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image of scared eyes | accountingweb | panic attacks

How to cope when panic attacks attack


Panic attacks are often dismissed as being all in the mind, but the experience is very real for those having them. Lucy Cohen shares some guidance she hopes will help other accountants to cope.

13th May 2024
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A strange whooshing filled my ears, like my head had been plunged underwater.

My chest tightened, and my heart rate soared.

My vision blurred at the edges and my breathing became ragged and shallow.

“I’m having a heart attack,” I thought.

Sitting at a dinner table in a private dining area during a business function, I watched everyone else chatter and laugh around me as I felt like my world was rapidly folding in on itself. Just at the moment when I thought I was about to pass out, someone took me by the hand.

“Come with me,” he said.

While I marvelled that my legs still worked, the kindly maître d’ sat me down in a quiet area and pressed an ice pack against the inside of my wrists. He waited with me until I felt better and calmly said to me: “My wife suffers with them too. I could see what was happening to you from across the room.”

“Suffers with what?” I replied thickly.

“Panic attacks,” he said.

That was my first panic attack, in 2014.

What is a panic attack?

A panic attack is a sudden episode of intense fear or anxiety that triggers severe physical reactions when there is no real danger or apparent cause. A panic attack may make you feel an overwhelming sense of dread, accompanied by symptoms such as a racing heartbeat, sweating, trembling, shortness of breath, chest pain, nausea, dizziness or a sense of losing control or impending doom. Just like me, many people who suffer them for the first time believe that there is something seriously wrong with them, like they are having a heart attack or about to lose consciousness.

Panic attacks can be extremely frightening. They often appear abruptly and can reach their crescendo within just a few minutes, leaving sufferers very little time to get themselves out of a situation. Even though panic attacks themselves are not life-threatening, their impact can significantly affect a person’s quality of life.

But aren’t they all in your head? Well, yes and no – it is a genuine physiological and psychological response to perceived danger or stress. While the triggers for panic attacks can often be rooted in psychological factors such as stress, anxiety or trauma, the experience is profound and involves significant physical symptoms. If you’ve ever had one, you’ll know how incredibly real those symptoms are. 

It’s far too easy to dismiss anxiety and panic attacks as a trick of the mind. There is a narrative that they are part of this new age nonsense that has people giving a label to every slight feeling they have. It’s probably all the millennials’ fault. Or maybe Gen Z. When we’re not busy eating avocado on toast, we’re going around calling panic attacks a medical condition. Pah! (I’m kidding, obviously).

The fact is, we have physical reactions to many things that are driven by our brains. We laugh when we are amused, smile when we are happy, and might shed a tear at a film, a song – or this article even. (I’m getting in there first before someone in the comments does.)

Those are physical reactions to the work of your brain – and panic attacks are no different. As soon as I wrapped my head around that, I felt the lifting of all my shame around suffering them. If I have the capacity to laugh at a joke, then I have the capacity for a panic attack, although I’d really rather have the former.

Anxiety is an ancient affliction

So is all of this mental health stuff a modern phenomenon? It’s commonly stated that anxiety wasn’t even widely acknowledged as an illness until the 19th century rolled around. 

If we focus away from the word “anxiety” and look at what has been written about in the past, mood disorders, particularly melancholia, can trace their roots back to classical antiquity. So, the notion of anxiety as a distinct and separate disorder may not be entirely novel, albeit it was labelled differently in the past. 

There are indications that ancient Greek and Roman philosophers and physicians recognised anxiety as a distinct phenomenon. In fact, Latin Stoic philosophical writings, such as the treatises of Cicero and Seneca, give early indications of the existence and treatment of anxiety disorders at the time.

Panic attacks go mainstream

Usually, there’s nothing like an indie trend going mainstream to kill its cool credentials, but in this instance, I greatly welcome them “selling out”.

Today, panic attacks are featured in popular culture. In the TV drama The Last of Us, the character Joel, played by Pedro Pascal (himself an anxiety sufferer), suffers a panic attack, and in the series Ted Lasso, our protagonist deals with both panic attacks and the stigma related to mental health issues in sport.

Although fictional, seeing them presented and sensitively dealt with in such prominent media is reassuring to those of us who have suffered them. When I first started experiencing them, I didn’t know how to describe them. Just saying, “I’m having a panic attack” when you’re in an objectively safe scenario seemed dramatic, and I feared the look you get when you know that someone is thinking, “Ah, so it’s all in your head.”

Given that I am an anxiety sufferer, it perhaps shouldn’t have surprised me that I might at some point suffer a panic attack, although the two things don’t necessarily go together. For me, anxiety has always been very thought-driven – I’m a catastrophiser, able to create scenarios in my head that my body then responds to as if they are real.

The panic attacks are different, though. At first, they seemed to come from nowhere and cruelly they often appeared when I was seemingly relaxed and enjoying myself. They were rare and unpredictable but would manage to show up at the worst possible moments.

As I started paying attention to them and to when and where they happened, I noticed a pattern. Whenever they showed up, they were always accompanied by a combination of the following:

  • being too warm
  • experiencing a sensory overload (noise, smells, sounds)
  • being tired
  • being in a situation where I was expected to be having fun.

Understanding what triggered them meant that I could handle them. It’s very tempting to avoid scenarios that can set them off; so many sufferers experience a significant reduction in their quality of life by avoiding situations that might trigger them. In my case, knowing that there were certain things I could control allowed me to be prepared. If I do experience one, I know exactly how to handle it; I understand that it won’t kill me, and I can find space and time to recover from it. 

