What to say (and what not to say): with scripts!

Ryan Engelstad
Mar 26 · 9 min read
Photo by Ian Espinosa on Unsplash

Picture yourself, at work, having a normal day. Maybe you’re having lunch or a casual conversation with a co-worker. As you go on about your weekend plans, you notice a look of confusion come across your co-worker’s face. At first you might think nothing of it — but as time goes on it becomes clear your co-worker is not simply preoccupied with the reports they have to file later today. They are clearly sweating and starting to breathe heavier but they’re not saying anything or bringing attention to how they’re feeling. You might even ask if they are okay, as they clearly become more distressed. They might try to pass it off as nothing or they might excuse themselves. What would you do?

It is possible, even likely, that the coworker in this scenario has just experienced a panic attack.

As a therapist, I have worked with hundreds of people experiencing a range of difficult emotional situations. As a result, I often find myself coaching my patients — as well as their friends, families, and significant others — on how to cope with these extreme emotion dysregulation events. I think it’s important to show some helpful (and unhelpful) scripts so people can see what works and what doesn’t work for people when they are in the midst of a panic attack.

Before It Happens

It’s important to know what a panic attack looks like, especially if you know that someone close to you experiences them.

For some people, it might resemble a heart attack, with chest pains and all. These experiences are so commonly confused for one another that there are several Youtube videos explaining the difference. Here is one:

An important thing to remember is that no two people are alike when it comes to what their panic attack might look like, and what helps them during a panic attack. Some people might seek solitude, while others might seek reassurance or support.

The key here is to get ahead of the panic attack. If you know someone is prone to having panic attacks, have a conversation with them about what, if anything, you can do to help them when they do experience it. Then, when it happens, you aren’t there invalidating them or panicking along with them.

This can be a tough conversation. Below are some important questions you can ask.

Questions to ask:

  • How do you know—or how might I know—you are having a panic attack?
  • When you feel a panic attack coming on or if I see you having a panic attack, do you want me to help/can I help?

If so…

  • What do you need?
  • What don’t you need/what don’t you want to hear?
  • Would it be okay if I tried to walk you through a breathing exercise or other coping skill?

If you don’t want me to help…

  • Is there anyone you’d want me to contact or get to help you instead?

The goal here is to be as clear as possible with your friend/coworker/family member on what they need. It is also important to not be offended if they don’t want you to do anything. Frequently, these experiences can be very intense or even embarrassing for an individual and that person may just want privacy to cope with these issues.

During a Panic Attack

Assuming you’ve had a conversation like the one discussed above, you will have some awareness of what the person needs while they’re in the midst of a panic attack. If that’s the case, do your best to follow those identified needs.

However, I can also offer you some general guidelines of what NOT to do:

  • Do not, under any circumstances, tell someone who is experiencing a panic attack to “calm down” or “relax.” If they could calm down or relax that easily, they would. Similarly, even though statements like “you’re okay!” or “there’s nothing wrong!” might seem innocuous and well-intentioned, they are unlikely to make the person feel any better. These are invalidating statements that will likely lead them to not trust you, or even to resent you as a result.
  • Do not try to relate to them in the moment or to talk about a time when you were “this worried” or “this anxious.” Try not to tell them you “know how they feel.” Unless you are a fellow panic attack sufferer, you probably don’t. Trying to relate in the moment will only take the focus away from the person in crisis.
  • Whether a person experiencing a panic attack is on medication or not, asking them if they’ve “taken their meds today,” or suggesting they need medication, is not generally helpful.
  • Unless you know from a previous discussion that this helps them, don’t tell them to sit down or give other directives. During panic attacks, people often experience a surge of adrenaline and trying to sit down or restrict themselves physically may only make things worse.

Positive things you can do for someone in the midst of a panic attack:

  • You can ask them if they want to go outside or go for a walk with you.
  • You can ask if you can help them.
  • You can offer to guide them through a coping skill, such as a breathing or mindfulness exercise discussed later in the article. The caveat here is that you’ve discussed these skill options with the person ahead of time. If you haven’t, the person may not feel these skills are helpful to them, even if they are helpful to others.
  • You can run interference for them. If you are co-workers, you can alert others (again, only if appropriate and previously discussed), help them leave the premises, or take calls for them. If you are at a family or friend gathering, you can escort them to a more comfortable room or location.

You can (and should) validate their experience, along with whatever they’re able to communicate. If they acknowledge they are having a panic attack, the following statements could be appropriate:

“I know this is scary but I’m right here for you.”

“Panic attacks pass and I’ll be here with you until it does.”

“Is there anything I can do to help you cope?”

These statements are useful in helping the person validate what they are experiencing and trust that they have the support they need to get through the crisis.

After a Panic Attack

One of the most important aspects of coping with panic attacks, and to a larger extent, negative emotions themselves, is recognizing when they have passed.

When anxiety is a frequent experience, it can feel like you’re always on the edge and can never truly relax. By forcing yourself to acknowledge the end of an anxious episode or panic attack, you are reminding yourself and reinforcing your awareness that your panic and anxiety will subside.

