Panic Attack While Driving: How to Get Off the Road Safely

Why panic can start behind the wheel

A panic attack is a sudden rush of intense fear with strong physical symptoms: a racing heart, sweating, trembling, shortness of breath, dizziness or feeling faint. The NHS notes that attacks can come on very quickly and for no apparent reason, so one can start on a road you have driven a hundred times. The NIMH lists "a feeling of being out of control" among the signs of panic disorder, and that feeling can be especially alarming when you are in charge of a moving car.

Driving also takes away the easy exits. You cannot stop the instant you want to, you are responsible for other people on the road, and on a highway the next safe place to stop may be minutes away. That matters, because the NHS describes agoraphobia, which can develop as a complication of panic disorder, as a fear of situations where escape might be difficult or help would not be available if things go wrong.

Fear of driving is often assumed to start with a crash, but research does not support that as the only route. A review in Clinical Psychology Review found that driving fear that did not follow a crash can be just as strong as fear that did. In a 2021 survey of 260 people with driving anxiety, panic attacks and criticism of their driving were more often named as how their anxiety began than crashes were; only 11.4% of people who had been in a crash saw it as the start. Heart palpitations and sweating were the body sensations they rated as most relevant.

While the car is moving: driving comes first

Breathing exercises, grounding games and guided apps are useful, but not at 60 miles an hour. While the car is moving, your only task is to drive safely until you can stop. Keep the steps simple:

• Eyes on the road and both hands on the wheel. Do not close your eyes, look at your phone or start an app, a video or a counting exercise.
• Cut extra demands: turn off the radio or podcast, and if you have a passenger, ask them to stay quiet or to read out directions for you.
• Keep a steady, legal speed that suits the traffic. Avoid sudden braking, and leave more space to the vehicle in front so you have time to react.
• Avoid unnecessary lane changes. If you need to change lanes to reach your exit, signal and do it only when it is safe.
• Tell yourself what is happening in one short sentence: "This is panic. I am driving. I am heading for the next safe place to stop."

Choosing a safe place to stop

Good places to stop are ones where your car is out of the flow of traffic: a service or rest area, a parking lot, or a quiet side street where parking is allowed. On a motorway or highway, that means leaving by the next exit and stopping once you are off the main road. Rules differ by country, so follow the ones where you drive. In the UK, the Highway Code lists places not to stop or park, including on a bend and near the brow of a hill.

Motorways and highways need extra care. In the UK, the Highway Code says you must not stop on the hard shoulder except in an emergency, and warns that hard shoulders give less protection than other places because they are so close to high-speed traffic. So if you can still drive safely, head for the next exit or services rather than the hard shoulder. If your symptoms make it genuinely unsafe to continue, for example your vision blurs, you feel you might faint, or you cannot keep your attention on the road, that is an emergency: stop where the local rules allow it, switch on your hazard lights, and follow the breakdown guidance for that road. On a UK motorway that means leaving the car by the side furthest from traffic if it is safe to do so and keeping well away from the vehicle and the traffic.

Once you are parked: letting the attack run its course

With the car parked and secured, and none of the warning signs in the next section, you can turn to the tools you could not use while moving. Sit back, put both feet flat on the floor and drop your shoulders. The NHS breathing exercise for stress suggests letting the breath flow into your belly without forcing it, breathing in through your nose and out through your mouth, and counting steadily from 1 to 5 on each breath if that helps, for at least 5 minutes. Separately from the NHS exercise, a practical grounding tip some people find useful is to look outward: name five things you can see through the windscreen, then four you can hear.

It can help to remember what the NHS says about how panic behaves: most attacks last between 5 and 20 minutes, though some have been reported to last up to an hour, and although they are frightening, they are not dangerous and will not cause you physical harm. Behind the wheel, though, the symptoms can make driving unsafe, which is why stopping comes first. Once you are parked, you do not need to fight the sensations. Let them rise, peak and fade while you sit somewhere safe.

Before you set off again, check two things honestly: have the symptoms passed, and do you feel able to concentrate on the road? If either answer is no, give it more time, or ask someone to collect you. Stopping is not a failure. It is exactly what a careful driver does when they are not fit to continue.

Signs it may not be panic: call for help instead

The NHS points out that most panic symptoms can also be symptoms of other conditions. Stop as soon as it is safe and call your local emergency number (999 in the UK, 911 in the US) if you have any of the signs below. Do not drive yourself to hospital: the NHS heart attack guidance says not to, and the call handler will tell you what to do. If your symptoms feel different from your usual attacks, or you have never had a panic attack before, get medical advice rather than assuming it is panic.

• Chest pain that feels tight or like squeezing, or chest pain spreading to your arms, neck or jaw.
• Severe difficulty breathing: gasping, choking or being unable to get words out.
• Lips or skin that look pale, blue or grey.

Medicines, alcohol and caffeine on the road

Some medicines used for anxiety affect driving. A 2011 systematic review and meta-analysis in Drug Safety found that benzodiazepine use was linked to a 60% to 80% higher risk of traffic accidents, that daytime doses of anti-anxiety drugs impaired driving performance, and that combining benzodiazepines with alcohol was linked to a 7.7-fold higher accident risk. In England, Scotland and Wales it is illegal to drive if a legal medicine makes you unfit to drive, and GOV.UK advises talking to your doctor about driving if you have been prescribed drugs such as diazepam, clonazepam or lorazepam.

That is not a reason to stop or change a prescribed medicine on your own. The NHS advises keeping to the treatment your doctor prescribed and only stopping when your GP advises it. Ask your doctor or pharmacist whether your medicine affects driving, and when it is safe to drive.

The NHS also lists caffeine, alcohol, sugary food and drinks, and smoking as things that can make panic attacks worse. Never drink alcohol to take the edge off a drive.

Panic disorder and your driving licence

The NHS notes that panic disorder may affect your ability to drive. In the UK, you must tell the DVLA if you are diagnosed with anxiety and it affects your ability to drive safely. If your driving is not affected, you do not need to tell them, and GOV.UK suggests asking your doctor if you are unsure. You can be fined up to £1,000 for not reporting anxiety that affects your driving. Other countries have their own rules, so check with your doctor or your licensing authority.

Separately, if you have ever actually fainted, blacked out or lost awareness, at the wheel or anywhere else, see a doctor before you drive again. The NHS lists feeling faint as a panic symptom, but losing consciousness is not the same thing and needs a medical assessment.

Getting back behind the wheel

After an attack in the car, it is natural to start avoiding the road where it happened, then highways, then driving alone. The NIMH lists avoiding places where panic attacks happened among the signs of panic disorder, and the NHS describes how this avoidance creates a cycle of living "in fear of fear". A 2023 systematic review of driving anxiety found that overly cautious driving, negative feelings and avoidance were all linked to it.

Habits you lean on to feel safe are called safety behaviours. For some drivers they might include only driving with a passenger or keeping a call open "just in case". In one small experiment with people who had panic disorder and agoraphobia, those told to drop their safety behaviours during a 15-minute exposure session had a greater fall in anxiety and in catastrophic beliefs than those told to keep them. That study was not about driving, so treat it as a reason to work on these habits gradually, ideally with a therapist, rather than to drop them all at once.

NICE guidance for panic disorder recommends cognitive behavioural therapy (CBT), delivered by a trained therapist. In England you can refer yourself to an NHS talking therapies service. Virtual reality therapy for driving fear is being studied, but a 2022 systematic review found the 14 available studies were all of low methodological quality, so it is not yet a proven alternative. If your fear began after a crash and comes with nightmares or flashbacks, tell your GP or therapist, because that can call for a different kind of assessment.