Importantly, I know there is no shame in it. If you’re running a business then it’s likely you’re already putting yourself into situations well outside of your comfort zone on a regular basis. If you’re prone to anxiety, you’ve given it the perfect breeding ground to throw itself your way.

How can you help?

If you ever witness someone having a panic attack, there are some key dos and don’ts.


  • Do stay calm and present: Maintain a calm demeanor to help soothe the person experiencing the attack.
  • Do offer reassurance: Gently remind them that they are safe and the attack will pass and use a calm and reassuring tone.
  • Do guide their breathing: Encourage slow and deep breathing. You can breathe with them to provide a rhythm to follow.
  • Do give them space: Allow some physical space and avoid overwhelming them.
  • Do stay with them: Remain with the person until the panic attack subsides. Your presence can provide comfort and security.
  • Do follow up: Encourage them to seek professional help if they haven’t already.


  • Don’t dismiss their feelings: Avoid telling them to “calm down” or that they are overreacting. Try not to express panic or frustration – it’s not their fault, and they’re likely to be really embarrassed about it already.
  • Don’t minimise the situation: Refrain from saying things like “it’s all in your head”. Or that you don’t understand what they’re so het up about. Their feelings and symptoms are very real.
  • Don’t give complex instructions: Keep your guidance simple and easy to follow.
  • Don’t crowd or overwhelm them: Avoid having too many people around or bombarding them with questions.
  • Don’t leave them alone too soon: Stay until they feel more in control and the immediate symptoms have passed. 

Why am I sharing all this?

I often get asked why I share this sort of content with the accounting community. After all, it’s not exactly a tax update or an MTD guide, so why is it even relevant? 

Well, running a business can be incredibly lonely at times. We have no benchmark for many of our experiences, no colleagues to use as a sounding board, and often no real support. I think that, as someone who has been doing this for the best part of 18 years, I can use my candour to alleviate some worries for another accountant who feels the same way.

If Bill Gates can publicly speak about his struggles with anxiety, then the rest of us shouldn’t feel bad about doing the same. There’s a huge strength in sharing your story with others – it might just make one other person feel a little less alone. 


For help with your mental health you can visit: 

Replies (5)

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By paulwakefield1
13th May 2024 18:51

I can completely identify with your article. I can remember the first time I had an attack some 37 years ago. I remember the date well because it was the evening before the hurricane hit overnight. I recognise your 4 bullet points plus there were a couple of other factors in my case. Particularly galling was that people thought I was drunk when I was stone cold sober (much to my chagrin). It took me 5 or 6 years to (more or less) completely control it and there are still situations where I worry I could be triggered.

You can be having an attack and still be completely conscious of how stupid it is - no, that's the wrong word; how unjustified it is. But the physical symptoms are very real.

Thanks (6)
By [email protected]
14th May 2024 16:36

The how you can help section is greatly appreciated. I have a friend that suffers from panic attacks, and now I feel I can be more understanding and helpful for them.

Thanks (1)
By taxwizard
14th May 2024 17:24

I struggle with anxiety and jump at times when I receive an email from an ex-client or their accountant or from a client who maybe attacking me. I need to realise there are worse things that could happen in life than email from an unhappy client

Thanks (0)
All Paul Accountants in Leeds
By paulinleeds
15th May 2024 22:39

An excellent and succinct article.

I’ve very recently (last few months) had a period of depression and anxiety that appears to have come from nowhere and slowly built up. I’ve stared anti-depressants and in the first two weeks I’ve noticed a sudden increase in my depressants and anxiety. I’ve been there before and know in a few weeks I’ll be much better.

In the last week I had a panic attack, the first in many years, and suddenly my blood pressure shot up, I saw stars in my eye, started to sweat and felt faint. It was quite scary. I’m not stressed, yet something in my head is telling my body something different.

I totally agree with the Dos and Don’ts. My partner was there to support me when I started to panic. Without her being there I would not have returned to a state of calm as quickly. It’s a scary time. It is all in the head, but it’s so real. Without feeling safe you can easily panic and your mind jumps from a simple issue to all hell breaking out in seconds.

Unless you’ve experienced panic, you simply do not understand what it’s like. I’m a very normal person.

I even said to myself and my partner this week that if I had a cough, cold or a broken leg that it would be easier to deal with. I fully understand that anxiety is just another ailment. I’m pleased that people are talking more about mental health in recent years. It does normalise the issue as just another illness.

I know some people complain about these non-accounts/tax articles. We are all human and even accountants have panic attacks. Running your own business e.g. from home/small unit is incredibly lonely at times. I fully agree that we have little benchmark, no or few colleagues to use as a sounding board, and often no real support.

Thanks (3)
By Hat Lady
16th May 2024 14:14

Thanks Lucy. Great article. I had my first panic attack at 15, when another girl passed out during school assembly. I had no idea what it was and it was many years before I realised. I've suffered from them in phases ever since then and never know what brings a phase on. About 5 years ago, I was having 10 or more a day and they were affecting my entire life. Then I watched a programme with Michael Moseley which showed a trial with Pro Biotics. I have been taking Probio7 (which has the 3 bacteria recommended in it) ever since and I've not had one. I feel the starting signs from time to time, but not one has developed into a full blown attack. They have been revolutionary for me.

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