panic procedure preparation

Overview

A panic procedure — sometimes called a panic action plan — is a simple written plan you prepare in advance to help you cope when panic symptoms start or a panic attack happens. It reminds you what to do, what helps you feel safe, and how to ask for support. It is a tool you can use in the moment, so you do not have to make decisions while your body is flooded with fear.

Yes. Around 1 in 10 people experience a panic attack at some point in their lives. Panic disorder, where panic attacks keep happening and you worry about when the next one will come, affects roughly 2 in 100 people in the UK in any given year.

Anyone can experience panic attacks, but they often begin in the late teens to early adulthood. Women are about twice as likely as men to develop panic disorder, but men and people of all genders can be affected. Children and older adults can also have panic attacks, sometimes with slightly different signs.

Symptoms

Common symptoms

• A sudden feeling of intense fear or a sense of doom
• A racing, pounding, or skipping heartbeat
• Chest tightness or discomfort
• Shortness of breath or a feeling of choking
• Dizziness, light-headedness, or feeling faint
• Trembling, shaking, or sweating
• Nausea or a churning stomach
• Numbness or tingling in the hands or face
• Feeling detached from your body or surroundings
• A fear that you are losing control or dying

Symptoms in children

• Crying, tantrums, or clinging to parents
• Complaining of a racing heart or trouble breathing
• Stomach aches, headaches, or feeling sick
• Fear of going to school, parties, or being away from home
• Meltdowns after school, when stress from the day catches up

Symptoms in older adults

• Breathlessness, chest discomfort, or dizziness
• Fatigue and a sudden drop in energy
• Fear of falling or fear of being alone
• Becoming less active or avoiding social activities
• Confusion or worsening memory, sometimes mistaken for a different condition

Causes

Main causes

• The brain's alarm system fires too strongly, even when there is no real danger.
• Stressful life events, such as bereavement, relationship problems, or job pressure.
• Physical triggers, including caffeine, alcohol, lack of sleep, or illness.
• Certain situations, such as crowded places, public speaking, or feeling trapped.
• Sometimes panic attacks happen with no clear trigger at all.

Risk factors

• A family history of panic disorder or other anxiety conditions
• Chronic stress or a history of difficult life events
• Childhood adversity or trauma
• Having depression or another mental health condition
• Heavy caffeine use, smoking, or recreational drug use
• Major transitions such as leaving home, pregnancy, or bereavement

When to see a doctor

See a doctor urgently if:

• If panic attacks become frequent or you constantly worry about having another one
• If you start avoiding leaving the house, going to work, or doing normal activities
• If you have thoughts of harming yourself
• If your panic symptoms are getting worse despite using your panic procedure

Book a routine appointment if:

• If this is your first panic attack and you want to understand what it is
• If you want help building a panic procedure or learning coping skills
• If you are unsure whether your symptoms are due to anxiety or a physical problem

Diagnosis

A qualified healthcare professional will ask about your symptoms, when they happen, how often they happen, and how they affect your life. They will also check for physical conditions that can cause similar symptoms, such as heart or thyroid problems. There is no lab test for panic disorder, so the diagnosis is based on your description of what you experience.

Tests that may be done

• A physical exam, including checking your blood pressure and heart rate
• Blood tests to check for thyroid problems, anaemia, or electrolyte imbalances
• An electrocardiogram (ECG) to check your heart rhythm if chest symptoms are present
• A simple anxiety or mood questionnaire

What to expect at your appointment

The doctor will likely ask you to describe a typical panic attack in detail: what you feel in your body, what thoughts go through your mind, how long it lasts, and what makes it better. If a physical cause is ruled out, they may explain that panic attacks are not dangerous and suggest a treatment plan or refer you to a mental health professional.

Treatment

Treatment for panic usually focuses on understanding panic, learning to respond calmly, and building skills so panic loses its power. A written panic procedure is one part of self-care. Professional treatment may include talking therapies and, in some cases, medication prescribed by a doctor. No specific medicines are named here, because the right choice depends on your individual situation.

Self-care at home

• Create your panic procedure: write down your triggers, early warning signs, and three calming actions, such as slow breathing, grounding, or stepping outside.
• Practise slow breathing: breathe in for a count of 4, hold for a count of 2, then breathe out for a count of 6. Repeat for a few minutes.
• Use grounding: name 5 things you can see, 4 you can hear, 3 you can touch, 2 you can smell, and 1 you can taste.
• Keep a small comfort kit with a calming phrase on a card, a cold drink, headphones, or an object that helps you feel steady.
• Tell a trusted person about your panic procedure and agree on how they can support you calmly during an attack.

Medical treatments

A doctor may recommend a talking therapy such as cognitive behavioural therapy (CBT), which is one of the most effective approaches for panic. They might also talk about a type of medication used for anxiety or depression, such as an antidepressant, if your symptoms are severe or if CBT alone has not helped enough. Any medicine must be prescribed and monitored by a healthcare professional. Never take someone else's medicine, and do not stop a prescribed medicine suddenly without speaking to your doctor.

When is surgery considered?

This is not relevant for panic. No surgery treats panic attacks.

Living with this condition

Living with panic means learning to spot your early warning signs and using your panic procedure before the attack peaks. It can help to keep your plan on your phone or in a card in your wallet, and to review it weekly so it feels natural. Remember that panic feels intense but it is temporary.

Lifestyle tips

• Keep a regular sleep schedule — poor sleep makes panic more likely.
• Limit caffeine and alcohol — both can trigger panic symptoms.
• Exercise regularly, even a brisk walk helps calm the nervous system.
• Build in daily downtime for relaxation, quiet, and rest.
• Practise saying 'no' to over-commitment and unnecessary stress.

Diet and exercise

Eating regular, balanced meals keeps blood sugar steady and can reduce anxiety. Avoid skipping meals, large amounts of sugar, and energy drinks. Exercise releases natural chemicals that improve mood and uses up the adrenaline that fuels panic — but start gently and choose activities you enjoy, such as walking, swimming, or yoga.

Mental health and emotional wellbeing

Panic can make you feel embarrassed, exhausted, and alone. You may worry about when the next attack will happen, and that worry itself can cause more panic. These feelings are a normal response to a frightening experience, not a sign of weakness. Getting support is a brave and sensible step.

Prevention

You cannot always prevent panic attacks, but you can reduce their frequency by learning your triggers, managing stress, and using your panic procedure early. You can also reframe panic as a 'wave' that rises and falls, rather than a danger. This shift in thinking can make a big difference over time.

Vaccines

This is not relevant for panic.

Screening programmes

There is no routine screening test for panic disorder, but during regular check-ups your doctor may ask about your mood and anxiety. If you are concerned, you can ask for an anxiety assessment.

Complications

If left untreated

• Avoiding places where panic has happened, which can develop into agoraphobia
• Frequent visits to emergency services because panic feels like a medical emergency
• Difficulty keeping a job, studying, or maintaining relationships
• Relationship strain because family members may not fully understand what you are going through
• Using alcohol or sedatives to try to cope with panic
• Depression and a lower quality of life

Long-term outlook

With the right plan and support, most people with panic attacks improve significantly. Learning to respond calmly to panic is a skill — and like any skill, it gets easier with practice. Many people go on to live full, active lives without constant fear of the next panic attack.

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