Surviving a Panic Attack in Public Places or Crowds

Why public places can feel hard after a panic attack

The NHS describes agoraphobia as a fear of being in situations where escape might be difficult or where help would not be available if things go wrong. It lists travelling on public transport, visiting a shopping centre and leaving home among the things a person may be scared of. NIMH describes the same fear of places or situations where escape or obtaining help might be difficult if you were to have a panic attack.

Cleveland Clinic says that for some people the fear of having a panic attack is often enough to trigger one. The NHS describes a cycle of living "in fear of fear": you may start to avoid certain situations because you fear they will trigger another attack, which can add to your sense of panic and may cause more attacks.

What to do in the moment

In its page on agoraphobia, the NHS lists self-help techniques that can help during a panic attack: staying where you are, focusing on something that is non-threatening and visible, and slow, deep breathing. Its page on panic disorder adds reminding yourself that the attack will pass and remembering that it is not life threatening.

These are practical ways to apply that advice in public. They are our own suggestions, not tested treatments.

• Find physical support: lean on a wall, pillar, cart or railing, or sit down on a bench.
• Slow your breathing. Cleveland Clinic suggests breathing in as slowly, deeply and gently as you can through your nose and out slowly through your mouth.
• Give your eyes a job: read a product label, a poster or a timetable in detail. This is one way to focus on something non-threatening and visible.
• Relax your muscles one group at a time (Cleveland Clinic).
• Name it: "This is a panic attack. It is uncomfortable. It will pass."
• Use headphones with calming audio if that helps you stay focused on your breathing.

In specific places

A few situations come up again and again. These are practical options, not medical advice.

• Supermarket or store: step into a quieter aisle, read labels while you breathe, and leave your cart if you need to.
• Train, subway or bus: hold a pole, plant your feet, and count stations instead of minutes.
• Plane: you can tell a flight attendant you feel anxious. Use headphones and breathe slowly.
• Concert, stadium or crowd: move toward the edge, where there is more space, rather than pushing out through the middle.
• Waiting room or queue: you can step aside and rejoin. Holding your place matters less than calming down.
• Driving: if it is safe, pull over and breathe until the attack passes before continuing.

Stay or leave?

The NHS advice during a panic attack is to stay where you are, if possible. The NHS also says that avoiding places where panic attacks occurred is how agoraphobia can arise, since it can develop by associating panic attacks with the places or situations where they happened and then avoiding them.

In 1999, Salkovskis and colleagues published an experiment with patients who had panic disorder with agoraphobia. The researchers 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, when tested again within two days, than those who kept them. That was a clinic experiment on a specific group of patients, not a rule for everyday life.

Leaving is not a failure, and your safety comes first. If you do step out, the sources do not say how long to stay or whether to go back. If you find yourself avoiding more and more places, talk to a doctor.

If someone asks whether you are okay

A calm, short answer lets you keep your attention on your breathing.

• "I'm okay, just need a moment to catch my breath, thanks."
• "I get panic attacks sometimes. It will pass in a few minutes."
• "Could you stay with me for a minute?" if you would like company.

When you start avoiding places

The NHS says someone with agoraphobia will avoid situations that cause anxiety and may only leave the house with a friend or partner, and that this change in behaviour is known as avoidance. It says agoraphobia can develop as a complication of panic disorder, and that not everyone with agoraphobia has a history of panic attacks. NIMH says agoraphobia can sometimes develop as a co-occurring condition of panic disorder.

This page is self-help and cannot tell you whether you have agoraphobia. The NHS says to speak to your GP if you think you may be affected, and that it should be possible to arrange a telephone consultation if you do not feel ready to visit in person. It also says you can refer yourself directly for talking therapies without seeing your GP. For lifestyle, the NHS lists regular exercise, eating more healthily and avoiding alcohol, drugs and drinks that contain caffeine, such as tea, coffee and cola.

Preparing before you go out

Preparation can be as simple as knowing what you will do if panic starts. Practise slow breathing at home so you know the pattern before you need it. Keep a short note on your phone with your early warning signs, the steps that help you, and a calming phrase such as "This will pass."

You can plan outings for quieter times while you build confidence. If you notice that you are relying on a particular item or a particular person to go out at all, that is worth mentioning to a doctor.

When to get urgent help in public

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, 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.