Breathing for anxiety and panic attacks

What happens in a panic attack

In a panic attack the heart races and breathing speeds up. You may feel faint, dizzy, sweaty or sick, your fingers may tingle, and your chest may hurt or feel as if you are choking. Many people feel a sense of dread or a fear that they are dying.

It feels dangerous, but it is not. Most panic attacks last 5 to 20 minutes, and some have been reported to last up to an hour.

Many of these symptoms come from the breathing itself. When you breathe faster or deeper than your body needs, you blow off too much carbon dioxide. Its level in the blood drops, blood vessels narrow, and you feel lightheaded, tingly and short of breath. Anxiety and panic are the most common causes of this kind of occasional overbreathing, called hyperventilation.

What to do during an attack

The NHS suggests:

• Stay where you are, if you can.
• Breathe slowly and deeply.
• Remind yourself that the attack will pass.
• Focus on positive, peaceful images.
• Remember that it is not life-threatening.

A slow breath out matters most. One simple way is pursed-lip breathing: purse your lips as if you were blowing out a candle and breathe out slowly through them. If you are with someone who is panicking, stay calm, reassure them and count slowly with each of their breaths.

Three exercises to try

All three are gentle and need nothing but a few minutes. Practise them when you are calm, so that in a hard moment your body already knows what to do.

1. The NHS 5-5 exercise. Sit in a chair that supports your back, stand, or lie down, and loosen anything tight. Let the breath flow deep into your belly without forcing it. Breathe in through your nose while counting steadily from 1 to 5, then breathe out through your mouth counting from 1 to 5. At first you may not reach 5, and that is fine. Keep going for at least 5 minutes. The NHS says you get the most benefit if you do it regularly, as part of your daily routine.

2. The physiological sigh. Breathe in through your nose, then take a second, shorter breath in on top, and breathe out slowly until your lungs feel empty. In a 2023 study, 108 people did one of four 5-minute practices every day for a month. Mood improved most with breathing exercises, and most of all with this one, called cyclic sighing in the study. Anxiety fell in every group, including the people who meditated, so the sigh was not better for anxiety than mindfulness. It was a small, early study, but this sigh is easy and quick to use. How to do the physiological sigh.

3. The long exhale. Breathe in for four counts and out for eight. Your heart slows a little each time you breathe out (how breathing works), so with a long exhale more of every breath is spent in that slower part. If eight feels too long, start with six. How to do the long exhale.

Why not a paper bag

Breathing into a paper bag used to be common advice for hyperventilation. Doctors no longer recommend it. Breathing your own air back in can lower the oxygen in your blood, and symptoms that feel like hyperventilation sometimes have other causes, such as heart or lung problems. Doctors have described deaths in people given a paper bag when their real problem was low oxygen or a heart problem.

When it is not just panic

Panic attacks are not dangerous, but other conditions can feel similar. Call your local emergency number (112 works anywhere in the EU) if:

• you have sudden chest pain that does not go away, especially if it feels like pressure, squeezing or burning, spreads to your arms, neck, jaw, stomach or back, or comes with sweating, feeling sick, lightheadedness or breathlessness;
• you are breathing very fast for the first time and do not know why.

If panic attacks keep coming back, talk to a doctor. Repeated panic attacks can be a sign of panic disorder, which is a recognised condition you can get help for.