Managing a Panic Attack at Work

You’re at work when you suddenly feel a deep sense of dread. Heart pounding, hands trembling, lightheaded, and drenched in sweat, you can’t breathe. You think you’re having a heart attack and feel like you’re about to die. You’re about to call for an ambulance when the symptoms start to fade. You just had a panic attack.

What Is a Panic Attack?

The American Psychological Association (APA) describes a panic attack as “a sudden surge of overwhelming fear that comes without warning and without any obvious reason.” The feelings and physical symptoms (such as shortness of breath and tightness in your chest) you experience are very real and can be very scary. Panic attacks won’t kill you, but depending on how severe and frequent they are, they can have a significant impact on your quality of life. Often triggered by stressful situations, the symptoms of panic attacks usually recede when the stress ends. Common triggers at work include public speaking, conflict, an important meeting, a major transition such as a promotion or a big project, or a work-related social event such as a meeting with a key client or after-work drinks.

Symptoms of a panic attack include the following, according to the APA:

• Racing heart rate

• Shortness of breath

• An almost paralyzing fear

• Dizziness, lightheadedness, or nausea

• Trembling, sweating, or shaking

• Choking or chest pains

• Hot flashes or sudden chills

• Tingling in fingers and toes (pins and needles)

• A fear that you’re going to die

Panic attacks are singular events; many people have only one or two in their lives. If you have had more than that, the APA suggests you contact a mental health professional for diagnosis and treatment, because you may have a panic disorder. A panic disorder is a condition in which people have frequent or debilitating fear and anxiety without a reasonable cause, and it may be accompanied by fear of another attack, concern about the impact of these attacks, and changing behavior in response to them. The persistent fear of future panic attacks is a key symptom of panic disorder and can lead to avoiding the situation that caused the attack—which can be a real problem at work. According to the APA, panic disorders affect approximately 1.3% of the U.S. population. The onset usually begins in adolescence or early adulthood, and although the causes are not clear, major life transitions and stressful social or economic events, such as a pandemic or a market crash, can trigger them. There also is a familial connection: If others in your family have had a panic disorder, you have an increased likelihood of suffering from attacks.

But if you find yourself having occasional or frequent panic attacks, know that they can be treated—and the earlier you get treatment, the better. Even if an attack is only your first or second, it’s important to seek medical attention when it’s over, because the symptoms are similar to those of serious health problems, like a heart attack.

Managing a Panic Attack at Work

We know work can be stressful, so it’s not surprising that many people experience panic attacks while on the job. This can add to your stress, because you’re not at home where you can lie down on the sofa or curl up on your bed.

When you feel a panic attack coming on, find a quiet, private place to sit until the symptoms pass. If you’re in a meeting or another high-pressure situation, try to calmly remove yourself by stepping out to get water or visit the restroom. If you’re worried about your absence raising alarms, text a colleague that you’re not feeling well and will be back when you feel better. Once you’re in quiet space, use the following strategies to manage your symptoms.

1. Breathe deep and slow. To try to control your breathing, close your eyes (this reduces stimulation), and focus on taking deep and slow breaths through your mouth. Breathe in for a count of four, hold for a second, and then breathe out for a count of four. This will slow your heart rate and may counteract feelings of dizziness. It will also give you a feeling of control and thus reduce your fear. If you cannot control your breathing, sit down and put your head between your legs, or breathe into a paper bag if you have one.

2. Try mindfulness. You are in a heightened emotional state; remind yourself to take long, slow, deep breaths. Focusing on your breath will distract you from your thought patterns. Tell yourself, “I am not dying. This too will pass.” Bring your attention to the present. Focus on your physical sensations, and name three things you can see, three things you can hear, and three things you can feel. If you practice yoga, a centering yoga pose (like Sukhasana or easy pose) can also bring on a state of mindfulness.

3. Visualize a peaceful and happy place. Think about a place that relaxes you: a favorite beach, a hike, a lake. Picture yourself there and focus on as many details as possible. Like the mindfulness exercise, focus on what you can see and hear and feel. Is there sun streaming through trees or reflecting off the lake? Is there a smell of leaves or flowers? What does the sand feel like between your toes?

4. Repeat a mantra. If you already have a mantra or favorite words of affirmation, repeat them. If not, close your eyes and repeat one of the following phrases: “This will pass,” or “I will be fine,” or “I will get through this.”

5. Take a break. If you can, tell your boss you’re not feeling well and need to step away. Take 15 minutes before going back to your office or your desk. Don’t check your phone. Drink a cup of herbal tea. Walk or sit outside. Or if you cannot remove yourself, or don’t have 15 minutes, then just sit still for 5 minutes. You may also want to go home for the rest of the day to relax and regroup, if possible. And if this is not your first panic attack, consult with a medical provider.

Helping Someone Who Is Having a Panic Attack

Don’t “diagnose” a panic attack in someone else, but learning to recognize the symptoms will help you better support someone who’s in distress. When speaking to them, remain calm and use a calm voice. You can help in the following four ways:

1. Ask. Don’t assume you know what’s going on. Calmly ask if and how they would like your assistance. Say something like, “Miguel, are you OK? Would you like me to go outside with you so you can catch your breath?” If the person seems like they can’t communicate and you think they are having a heart attack, then call an ambulance immediately and let medical professionals make the assessment.

2. Find a quiet, private place. Reducing environmental stimuli can ease stress and help reduce the effects of dizziness and nausea. Ask your colleague whether they’d like you to help them find somewhere quiet to sit. If they say yes, do so. If they say no, then ask if there is anything you can do to help them. And if they refuse your help, then just let them know you are there for them if they change their mind.

3. Listen. Respect boundaries, and if the person is able to say how you can support them, follow their lead. Remember that their response may be curt because they’re in emotional distress. They may be ashamed to be experiencing a panic attack in public. If they ask you to leave, let them know that you’ll be nearby if they change their mind. Say something like, “I don’t want to leave you alone when you seem so distressed, so I will be nearby to support you if you need me.” Then give them some space but stay close enough to come if they call you.

4. Reassure. If the person asks you to stay, tell them that you are there to support them. Introduce a mantra as a way of focusing their attention elsewhere. Suggest they repeat after you, “I am going to be OK.” Help them breathe slowly. Model slow and purposeful breathing. Ask them to close their eyes and to breathe along with you, using the method described earlier. Repeat until their breathing slows and they regain control.

After the panic attack passes, reassure your colleague that the experience will not affect the way you think about them at work, and that you will protect their privacy and not share what happened with anyone. (And, of course, do that.) Encourage your colleague to take a few minutes, or the rest of the day, to recover if they’re able to.

Sharing About Your Panic Attacks

You don’t need to share with your boss or HR that you get panic attacks. However, if you choose to disclose your panic disorder, remember that you get to decide how much you want to share. Disclosure about your panic disorder may be protected under the Americans with Disabilities Act or equivalent, which means that your disclosure cannot be cause for dismissal or demotion. It also means that you may qualify for accommodations, such as taking more breaks. Check with a lawyer to see what applies in your area.

Although panic attacks can be distressing, the implications for how people see you at work can cause additional stress. The strategies described here can help you manage your symptoms and keep them from taking over your workday. Of course, don’t neglect to seek out professional support and guidance as well if you need it.

Copyright 2022 Harvard Business School Publishing Corp. Distributed by The New York Times Syndicate.