Panic Attacks: Why Breathing Retraining can Make Things Worse and What to do Instead

If you walk into a doctor’s office, a yoga studio, or even a high-stakes corporate boardroom and announce that you are feeling anxious, the response will be almost Pavlovian. Someone, inevitably, will tell you:

"Just take a deep breath."

It is the universal panacea. Breathing retraining—specifically deep, diaphragmatic breathing—has been the first line of defense for anxiety for decades. It appeals to our intuitive sense of biology: anxiety speeds us up, so slow breathing should slow us down. It appeals to our desire for control: the breath is one of the few autonomic functions we can consciously modify.

While breathing retraining remains a popular tool, research suggests that for many, focusing on the breath during a panic attack transforms a natural bodily function into a battleground. Some worry about not breathing the "right way." Some become hyper-focused on their breathing mechanics, counting seconds and measuring intake. Others get frustrated as they were hoping for immediate relief from panic, and when the "cure" fails, they spiral even deeper.

This article is an attempt to help you understand the necessary nuance of using breathing techniques to help you through a panic attack. We will explore why a "tactical pause" makes neurobiological sense, why relying on breathing control can set a trap that risks making your panic worse, and how to understand the chemical reality of your own body and balance the use of coping techniques (strategies that can reduce the distress during a panic attack) and treatment methods (techniques that eventually reduce the reoccurrence and severity of panic attacks).

Part I: The Neurobiology of the "Cup"

It is helpful to visualize a panic attack using the analogy of a cup of water. Imagine that your brain is a waiter. Its job is to scan the environment for threats. When you perceive a danger—whether it is a tiger in the tall grass, a hostile tone in your boss’s voice, or a strange flutter in your chest—your brain instantly pours a "cup" of specific neurotransmitters and stress hormones, primarily adrenaline and cortisol. This chemical cocktail is dumped into your bloodstream immediately. Its purpose is evolutionary: it prepares your muscles for movement (fight or flight) and sharpens your senses.

Now consider this: Once that cup is poured, those chemicals are in your system. They cannot be un-poured. There is no biological "undo" button.

Your body must now metabolize these stress hormones. In the absence of true danger or excessive monitoring, this metabolic process usually takes about 15 to 30 minutes. During this time, you will feel the physical effects: a racing heart, shallow breath, sweating, shaking, and perhaps dizziness. This is not a sign that you are dying; it is a sign that your liver and kidneys are processing the "cup" that was poured.

If you feel those sensations—the racing heart, the tight chest—and you interpret them as dangerous, you start panicking about your panic. This state is known as hypervigilance. Your brain, detecting your fear, assumes there is a valid threat present.

The waiter (your brain) sees your fear and says, "Oh, we are still in danger? I better prepare you." And it pours another cup of the same neurotransmitters.

This new batch acts on top of the old batch. It will now require an additional 15 to 30 minutes to be metabolized.

If you are panicking, and you start using breathing techniques with the expectation that they will make the feeling stop immediately, you are setting yourself up for the "Second Cup." Breathing techniques can make us feel more comfortable physically by loosening muscle tension, but they will not speed up the metabolism of these neurotransmitters. Your body processes adrenaline at a fixed rate. You cannot "breathe" the chemistry out of your blood faster than your biology allows. If you start worrying about your breathing not working fast enough ("I'm breathing deeply but my heart is still racing!"), you are signaling a new threat. You are producing another cup.

Suddenly, what should have been a 20-minute wave of anxiety becomes a prolonged, rolling storm of panic, fueled not by the original trigger, but by the desperate attempt to stop the physiological process.

Part II: The Case for the "Tactical Pause"

Does this mean we should abandon breathing techniques entirely? Is "take a breath" bankrupt advice?

Not entirely. It is rooted in the specific neurobiology of the "Freeze" response.

When mammals face a sudden threat—a predator in the grass, or a shocking realization—the immediate instinct is often not flight, but immobility. We freeze. We stop moving to avoid detection, and simultaneously, we hold our breath. This unconscious breath-holding increases muscle tension and signals to the brain that the threat is imminent.

