A panic attack at work can bring another worry on top of the symptoms: “What if people notice?” You might be listening in a meeting, serving a customer or trying to finish an ordinary task when your heart starts racing. It can be hard to pay attention to your work when you are also wondering whether you will need to leave.
My panic attacks first started while I was working in the NHS, and I have had them at work. I have also had a panic attack in the middle of giving a presentation during an interview for a new job. I had a dry mouth and was hyperventilating, but I carried on. It was extraordinarily difficult. I am telling you this because I know what all of this feels like.
I also found it difficult to tell people at work what was happening. I eventually needed time off, as I explain in my personal account of panic attacks. Needing a break, support or sick leave does not mean you have failed at your job.
There are two things to work on: what you can do during an episode, and how to stop the fear of another one from deciding which parts of work you can manage. You do not have to solve both in the middle of a meeting.
What to do if you have a panic attack at work
First, consider the task you are doing. If you are driving, using machinery, working at height or responsible for someone’s immediate safety, follow the appropriate stopping or handover procedure if symptoms affect your ability to work safely. That is a practical safety decision. It is not an opportunity to practise staying with anxiety.
The suggestions below can help when you recognise your usual panic symptoms. If something feels different, check it with your GP. My main guide to panic attacks explains the symptoms in more detail.
1. Name what is happening
If you recognise the pattern, you might quietly remind yourself, “I have felt this before. I can decide what to do next.” You do not have to convince yourself that the sensations are pleasant, or keep repeating the sentence until you feel certain.
2. Bring some attention back to the room
Read the next line of the agenda or listen to the person speaking. Notice the feel of your feet on the floor. Choose one thing rather than trying several techniques at once. If you use breathing, aim for an easy, comfortable rhythm rather than forcing a large breath. The HSE’s panic guidance includes breathing and grounding options.
3. Would a short break help?
You may be able to stay where you are, or you may need a short break. Think about whether you can carry on with your work safely. If you need a break, take one.
4. Getting back to your work after a panic attack
If you can continue safely, write one note, listen to the next point or complete the next small part of the task. Some anxiety may still be there. The aim is to return to the work in front of you, even if you still feel anxious. You do not need to keep checking whether the feeling has gone. For fuller instructions during an attack, see my guide to what to do during a panic attack.
What if you really need to leave?
It can help to take a short break. You might say, “I’m feeling unwell and need a few minutes. I’ll let you know when I’m ready to come back.” If someone needs to cover your work, arrange that before stepping away where possible.
If you are well enough, returning to part of the meeting or task can be useful. If you cannot return, that does not make the day a failure. Later, look at what would help next time. The concern is a pattern in which you begin avoiding more and more work solely because you fear panic. I explain how that develops in the cycle of fear and avoidance.
Meetings and presentations
It helps to be specific about what you fear. “I might become anxious” is different from “If my voice shakes, I will be unable to finish a sentence.” The second is specific enough to check against what happens when you speak.
For example, imagine that you have started missing team meetings after a panic attack. You might arrange to attend a shorter meeting and contribute one prepared point. Afterwards, ask what happened: did your voice shake, were you able to finish, and how did the conversation continue? Feeling anxious does not, by itself, tell you whether the feared outcome occurred.
Start with something you think you could try and build up from there. That might mean asking a question before giving a longer update. It does not have to follow a fixed ladder or involve removing every support at once. Ordinary preparation and notes are useful; the question is whether the preparation helps you communicate or has become hours of rehearsal to guarantee that nobody could notice anxiety.
Panic on the shop floor or in public-facing roles
When someone is waiting for you, it can feel as though you have to respond immediately. A short sentence can give you time: “Bear with me while I check that,” or “I need a colleague to help with this.” You can ask for help without explaining your health to a customer.
A colleague who knows the agreed plan may be able to cover briefly. In clinical, teaching or other safety-sensitive work, use the normal handover arrangements. Do not rush an important decision to get the interaction over with.
Afterwards, you may want to replay every expression on the other person’s face. That cannot give you reliable certainty about what they thought. If there is a practical issue to address, address it; otherwise, try to return your attention to the next part of the day.
Should you tell your manager?
This depends on what support you need and whom you feel able to approach. You can begin with the practical difficulty rather than your whole history. A manager, occupational health service, HR contact or staff representative may be a useful starting point, depending on your workplace.
You might say: “I’ve been having panic attacks at work. Sometimes I need a short break. Can we talk about what would help and who I should contact if it happens?” You can focus the conversation on what would help you do your work.
Useful questions include:
- Who can cover if I need to step away from a task?
- Could we agree a temporary change to duties, hours or meeting expectations?
- What information needs to be shared, and with whom?
- When will we review whether the arrangement is helping?
The World Health Organization describes workplace adjustments and supported return-to-work plans as part of helping people with mental health difficulties remain in or return to work. What is appropriate needs to be discussed for your circumstances. Bullying, excessive workload or unsafe conditions also need attention; practising with panic does not make those conditions acceptable.
Sick leave and returning to work
Sometimes time off is necessary. Discuss what you need with your GP and, where available, occupational health. Time away may give you an opportunity to begin treatment and recover enough to consider a return.
When a return is appropriate, a specific plan is easier to work with than “I’ll go back when I feel completely confident.” Depending on the job, the plan might involve a discussion with your manager, reduced hours or a gradual return to particular duties. Agree the steps and review them alongside your care. The purpose is a sustainable return, not getting back as quickly as possible at any cost.
After a panic attack at work
Give yourself a little time before deciding what the episode means for your whole career. You may be tired, embarrassed or frustrated. Those feelings are understandable, but they are not a reliable basis for cancelling every future meeting or taking on extra work to prove that nothing happened.
Later, it can help to ask: What was I afraid would happen? What actually happened? Was there anything that helped? Was there support I needed? Then decide whether there is anything you would do differently next time. If checking your pulse, searching symptoms or repeatedly asking whether you looked strange is taking up the rest of the day, include that in the plan you discuss with a therapist.
When to get help
Speak with your GP or a qualified therapist if attacks are recurring, you are missing work, or much of the day is spent anticipating the next episode. NICE guidance on panic disorder includes self-help, psychological treatment and medication, with the choice based on assessment and your circumstances. You can read how CBT for panic attacks works before deciding what to discuss.
Think about the particular part of work you want help to regain: attending meetings, teaching a class, talking to customers or simply concentrating at your desk. That gives you and the person helping you a more useful starting point than asking yourself to “be confident” for an entire working day.