacting like he always does, and it might help you. This will pass quickly, and he doesn't think it's serious."
• Asking questions like “Are you reacting to the present situation or something from the past?” calmly can help the victim sort through their thoughts and distinguish past memories from real current danger signs. Listen and accept their answer. Sometimes, victims of abuse may have strong reactions to real-life danger signals. The best way to support them is to ask the right questions and let them process the events themselves.

Don’t say, “Calm down,” or “There’s nothing to panic about.” A condescending attitude could make them even more frightened. Additionally, telling them there's nothing to fear may just remind them of how detached from reality they feel, making the panic even worse. Instead, try saying, “I understand you're feeling confused. It’s okay. I’m here to help you.” or “This will pass quickly. I know you're scared, but I’m here with you, and you’ll be fine.”

• The key is to treat this situation as seriously as if they were bleeding from a serious injury. Although you can't physically see what's happening, something very frightening is occurring for them. That situation is real in their mind. The only way you can help is to acknowledge the problem from that perspective.

Don’t pressure them. This is not the time to force the patient to figure out why they're panicking or do anything that might intensify their fear. Reduce their stress by creating a peaceful environment and guiding them into a relaxed state. Don’t insist they identify the cause of their panic, as that will only worsen things.

• Listen supportively if they attempt to sort through their reactions. Don’t judge; just listen and allow them to express themselves.

Encourage them to focus on controlling their breath. Regaining control of their breathing will reduce symptoms and help them calm down. Many individuals experience short, rapid breaths, or even hold their breath during a panic attack. This reduces oxygen intake and causes the heart rate to accelerate. Use the following techniques to help them breathe normally:

• Counting breaths. Guide the person to inhale and exhale according to your counting rhythm. Start by counting aloud, encouraging them to inhale for 2 counts, exhale for 2 counts, and gradually increase to 4 counts, then 6 counts if possible, until their breathing slows down and becomes steady.
• Request them to breathe into a paper bag. If they’re open to it, hand them a paper bag. However, be mindful that for some, a paper bag may trigger fear, especially if they have had a negative experience with it during past panic attacks.
  • This technique helps prevent rapid breathing, but it may not be necessary if they are holding their breath or breathing too slowly during a panic attack. If necessary, guide them to breathe in and out of the bag 10 times, then switch to normal breathing without the bag for 15 seconds. It’s important not to overuse the bag to avoid an excessive buildup of carbon dioxide and a decrease in oxygen, which could worsen their health issues.
• Encourage them to inhale through the nose and exhale through the mouth as though blowing bubbles. You should do this with them.

Keep the person cool. Many panic attacks come with a sensation of heat, particularly around the neck and face. A cold object, such as a damp cloth, can help alleviate this symptom and reduce the intensity of the panic attack.

Don’t leave the person alone. Stay with them until the panic attack subsides. Never leave someone who’s having trouble breathing. The person may appear unfriendly or rude, but understand what they are going through and wait for them to return to normal. Ask if there’s anything that helped them during past panic attacks, if they need medication, and when they usually take it.

• Even if you don’t think these things will help, remember that distracting them is important. Left alone, the person will only have their own thoughts to deal with. Just your presence helps them stay grounded in reality. Being isolated during a panic attack is terrifying. However, in public spaces, ensure others maintain distance from the individual. While they may have good intentions, their interference could make the situation worse.

Wait for their panic attack to pass. While this time may feel endless (especially for both you and the patient), the panic attack will eventually subside. Panic attacks typically peak within 10 minutes and then gradually diminish.

• Less intense panic attacks tend to last longer, but the person will be better able to handle it, so the duration isn’t as significant.

Tìm sự trợ giúp y tế. Nếu các triệu chứng không thuyên giảm trong vòng vài tiếng, bạn nên cân nhắc tìm lời khuyên y tế khẩn cấp. Tuy đây không phải là trường hợp đe dọa tính mạng, bạn vẫn nên gọi điện, dù chỉ để xin lời khuyên. Bác sĩ phòng cấp cứu thường sẽ cho bệnh nhân dùng thuốc Valium hoặc Xanax, và có thể là thuốc chẹn Beta như Atenolol để làm dịu nhịp tim và giảm mức adrenaline trong cơ thể.

• Nếu đây là lần đầu tiên lên cơn hoảng sợ, có thể bệnh nhân muốn tìm sự chăm sóc y tế vì lo sợ. Tuy nhiên, nếu trước đây đã từng trải qua cơn hoảng loạn, có lẽ họ sẽ biết việc cấp cứu có thể khiến tình trạng xấu hơn. Bạn hãy hỏi ý họ. Quyết định cuối cùng sẽ phụ thuộc vào trải nghiệm của bệnh nhân và sự tương tác của bạn với họ.

Giúp người bị hoảng loạn tìm trị liệu tâm lý. Cơn hoảng loạn là một dạng rối loạn lo âu và cần được điều trị chuyên khoa. Một chuyên gia trị liệu giỏi sẽ xác định được tác nhân gây hoảng loạn, hoặc ít nhất cũng giúp bệnh nhân nắm rõ hơn về khía cạnh sinh lý học của tình huống. Nếu bệnh nhân bắt đầu trị liệu, bạn hãy để cho họ xử lý theo nhịp độ của riêng họ.