In this specific context, the instruction to "take a breath" is a manual override code. It breaks the freeze response. It signals to the body: If I am exhaling, I am not hiding. If I am breathing, I am not dead.

Now, think of the classic advice to count to 10 before speaking when you are very upset.

When the amygdala (the brain’s alarm system) fires, it effectively hijacks the brain's resources. It routes blood flow away from the prefrontal cortex—the center of logic, language, and rational planning—and toward the limbic system and muscles. This is why you cannot read a book while a plane is going through severe turbulence; the biological alarm makes you temporarily cognitively impaired.

Taking one or two slow, deliberate breaths acts as a physiological bridge. It is a Tactical Pause. It allows the cortex to come back online. It inhibits the immediate impulse to bolt from the room. It buys you the three seconds of clarity needed to access your rational coping thoughts ("This is just adrenaline," "I am safe").

So, let us be clear on the distinction: A "Tactical Pause"—one or two breaths to break the freeze and reboot the cortex—is a valid, functional tool.

The problem arises when, instead of using the breath as a way to access rational thought, you try to use the breath to exorcise the panic.

Part III: Unintentional Exposure and the Interoceptive Sensitivity

Breathing retraining is often packaged as a relaxation technique. Yet to some, it creates a paradox: the more they relax and focus, the more terrified they become. This is a case of unintentional, surprise interoceptive exposure.

Many of those who are affected by panic disorder have very high interoceptive sensitivity. Interoception is the sense of the internal state of the body. Most people ignore their heartbeat unless they have just run up a flight of stairs. Most people ignore their breath unless they have a cold. However, people with panic disorder feel every beat, every twitch, and every shift in air pressure within their lungs.

This type of hyper-focusing is referred to as Cognitive Attentional Syndrome (CAS). The affected person not only reacts to felt changes within body function that occur spontaneously, they search for such changes. They scan their body like a security guard watching monitors, hoping to notice a symptom early enough to prevent a disaster.

When a therapist tells a client to "focus on their breathing" and "ensure it is deep and diaphragmatic," for some clients it is like being asked to stare directly at the source of their terror. They are asking a person terrified of their own physiology to hyper-focus on that physiology.

In standard interoceptive exposure, the client knows what is coming. We say, "We are going to spin in a chair to make you dizzy," or "We are going to breathe through a straw to simulate air hunger." The client expects the anxiety. It is part of the deal. The subsequent learning is: "I felt the symptom, and nothing bad happened."

When a client uses breathing retraining as a coping mechanism, the context is different. They expect relief. They expect the panic to stop.

If the client focuses on their breath, notices the tightness of their diaphragm (a natural result of adrenaline), and feels more anxious, they are at risk of forming some catastrophic conclusions:

1. "I was told this technique would cure me."

2. "It is making me feel worse."

3. "Therefore, my panic is beyond the cure. I am broken."

   
   

The failure of the "calming" technique can lead people to believe that there is no effective treatment for panic, deepening their hopelessness.

Part IV: Real vs. Induced

Why is it that some clients are perfectly fine with interoceptive exposure exercises in the safety of a therapist's office (spinning, hyperventilating) but crumble during a spontaneous panic attack at the grocery store?

The physiology is the same: adrenaline, racing heart, dizziness. But the context is radically different. Think of interoceptive exposure like watching a horror movie or playing with shadow puppets on the wall. You see the monster, but you know you pressed "play." You know your hand is making the shadow. You are the director. You can tolerate the fear because the context is safe and self-inflicted.

Spontaneous panic is like seeing a monster in your living room when you didn't turn on the TV. It feels like a home invasion.

When a client uses breathing retraining to try and stop a spontaneous attack, they are desperately trying to turn the TV off. They are trying to "make the monster go away."

By struggling to control the breath, they are sending a message to the amygdala: "This monster is real. It is not a shadow puppet. If I don't breathe perfectly, it will get me."