So, as a support person in the aftermath of a panic attack, helping the person acknowledge when the panic attack subsides can be good for you and for them. As previously identified, one of the biggest errors people make when trying to support someone during a panic attack is projecting their own need for the person to be okay. This might look like this:

Friend/coworker: [Begins panicking.]

You: “You’re going to be okay!”

Friend/coworker: [(internally) They don’t know that. What if I’m not going to be okay?! (Panic intensifies)]

So, instead of telling the person experiencing a panic attack that they are going to be okay, or, when the panic attack is over, actually telling them that they are okay, it is important to simply validate their experience that they just went through. It might look like this instead:

Friend/coworker: [Panic attack resolves].

You: “I can’t imagine how hard that was, it seems like you’re breathing a bit easier now. Do you want to talk about how you’re feeling or would you prefer to rest?”

This is an opportunity for you (and more importantly, them) to debrief and get back to neutral. Once they have done so, which could take minutes, hours, or days depending on the severity of their symptoms, you may want to check in with them as to how they’re doing and if the support you offered was helpful, or if they’d rather you do something differently next time.

Lessons From the Different Therapeutic Approaches

Panic attacks are treated in different ways depending on the treating doctor’s or therapist’s philosophy or approach. People in a support role can better understand panic attacks and better support those who experience them by educating themselves on how panic attacks are treated.

First, a note on medication of panic attacks and panic disorder: medication can be helpful in the treatment of panic attacks, but typically it only addresses the symptoms of the disorder. Often, panic attacks have a root cause or trigger, and these issues are not addressed by medication, which is why talk therapy is often recommended in conjunction with or prior to going on medication.

Now, we’ll go through a few useful therapeutic frameworks and skills we can offer people who might experience panic attacks.

Cognitive Behavioral Therapy, or CBT, is one of the most common and well-researched therapeutic approaches for panic disorder. Cognitive Behavioral Therapy aims to look at the cycles, both positive and negative, that contribute to symptoms like anxiety and panic attacks. Here are some examples of interventions that could be introduced into these cycles to improve functioning:

  • Relaxation Techniques: Relaxation exercises aim to help a person focus their attention on their breath, body, or surrounding environment and away from whatever anxious or panicked thoughts they may be experiencing. Here’s an example of a simple breathing exercise anyone can learn or offer to others in times of crisis:
  • Cognitive reframing: This skill involves re-framing the circumstances or triggers that contribute to anxious thoughts and panic attacks. For example, the ability to view triggering situations in a way that reduces the perceived threat. (This skill takes time to develop and it would only be practiced initially in therapy. As such, it should not be attempted by those without proper training. This is why statements like “everything is okay, just relax” are ineffective.)
  • Systematic desensitization: This is a somewhat controversial approach to reducing the anxiety and fear associated with various triggers. It is controversial because it is counter-intuitive. Why expose ourselves to triggers that might induce anxiety or panic attacks? Because under controlled conditions, we can increase our frustration and anxiety tolerance. We can also grow to have “corrective experiences,” in which we can experience triggering situations without experiencing uncontrollable anxiety or panic. This is another intervention that should only be offered by a professional. Do NOT offer to expose someone prone to panic attacks to one of their triggers, even if you want to “show them there’s nothing to be afraid of.”

Similarly, Dialectic Behavioral Therapy (DBT) also helps people with anxiety and panic attacks better tolerate intense negative emotions. DBT focuses specifically on skills like mindfulness to help people to be in the present moment without judging themselves or their circumstances.

An example of a mindfulness or grounding skill someone could use in a panic attack might be the “54321 method.” Tune into your senses and the present moment by focusing on:

  • 5 things you can see
  • 4 things you can feel
  • 3 things you can hear
  • 2 things you can smell
  • 1 thing you can taste (or take one deep slow breath)

By practicing mindful awareness of your present sensory perception, you are focusing on neutral or positive aspects of your present experience that are NOT negative or anxious thoughts related to your panic attack. Here is a walk-through of this technique:

This is absolutely a technique you could offer someone experiencing a panic attack if you have pre-discussed working on a coping skill when an attack happens. You may also want to introduce the method to them before they are in the midst of an attack, so they can agree this is something they think might be helpful.

Of course, there are other therapeutic approaches as well. Psychodynamic approaches will help a person identify historical or root causes to their anxiety or panic attacks. EMDR might be useful in helping someone process their trauma if their anxiety or panic attacks are trauma based.

These approaches, however, should not be considered when thinking about how you can help someone experiencing a panic attack. In that moment, it isn’t useful to deal with why they are having a panic attack. The most important thing you can do is just be present with them — in whatever capacity they need.

Better Humans

Better Humans is a collection of the world's most trustworthy writing on human potential and self improvement by coaches, academics, and aggressive self-experimenters. Articles are based on deep personal experience, science, and research. No fluff, book reports, or listicles.

Thanks to Terrie Schweitzer

Ryan Engelstad

Written by

Therapist writing about mental health and behavior change. Check out my podcast, Pop Psych 101: https://www.poppsych101.com

Better Humans

Better Humans is a collection of the world's most trustworthy writing on human potential and self improvement by coaches, academics, and aggressive self-experimenters. Articles are based on deep personal experience, science, and research. No fluff, book reports, or listicles.

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