Breathing Exercises for Panic Attacks and Panic Disorder: Evidence and Cautions

If you need help right now

Call 911 if you have chest pain, pressure or discomfort, severe trouble breathing or fainting, or think you may be having a heart attack. Panic symptoms and medical emergencies can feel alike, and the NHS notes that most panic symptoms can also be symptoms of other conditions or problems. [1] MedlinePlus says rapid breathing for the first time may be a medical emergency. [2] If panic comes with thoughts of harming yourself, call or text 988. [3]

Purpose of this page

This page explains what research says about breathing and panic. It does not offer a panic protocol. Everyday guidance on panic attacks is on the panic attacks page. A related safety topic, overbreathing, is on the breathwork safety page.

What panic is, and what breathing has to do with it

The NHS says a panic attack brings a rush of intense mental and physical symptoms, such as a racing heartbeat, shortness of breath, dizziness and tingling, that most often last between 5 and 20 minutes. [1] It also says that although panic attacks are frightening, they are not dangerous. [1] People in a panic often breathe fast. MedlinePlus explains that excessive breathing lowers the level of carbon dioxide in the blood, which causes many of the symptoms of hyperventilation. [2]

What health services suggest

During an attack the NHS suggests staying where you are if possible, breathing slowly and deeply, and reminding yourself that the attack will pass. [1] To help prevent further attacks it suggests learning breathing exercises for stress. [1] It lists talking therapies and medicine as the main treatments for panic disorder. [1] For the gentle practice the NHS describes, see its guide, which says to let the breath flow into the belly without forcing it. [4]

What trials found

A network meta-analysis of 72 studies and 4,064 participants broke CBT for panic disorder into parts. [5] It found breathing retraining and in vivo exposure appeared to improve acceptability while having small effects on efficacy. [5] It also found interoceptive exposure and face-to-face delivery were associated with better results, and muscle relaxation with significantly lower efficacy. [5]

A randomized trial of 74 people with panic disorder compared two opposite breathing therapies that used a handheld carbon dioxide monitor, against a waitlist. [6] Both reduced panic severity at one month, but the authors concluded that improvement must have depended on elements common to both rather than on the carbon dioxide change itself. [6] They noted that the theory behind teaching people to stop hyperventilating has tenuous evidence. [6] Waitlist comparisons also cannot separate the treatment from attention and expectation.

A multisite study of 69 adults used a four-week, clinician-trained program with carbon dioxide and breathing-rate feedback and reported a response rate of 83% and a remission rate of 54%. [7] It had no control group within the study; its results were compared against an earlier controlled trial. [7] Several authors disclosed research grants from an organization abbreviated PAHS in the paper's conflict statement; the abstract does not say more. [7] We do not list devices. The program in the study used clinician training and feedback equipment, so it is not something to copy from a description.

Evidence label overall: mixed. Breathing can help some people feel steadier, but the best-supported route for repeated panic attacks is clinician-led care such as CBT.