This transforms the breathing from a biological function into a desperate safety maneuver that reinforces the perception of the threat. The harder you try to breathe the panic away, the more you validate the idea that the panic is dangerous.

Part V: Treatment, Coping, and Safety Behaviors

To navigate recovery, we must distinguish between three distinct concepts: Treatment, Coping, and Safety Behaviors.

1. Treatment Strategies These are interventions designed to change the underlying mechanism of the disorder. In panic, the goal is to change the belief that anxiety is dangerous, reduce avoidance and monitoring. The gold standard is exposure (inducing symptoms to learn they are safe, or exposing oneself to situations like a long lineup at the cash register to learn that trapped feelings are tolerable).

2. Coping Strategies These are techniques used to manage distress in the short term. The "Tactical Pause" (1-2 breaths to engage the cortex) is a coping strategy. It doesn't cure the panic, but it helps you think clearly enough to navigate the situation. If you are experiencing a panic attack in the context of PTSD, or because you are worrying about tomorrow's presentation, then diaphragmatic breathing is useful. It allows you to divert your attention from your painful memories or your worries.

3. Safety Behaviors A safety behavior is something you do to prevent a perceived catastrophe. This is where breathing goes wrong.

If you believe: "If I don't breathe slowly, I will pass out or die," then breathing slowly is a safety behavior. It reinforces the belief that the panic could kill you if you didn't intervene.

Consider Sarah, a marketing executive who swears by her breathing app. When she feels panic in a meeting, she excuses herself to the restroom and follows the pacer on her phone for 10 minutes until the feeling subsides.

The Problem: Sarah believes the breathing "saved" her. She learns: "I can only handle meetings if I have my breathing app." Eventually, Sarah begins to avoid long meetings where she might not be able to escape. Her reliance on the breathing technique as a "rescue" has inadvertently increased her avoidance and narrowed her life. She attributes her survival to the app, not to her own resilience or the fact that panic is inherently harmless.

Part VI: The "Intruder" Experiment

Proponents of breathing retraining often argue that it works via distraction. "Counting breaths takes your mind off the panic." And that is true, provided that the person is not excessively preoccupied with their body sensations.

This argument provides us with a unique opportunity to test the very nature of panic. We can design a simple mental experiment to prove that panic, of itself, is not dangerous.

Consider this: You cannot distract yourself from true danger.

If a man with a knife broke into your home, could you "breathe your way" into ignoring him? If you started counting backwards from 100 by 7s, would the intruder disappear?

No. Your biology would not allow it. Your survival instincts would lock your focus onto the threat. The very fact that you can distract yourself from a panic attack (by focusing on breath, or a movie, or a conversation, or counting blue objects in the room) is the ultimate proof that panic does not represent any danger. It is held in place only by our beliefs that it does.

We can use this logic as a powerful intervention to help us stop panicking about panic:

• Hypothesis: You believe you are having a heart attack or a medical emergency.

• Action: Try to distract yourself by counting backward from 100 by 7s, or by focusing intensely on your breathing rhythm for 60 seconds.

• Result: Did the symptoms fade, even slightly, while you were concentrating on the numbers?

• Conclusion: If it were a heart attack, counting numbers would not make it stop. The fact that shifting attention shifted the symptom proves that the symptom is driven by attention (CAS), not by pathology.

  
  

Here, we use the breathing/distraction not to "fix" the panic, but to expose the lie of the panic. We use it to prove that the "monster" is actually a shadow puppet.

Part VII: The Solution — Ease Into Panic

If trying to control the breath often creates more panic (the Second Cup), what is the alternative?

Research consistently shows that Interoceptive Exposure (IE) is superior to breathing retraining for long-term recovery. In IE, we do not try to calm down. We try to create symptoms. We might ask clients to hyperventilate intentionally. Why would we do this? To prove that the sensation (breathlessness) does not lead to the catastrophe (death). When a client hyperventilates for two minutes and doesn't pass out, the cognitive shift is profound. They learn they don't need to control the breath to survive the breath.

