What to say when someone you love is having a panic attack

Why these four lines, in this order

Line 1 goes after the thought that is running the whole thing, the one about dying or about this being the heart attack.

Line 2 goes after the fear underneath that one, the fear of being left in it alone.

Line 3 hands them two choices instead of an open question. In that state a decision is close to impossible, and a choice is easy.

Line 4 takes the pressure off. They do not have to perform their way out of this, and you are not asking them to.

The part people skip is the last one. Stop talking, and stay.

How to say them

Go slower than feels natural, and keep your voice low and even. They are not listening to your words so much as to how steady you sound.

Sit beside them if you can, or crouch so your eyes are level with theirs. Standing over someone makes it feel like an emergency.

Leave a real pause after each line. Let it land before you give them the next one.

If they cannot answer line 3, that is fine. Pick one yourself, say it kindly, and move toward it with them.

What not to say

"Calm down" is the one almost everyone reaches for, and it almost never works. Nobody has ever calmed down because they were told to.

"It's all in your head" tells them you do not believe what they feel, and what they feel is very real to them right then.

"What's wrong?" and "What do you need?" are open questions. They ask a mind that has gone blank to come up with an answer.

You also do not need to explain panic to them, or to reason with the fear. Explaining can wait until they are breathing normally again.

When it is more than a panic attack

The four lines are for a person who has had these attacks before and knows what they are, or for someone you can see is frightened but physically safe.

If this is the first time, if the chest pain is new or feels different, or if they say it is the worst they have ever had, call your local emergency number. It is always fine to be told it was panic.

And if they have fainted, cannot speak, or are not coming round after a few minutes, get help rather than waiting it out.

When the attacks keep coming back

The four lines help in the moment, but they do not stop the next one from coming. If the attacks keep returning, that is worth taking seriously, and it is nothing to be ashamed of.

A good first step is to see a doctor, who can rule out anything physical and talk through the options with them. A therapist who works with anxiety can also help them look at what is feeding the attacks.

In the meantime, you can help them notice what was going on before each one, such as how little they slept, what they were worried about, or how much was on their plate. Do it gently and when they are calm, never in the middle of an attack. Over time, that picture is often what shows them where to start.