• Cho họ biết rằng trị liệu tâm lý không phải dành cho người mất trí. Đây là một phương pháp trị liệu chính thống đang giúp đỡ hàng triệu người. Hơn nữa, chuyên gia trị liệu có thể kê toa thuốc để kiểm soát bệnh. Thuốc men có thể không chấm dứt hoàn toàn cơn hoảng loạn, nhưng chắc chắn giúp giảm tần suất và cường độ của các cơn hoảng loạn.

Chăm sóc bản thân. Bạn có thể cảm thấy có lỗi vì chính mình cũng hoảng hốt trong khi bạn của bạn đang lên cơn hoảng loạn, tuy nhiên điều đó là bình thường. Hãy hiểu rằng lo lắng hoặc sợ hãi là phản ứng tự nhiên khi chứng kiến một người lên cơn hoảng loạn. Nếu cảm thấy có ích, bạn hãy hỏi người đó xem liệu bạn có thể trao đổi với họ để sau này bạn có thể xử lý tốt hơn không.

• Nếu người đó mắc hội chứng ám ảnh sợ và điều này gây ra cơn hoảng loạn, bạn hãy giúp họ tránh xa tác nhân đó.
• Đưa bệnh nhân ra ngoài nếu cơn hoảng loạn khởi phát giữa đám đông hoặc ở nơi ồn ào. Bệnh nhân cần được thư giãn và ra nơi thoáng.
• Nghiên cứu cho thấy vuốt ve một chú chó sẽ giúp giảm huyết áp, nếu họ có thú cưng ở gần đó.
• Nếu người ở gần bạn mắc chứng rối loạn hoảng sợ và thường xuyên lên cơn hoảng loạn, điều này có thể gây căng thẳng cho mối quan hệ của bạn. Cách đối phó với ảnh hưởng của chứng rối loạn hoảng sợ trong mối quan hệ nằm ngoài phạm vi của bài viết này, nhưng nói chung bạn nên nhờ sự hỗ trợ chuyên khoa.
• Các triệu chứng ít gặp hơn bao gồm:
  • Có những ý nghĩ rối loạn hoặc tiêu cực
  • Suy nghĩ dồn dập
  • Có cảm giác phi thực tế
  • Cảm giác như tận thế
  • Cảm giác như sắp chết
  • Mẩn ngứa
• Nếu người đó muốn được ở một mình, bạn hãy lùi lại một bước, nhưng đừng rời đi.
• Bảo họ tưởng tượng ra một quang cảnh xinh đẹp như bãi biển hoặc đồng cỏ xanh để làm dịu tâm trí.
• Nếu không có sẵn túi giấy, bạn hãy thử bảo họ khum hai tay lại và thở qua lỗ nhỏ giữa hai ngón tay cái.
• Đừng ngần ngại gọi cấp cứu để được giúp đỡ, đó là công việc của họ!
• Đề nghị bệnh nhân tập trung trí não vào các màu sắc, hoa văn và đếm số. Bộ não không thể cùng một lúc tập trung vào những điều đó và cơn hoảng loạn. Ngoài ra, nếu đây là đợt tái phát, bạn hãy trấn an rằng họ sẽ không sao. Bảo họ lặp lại câu “Tôi sẽ không sao”.
• Khuyến khích họ đi vệ sinh để chất độc được thải ra khỏi cơ thể và giúp họ tập trung vào việc khác.
• Tư thế “đứa trẻ” (một tư thế yoga) có thể giúp người ta bình tĩnh lại.

• Panic attacks, especially for those who have never experienced one, can resemble a heart attack. However, a heart attack can be life-threatening, and if you're unable to distinguish between the two, it's best to call for emergency help.
• If using the paper bag breathing method, ensure that the bag is securely placed around the nose and mouth to allow exhaled air to be re-inhaled. Do not cover the head, and never use a plastic bag.
• Keep in mind that many people with asthma also experience panic attacks. The key is that these individuals must regain control over their breathing. If the person cannot restore normal breathing and doesn't receive timely emergency care, the outcome of an asthma attack could be severe, potentially even fatal.
• Verify that the difficulty in breathing is not due to asthma, as asthma is a completely different condition requiring a different treatment approach.
• During a panic attack, someone with asthma might want to use an inhaler because they feel tightness in their chest and shortness of breath. You must confirm that they are having a panic attack and not an asthma attack, as using the inhaler unnecessarily could worsen the panic attack, as the medication in the inhaler may increase heart rate.
• Breathing into a paper bag also means inhaling carbon dioxide, which can lead to respiratory acidosis. Respiratory acidosis is a dangerous condition that prevents oxygen from binding with hemoglobin (in blood). Any attempts to manage a panic attack using the paper bag breathing method should be carefully monitored or entirely avoided.
• Although most panic attacks are not life-threatening, if the attack is caused by an underlying issue such as tachycardia or arrhythmia, asthma, and/or dysregulation of the parasympathetic nervous system, the patient could die. Tachycardia can lead to death.

• Paper bag (optional)
• Wet towel