This leads us to the counter-intuitive "Ease Into Panic" approach. Instead of fighting the physiology with diaphragmatic control, we invite it.

When the cup of adrenaline is poured, and your heart starts to race, the instinct is to clamp down and force calm. Instead, try this:

• "My heart is racing? Okay, let it race. It has a lot of energy to burn off."

• "I feel short of breath? I’ll sit here and wait for my body to figure it out."

• "I feel dizzy? I will allow the world to spin for a moment."

  
  

Acceptance reduces the friction. It prevents the second cup from being poured. The panic attack, deprived of the resistance and fear that fuels it, naturally runs its course. It allows the body to metabolize the stress hormones much faster than if we tried to fight them. By saying "Yes" to the symptoms, you remove the "danger" signal. You tell the waiter: "No more cups, thank you. I'm just processing this one."

Part VIII: The Nuance — The Pain Model

Does this mean breathing retraining is useless? No. But let's be precise about the intent.

Meet Leo. Leo has suffered from panic for years. He knows it won't kill him. But he also knows it hurts. It is uncomfortable, exhausting, and frightening.

When panic hits, Leo takes that initial tactical pause—two breaths to engage his cortex and remind himself he is safe. Then, he uses slow, rhythmic breathing. Leo tells himself:

"This is painful. I’m having a panic attack. I’m going to slow my exhalation just to make myself 10% more comfortable while I wait for this to pass. Just like I would breathe through a migraine or a stubbed toe."

Leo is not breathing to prevent death (safety behavior). He is not breathing to fix himself (treatment). He is breathing to comfort himself (coping). The difference between relaxing into and fighting against might be subtle but it is vital. A person fighting against panic might tell themselves: "I must breathe deep to make the anxiety go away immediately or else I will lose control." A person easing into the panic will say: "I am feeling high arousal. I will use my breath to signal to my body that I am safe, even though I feel scared."

Part IX: Silencing the Scanner

Returning to recent research, such as the 2025 Journal of Affective Disorders review ("Common threads: Altered interoceptive processes"), we understand that panic sufferers have a broken signal-to-noise ratio. They perceive normal biological fluctuations (noise) as emergency sirens (signal).

Rigid breathing rules ("You must use your diaphragm," "Count to four in, count to six out") add more noise to the system. They give the brain more data to monitor, more metrics to fail at. By letting go of the need to control the breath, we reduce the interoceptive noise. We stop feeding the Scanner. We allow the body to return to homeostasis on its own timeline.

Conclusion: To Breathe or Not To Breathe?

So, should you breathe through panic?

The answer lies in your motivation. Ask yourself why you are reaching for the breathing technique.

If you are using the breath as a tactical pause—a momentary reset to break the freeze response and engage your prefrontal cortex—then breathe. It is the necessary pause that allows rational thought to come online.

But if you are using the breath to control, to fix, or to escape, then you are caught in a safety behavior. You are snapping the rubber band against your wrist. You are treating the "horror movie" like a real "robber," and in doing so, you are keeping the alarm bells ringing.

Effective treatment asks you to drop the shield. Many clients use layer upon layer of coping techniques without any long term relief. For some, deep breathing is the heaviest shield they carry. True recovery comes when you realize you don't need the shield. You can hyperventilate, you can tremble, you can feel the air hunger, and you will still be standing when the feeling passes. You do not need to master your breath to master your life.

Sometimes, the bravest thing you can do is simply let yourself gasp, wait for the adrenaline cup to empty, and trust that your body remembers how to exhale.

References

• Craske, M. G., et al. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy.

• Schmidt, N. B., et al. (2000). Dismantling cognitive–behavioral treatment for panic disorder: Questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology.

• Nordbø, S. S., et al. (2025). Common threads: Altered interoceptive processes across affective and anxiety disorders. Journal of Affective Disorders, 368, 11-25.

• Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. Guilford Press.