How to Handle a Panic Attack at Work Discreetly

Panic at work is still panic

A panic attack at work is the same kind of event as one anywhere else. The NHS describes it as a rush of intense mental and physical symptoms that can come on very quickly and for no apparent reason, and says it can be very frightening and distressing. Cleveland Clinic says panic attacks are sudden, intense feelings of fear that cause physical symptoms such as a racing heart, fast breathing and sweating.

The sources do not explain why attacks happen at work in particular, so this page does not guess. It does cover what the NHS and Cleveland Clinic suggest during an attack, how to do those steps discreetly, and what the U.S. Equal Employment Opportunity Commission (EEOC) says about your rights at work in the United States.

The steps the sources suggest

When you feel a panic attack coming on, the NHS suggests the following. Cleveland Clinic gives a similar list for managing the symptoms until the attack resolves.

• Stay where you are, if possible.
• Breathe slowly and deeply. Cleveland Clinic suggests breathing in slowly and gently through your nose and out slowly through your mouth.
• Remind yourself that the attack will pass, and remember it is not life threatening.
• Focus on positive, peaceful and relaxing images.
• Relax your muscles, one muscle group at a time (Cleveland Clinic).
• Practise mindfulness, focusing on the present to ground yourself (Cleveland Clinic).

At your desk: a quiet routine

These are discreet ways to do the steps above. They are our own suggestions for the workplace, not tested treatments, and none of them should stop you from leaving the room if you need to.

• Plant both feet flat and press them into the floor, then release. Notice the pressure of the floor under you.
• Rest your forearms on the desk or your palms on your thighs, so your hands are still.
• Breathe in through your nose and out slowly. A slow exhale is hard for others to hear.
• Relax your jaw, then your shoulders, then your hands, one at a time.
• Look around the room and quietly name a few things you can see, to bring your attention to the present.
• Hold a cool drink or a water bottle and notice the temperature in your hand.
• Remind yourself silently: "This is a panic attack. It will pass."

In a meeting or on a video call

Meetings can feel hard because leaving feels conspicuous. These are practical options, not medical advice.

• On video, you can turn your camera off for a moment. "One moment, I will be right back" is enough.
• Mute yourself while you breathe slowly.
• Take notes, if that helps you stay focused on the present.
• If you are asked to speak, it is fine to say: "Let me think about that and come back to you."
• If you need to step out, a short "Excuse me for a moment" is enough. You do not owe anyone an explanation.

If you need to step away

The NHS advice is to stay where you are, if possible. If you decide you need a break, that is your call, and a restroom, a stairwell or a short walk outside are all options. The sources do not say how long a break should be.

Salkovskis and colleagues studied patients with panic disorder with agoraphobia and tested the idea that safety-seeking behaviours help to maintain anxiety because they prevent patients from benefiting from disconfirmatory experience. Patients who stopped such behaviours during a 15-minute exposure period showed a significantly greater decrease in catastrophic beliefs and anxiety. That was an experiment with patients with panic disorder with agoraphobia, so it does not tell you what to do at your desk. If you find you are avoiding meetings, rooms or situations because of panic, it is worth talking to a doctor.

Your rights at work in the U.S.

The EEOC says that if you have depression, post-traumatic stress disorder (PTSD) or another mental health condition, you are protected against discrimination and harassment at work because of your condition, you have workplace privacy rights, and you may have a legal right to reasonable accommodations. These rights come from the Americans with Disabilities Act (ADA). The EEOC document is about the United States; the sources on this page do not cover other countries.

On privacy, the EEOC says that in most situations you can keep your condition private, and that an employer is only allowed to ask medical questions in four situations, including when you ask for a reasonable accommodation. Whether to tell your manager is your decision.

On accommodations, the EEOC says a reasonable accommodation is a change in the way things are normally done at work. Its examples include altered break and work schedules (for example, scheduling work around therapy appointments), quiet office space or devices that create a quiet work environment, changes in supervisory methods, specific shift assignments, and permission to work from home. It says you can get one for any mental health condition that would, if left untreated, "substantially limit" a major life activity, and that if an accommodation would help you do your job, your employer must give you one unless it involves significant difficulty or expense. To ask for one, tell a supervisor, HR manager or other appropriate person that you need a change at work because of a medical condition.

Looking after yourself outside work hours

The NHS lists things that may help prevent a further attack: regular physical exercise to reduce stress and tension, breathing exercises for stress, activities like yoga and pilates to help you relax, and avoiding sugary food and drinks, caffeine and alcohol, and smoking, which it says can all make attacks worse. The National Institute of Mental Health (NIMH) says getting enough sleep and exercise, eating a healthy diet and turning to family and friends you trust for support can help, although this alone cannot replace treatment.

NIMH says that if anxiety starts to cause problems in everyday life, such as at school, at work or with friends and family, it is time to seek professional help. The NHS says to see a GP if you have been experiencing symptoms of panic disorder. A GP or your own doctor can explain what options exist for you.

When to get urgent help at work

Cleveland Clinic says some panic attacks have signs that can resemble a physical problem, like a heart attack. If you have chest pain, trouble breathing or lose consciousness, seek emergency medical care. The NHS says most panic symptoms can also be symptoms of other conditions or problems, so you may not always be having a panic attack. If you ever have thoughts of harming yourself, contact emergency services or a crisis line straight away. In the U.S., call or text 988.