Five effective ways to help clients with panic attacks

Panic attacks are sudden and very intense periods of fear, stress and anxiety, which may last anything from minutes to hours. Around one person in ten experiences at least one panic attack in their lives, often triggered by a stressful event. In the UK, approximately one person in fifty has panic disorder[1].

This generally develops when they are in their twenties and the condition is approximately twice as common in women as it is in men. 40-70% of those who have daytime panic attacks also experience nocturnal panic attacks which begin while they are sleeping.

Here are our top self-help tips for helping clients who present with this issue, though bear in mind that any physical symptoms should be checked by a GP before you begin.
Please feel free to post your favourite tips or techniques for working with this issue in the comments box below. 
  1. As with any anxiety-related issue begin by teaching the client about the biology of what's happening to them; help them understand that (even though it can be unpleasant and scary) they are physically safe during an attack.
  2. Teach coping strategies:
    a) relaxation and breathing techniques. Remember that it’s best for clients to learn these when they are feeling relatively calm, then use them if panic strikes.
    b) distraction techniques focus the client's mind and thoughts on something else while the attack happens, and the best distractions engage the client's cognitive faculties. (Counting, recalling a favourite poem or song, using a SUDS scale to rate the panic at regular interval.)
    c) exercise is useful if clients find relaxation difficult: dancing, jogging on the spot etc. This is counter-intuitive (why would you do something to increase your heart rate if it’s already racing?) but dispels the stress hormones naturally, by physical action.
    d) help the client to identify challenges to the negative thoughts they experience during an attack, future pace using these in hypnosis.
    e) set triggers and anchors so the client can interrupt or dispel panic symptoms
  3. Review the client's lifestyle and encourage them to
    a) eat a healthy diet
    b) take appropriate exercise for their age and health levels
    c) use self-hypnosis or meditation regularly
    d) quit or reduce smoking, alcohol and caffeine
  4. Use metaphors, suggestion and future pacing to aid relaxation, help the client feel in control, and boost their confidence that they can beat this.
  5. Explore why the client's unconscious believes the panic attacks happen, or are necessary, using parts, regression or other analytical techniques.



Author: is Senior Tutor At Yorkshire Hypnotherapy Training, which offers multi accredited hypnotherapy practitioner training in Wakefield and York, along with taster days and foundation levels. Debbie has written a chapter on working with IBS in The Hypnotherapy Handbook, aimed at students and newly qualified hypnotherapists and also offers supervision and continuous professional development (CPD) for those in practice. Please contact Debbie to find out more.


  1. I've seen it suggested that clients who have experienced frequent panic attacks could be encouraged to carry a small notebook to write down a detailed account of their panic attack symptoms as they occur each time. As far as I remember, the intended benefits were: to increase the client's awareness that each attack is just a patterned process that will run its course, making it more predictable and less scary; give the client something positive to do during the attack and generate a sense of taking control by writing it down; help the client to notice the most usual starting point within their pattern of symptoms, so they can start using breathing techniques etc at the earliest opportunity; and help the client to describe the pattern in detail to the therapist, so s/he can identify effective triggers and anchors for the individual. I'd be interested in your views.

  2. Yes, I can see this working for some clients. The trick to the best distraction techniques is to use the left brain (the logical side) as much as possible. Writing things down would do this.


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