How to Stop a Panic Attack in Its Tracks, According to an ER Doc

By Leah Zerbe for Dr. Axe.

Emergency room doctors are trained to stay cool and focused in the face of complete chaos. These professionals live in a world where the difference between life or death sometimes hinges on a split-second decision. So it’s super clear a special kind of calm is required.

For emergency medicine doctors like Amy Sedgwick MD, FACEP, the key to commanding a room — and her team — in the most stress-filled situations always centered on clearly delegating and assigning roles — and focusing on her own breath so that she can save others.

“As the leader, empowering my team members to do their best work is incredibly calming,” Sedgwick says.

“That aside, there is still the reality of being the person who is ultimately making the call, telling the bad news or having difficult conversations with colleagues,” she adds. “In these moments, I rely on stopping for a moment, taking five breaths, reassuring myself that I am well-trained, and that I can handle anything coming my way. This approach has never failed me — in the ER, or otherwise.

The focus on the breath is a natural one for Sedgwick, who is also a long-time yoga practitioner and teacher with Yoga Medicine. And it’s her mix of medical and traditional practices that make her well equipped for treating a common emergency room and urgent care situation: panic attacks.

Anxiety disorders are the most common class of mental disorders in the U.S. population, with an estimated 12-month and lifetime prevalence of 19 percent and 31 percent, respectively. Generalized anxiety disorder and panic disorder are among the most common conditions that fall under the anxiety disorder umbrella.

Panic attack symptoms generally last less than 30 minutes and often include symptoms like an accelerated heart rate, shortness of breath and sometimes even brief chest pain. Although 30 minutes or less may not seem like a long time, if you’re the person experiencing this intense burst of fear, it often feels much longer. People suffering from panic attacks often say they experience fear of dying, feeling detached or even feeling like they’re losing control.

What can make a panic attack even more unnerving is the fact that they often appear out of the blue with no warning. But on the inside, your body’s sympathetic nervous system is going into absolute overdrive.

Hot to Stop a Panic Attack: Increase ‘Traffic’ Along the Vagus Nerve

If you’ve ever experienced a panic attack, you know it’s a scary situation that can feel very out of control. In some cases, it can feel like you’re almost having an out of body experience. Because breathing and heart rate is often elevated, connecting your attention and awareness to the breath may seem counterintuitive for someone in the middle of a panic attack.

But it’s Sedgwick’s go-to plan of attack when trying to stop a panic attack in its tracks.

“To calm patients having panic attacks, I do guided breathwork and have them first just slow their breathing down,” she explains. “Once they can do that, we start to extend the length of the exhale if possible.”

She said gently extending the exhalation helps increase ‘traffic’ along our vagus nerve, which innervates many of our visceral organs. “I have had great success with this alone, and the added bonus is that patients walk away with a real life experience of helping themselves with something they always have: their breath.”

Sedgwick says there certainly are cases that don’t respond to breathwork alone. Under these circumstances, she adds in some simple movement like raising the arms up on the inhale and “floating” the arms down on the exhale. “Sometimes I use imagery such as asking them pick a color they like. As they inhale the color gets brighter and with the exhale it gets dimmer,” she says. “In all, I am trying to get them to focus on one thing and just stay with it. This is usually quite effective.”

Breathwork in yoga is known as pranayama, and can different techniques can be stimulating or calming, depending on what you choose. Pranayama benefits can include stimulating your body’s “rest and digest” parasympathetic nervous system if you choose breathwork like nadi shodhana.

A regular hatha yoga practice, including a yoga nidra sessions, are shown to increase anxiety levels, particularly in people who are most anxious.

“I think having a practice you can consistently fall back upon — whether it’s yoga, meditation, connecting with the outdoors — in both good times and bad is the great comfort that we humans can provide for ourselves,” Sedgwick says. “When we do this, we are then calm, nurtured and available to do good for others. All that good comes back full circle and makes life truly beautiful.”