It can happen anywhere. Panic seizes and breathing becomes difficult, sweating ensues and functional behavior stops. According to the American Psychological Association, panic attacks are the classic "flight or fight" response, except they are likely to be a response that is very out of proportion to the stimulus. This notwithstanding, there is a psychological and physiological change in the body.
Know that It Will Pass
Because it is essentially that “fight or flight” response, with a heightened central nervous system, the body cannot sustain it. Fight or flight was designed for imminent danger and not for continuing situations. The attack can cause the sense of time to distort, minutes feeling like hours, but keeping in mind that the attack, in fact, won’t last more than a few minutes can mitigate the feelings of panic and make the whole process endurable.
Also know that while the heart is racing, the fingers may be tingling, and the head feels light, people rarely pass out from a panic attack. Panic attacks don’t cause or indicate a heart condition. The physiological effects of a panic attack are transitory. Panic attacks sometimes fade into anxiety, and prolonged anxiety can have an effect on memory and health, but even that is reversible.
Get Control of the Body
The heart and respiration rates can go up significantly during a panic attack. This is part of the physiological response and due to the adrenalin that is released into your system. Getting control of those responses can go a long way to alleviating the negative feelings from a panic attack.
Similarly, when the respiration rate is too high for the activity level, that creates a problem for your body as well as the stress level. Hyperventilating can cause a feeling of lightheadedness. Bringing the respiration rate to normal is a healthy thing to do.
Relaxation techniques include visualization and progressive muscle relaxation. Both of these techniques could be done discreetly in a public place. Visualization is just thinking of a place or time that is peaceful. Imagine being there in all its detail: temperature, sounds, even smells. Giving the mind a little vacation can encourage the body to follow. Progressive relaxation is best accomplished laying down or even sitting comfortably in a chair, but in an emergency could even be done standing in a check-out line in the store or airport. By focusing on one muscle group at a time, tensing the muscle and then relaxing it, and moving in a logical pattern in the body (from the toes up, or from the eyebrows down), the body refocuses its attention and the panic disperses.
A great relaxation technique for lowering both heart rate and respiration is conscious breathing. Make every breath intentionally slow and deep. Concentrate on how it feels as the air goes in and slides back out. Breathe in, taking five seconds for the full inhale. Hold for five seconds and then release the breath in the same, slow manner. Imagine the air filling the lungs and oxygenating every cell in the body.
Get Control of the Mind
Panic attacks are characterized by “catastrophizing,” thinking about disastrous consequences or perceiving calamitous threats. These are unfounded and unlikely, but the person’s thoughts can be relentless. They think the same thing over and over. To a lesser degree this is a hallmark of stress and many other mental disorders.
For hundreds of years the answer has been to replace these thoughts with one, controlled thought. In the tradition of using a mantra, which could be a word or a sound, the mantra is repeated calmly to exclude other thoughts from the mind. It becomes a peaceful rhythm which eventually acquiesces to compatible thoughts. If practiced ahead of time with some level of meditation, it could be a powerful way to gain back control of the panicked mind.
Also using a phrase, established ahead of time, such as “this will pass,” or “it will be okay,” can also help. Repeating this phrase to yourself in a slow, steady voice goes a long way to calm the mind.
Another way to get control of the mind is to live outside the experience. Instead of being on the roller-coaster ride, observe it without judgment. Notice the respiration and heart rate, notice the thoughts that cross the mind. Accept them without any feeling they need to be acted on. Have an “isn’t that interesting” attitude. Instead of trying to control the experience, which can cause more tension, just flow with it. This works in conjunction with the first suggestion: knowing that it will pass.