What's Happening During a Panic Attack — and How to Stop It

What we checked to reach this conclusion

We reviewed peer-reviewed clinical research on panic disorder, including randomized controlled trials and meta-analyses on both pharmacological and psychological treatments. We cross-referenced findings from neuroscience on the fear-response circuit, examined Stanford's 2023 breathing study directly, and looked at the long-term outcomes data for CBT versus medication versus combination approaches. Where evidence from large-scale trials conflicted with older conventional wisdom, we followed the trials.

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  The physiology of a panic attack confirmed Peer-reviewed neuroscience confirms that panic attacks are driven by amygdala activation triggering the hypothalamic-pituitary-adrenal (HPA) axis — a well-mapped biological process, not a character flaw or weakness.
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  Physiological sighing efficacy verified A 2023 randomized controlled trial published in Cell Reports Medicine (Balban et al., Stanford) directly compared breathing techniques and found physiological sighing reduced physiological arousal faster than box breathing, mindfulness, or cyclic hyperventilation.
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  CBT superiority over medication reviewed Multiple meta-analyses — including a 2021 Cochrane review — confirm that CBT, particularly with interoceptive exposure, produces better long-term outcomes than antidepressants or benzodiazepines alone, with significantly lower relapse rates after treatment ends.
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  Benzodiazepine risks checked against clinical evidence Evidence confirms that while benzodiazepines provide rapid short-term relief, they are associated with dependence, withdrawal-induced rebound panic, and — critically — they prevent the learning process that extinguishes the panic response, making them counterproductive for long-term recovery.

There's no single right answer — it depends on where you are right now

What works best depends on whether you need to manage an attack happening right now, get through the next few weeks, or build genuine long-term freedom from panic. The approaches below aren't mutually exclusive — many people combine them.

What people reach for first — that actually makes things worse

These approaches are intuitive and widely recommended, which is exactly why so many people get stuck in a panic cycle for longer than they should.

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  Breathing into a paper bag — This is outdated advice based on the assumption that panic is always caused by hyperventilation-induced CO₂ loss. In reality, many panic attacks do not involve hyperventilation, and rebreathing CO₂ can be dangerous in people with underlying respiratory or cardiac conditions; it has been removed from clinical guidelines.
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  Avoiding situations where you've had attacks — Avoidance provides short-term relief but tells your brain the threat was real, making the fear stronger over time. It's the primary driver of panic disorder escalating into agoraphobia. Every avoided situation narrows your world and raises your baseline anxiety.
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  Taking benzodiazepines (Xanax, Valium, Ativan) as your main management strategy — Benzodiazepines stop the attack but actively prevent the emotional learning your brain needs to stop generating attacks. They create physical dependence rapidly — sometimes within weeks — and withdrawal can itself trigger severe panic. The clinical evidence is clear: they should not be a first-line or long-term treatment for panic disorder.
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  Telling yourself to "just calm down" or trying to suppress the feelings — Trying to suppress fear during a panic attack paradoxically intensifies it — a well-documented phenomenon called the "ironic process theory" (Wegner). The more mental effort you spend fighting the sensations, the more attention your brain allocates to them. Acceptance-based approaches, which acknowledge the sensations without fighting them, consistently outperform suppression strategies.