How to Calm Down: 7 Evidence-Based Skills for Crisis Moments
- Terri Kern
- Jun 22
- 7 min read
Updated: Jul 9
Stop Emotional Spirals with Science-Backed Tools from Dialectical Behavior Therapy: A Guide to Managing Panic Attacks
The first time I had a panic attack, I was in my forties. It was noon during a busy workweek. I couldn’t catch my breath. My heart was racing, and my arm went numb. I was convinced I was having a heart attack.
Calm on the outside and panicking inside, I drove myself to the hospital. When I walked in, clutching my chest, they quickly escorted me back to the ER. They attempted to put me in a wheelchair, but I refused. All I wanted was answers.
Is this it for me? Is my life going to end here in the ER of St. Anne's Hospital in Toledo? Nobody in my family even knows I'm here! Should I call them? Will they call them? Oh my God, what about my daughter? How would she manage without me? Where is my will? Who knows how to find it? Nobody at work even knows I'm missing! What if someone is looking for me? Am I going to get fired? Holy crap! I feel terrible! My heart is racing; it’s going to explode! What will that feel like? Will I bleed out everywhere? What is happening to me?
Recognizing the Racing Thoughts
To make a long story short, the medical team recognized that I was experiencing a panic attack. They gave me medication to calm my body down. After that, they sent me home.
Yes, I drove myself home, and my family was furious that they had no idea what occurred! Someone in my family said, "Next time, just breathe!" What??
Why "Just Breathe" Fails (And What Actually Works)
As someone who struggles with anxiety, certain phrases make me feel worse:
“Calm down, there’s nothing to worry about.”
“You’re overreacting; it’s not a big deal.”
“Just think positive thoughts.”
“Why can’t you just get over it?”
“You’re being dramatic.”
“Stop making a scene.”
“Other people have it worse than you.”
“You should just breathe and relax.”
“This is all in your head.”
“You need to toughen up.”
Here’s the truth: those of us suffering from anxiety and panic already know we should calm down and "just breathe."
Do you want to learn how to journal? Download the Therapy Journal For Beginners for FREE.
Physiological Responses During a Panic Attack: Why "Just Breathe" Doesn't Work
During a panic attack, the body goes through intense physiological changes driven by the "fight or flight" response.
Here's what commonly happens:
Elevated Heart Rate: Your heart races, creating feelings of palpitations due to adrenaline.
Hyperventilation: Fast and shallow breathing can lower carbon dioxide levels, leading to dizziness.
Muscle Tension: Muscles may tighten up, leading to discomfort or pain.
Increased Sweat: You might sweat excessively, feeling clammy as your body reacts to perceived danger.
Digestive Issues: Your digestive system may react negatively, causing nausea or stomach cramps.
Involuntary Shaking: Trembling may occur as the body prepares for action.
Choking Sensation: You might feel like you can’t breathe, which intensifies panic.
A Sense of Unreality: Some people report feeling detached, which can be distressing.
Overwhelming Fear: Panic attacks often bring a fear of losing control, going crazy, or even dying.
So, if a patient is having a panic attack during a session with me, I wouldn’t say, "Just calm down and breathe!"
Can you imagine? You're feeling panic, and your therapist tells you to calm down? You’d think, "No kidding! I should have figured that out myself!"
After that, you likely wouldn’t return for more sessions. Am I right?
How to Calm Yourself Down
Panic attacks can be overwhelming, often mimicking symptoms of other medical conditions, like a heart attack. Understanding physiological responses can help you manage your experiences more effectively.
Understanding the Anxiety Scale
Familiarizing yourself with the Anxiety Scale is crucial. The scale ranges from 1 (calm) to 10 (panic). This awareness allows you to intervene before escalating to a panic attack.
Keying Up: Your muscles and chest begin to tense up.
Increased Pressure: You may feel pressure or tightness in your chest, indicating physical anxiety.
If you want to manage your anxiety symptoms, start by familiarizing yourself with the Anxiety Scale.
Look through the terms on the Anxiety Scale, from 1 to 10, and recognize how each level feels in your body.
The aim of the Anxiety Scale is to help you become aware of your body’s signals before reaching panic. Early intervention can make a significant difference.
7 Evidence-Based Skills for Crisis Moments
Interventions for mood disorders like anxiety, depression, or mania are straightforward. In fact, all interventions in Dialectical Behavior Therapy (DBT) are simple.
The challenge lies in actually applying these techniques when needed most. When we begin to spiral, we must commit to taking a different action.
This commitment is one of the hardest things we'll ever face.
Changing our reactions to physical sensations and mental cues is tough. Our brains tend to head toward panic mode.
Panic distorts our perception of reality. It can feel like imminent danger is lurking around every corner.
These beliefs are part of the anxiety disorder. It's vital to restore control over our thoughts and emotions, even though it's not easy.
Let’s simplify things:
HOW: Observe thoughts or sensations without judgment (e.g., "My heart is racing… and that’s just a fact.").
WHY: Stops the "thought → fear → worse thought" cycle by engaging the prefrontal cortex, or PFC, which is the rational part of our brain.
Our brains are at risk of getting "hijacked" by the limbic system to which our amygdala belongs, also known as our emotions. Those pesky emotions (!) takes our focus off of the present moment and shifts us into "autopilot" - racing thoughts, catastrophizing, whole arguments with people in our head, all the shit we have to do with no time to do it all, etc.
Mindfulness is a skill that's built when we intentionally and gently bring our focus back to the here and now. You have to practice, practice, and practice some more.
MINDFULNESS IS THE SKILL UPON WHICH ALL GOOD MENTAL HEALTH IS BUILT.
HOW: Ask, "What’s the most loving AND logical response right now?" (e.g., "Rather than walking away from this hard thing, I’ll sip water, not bolt.").
WHY: Balances the emotional (amygdala) and logical brains, PFC, to prevent impulsive reactions. Name one time you've acted out when pissed off and impulsive where it made things better for you and not worse? Me - 0. And I used to act out A LOT.
Our brains are wired to feel a whole lotta stuff (check out The Feelings Wheel). These skills don't change how you feel, your feelings are never wrong. What gets us into trouble is how we behave when we're in our feelings. The goal and the challenge is to keep the rational brain engaged while we're feeling intensely so we behave in ways that make things better, not worse. Simple, and yet so, so hard to do because it's a skill we have to build.
HOW: Whisper your exact emotion, like "This is dread, not danger." or "My panic is a false alarm." Use The Feelings Wheel to help you!
WHY: Labeling feelings can cut amygdala activation by 50% based on UCLA fMRI studies.
Human emotions, for which our brains are wired, tell us how to act and react to the millions of experiences we have all day every day of our lives. People tell me all the time - "I'm not an emotional person", or "I don't do emotions like that," or "I don't feel anything." INACCURATE. People with emotional regulation skills don't always like the way we feel, and we have skills that help us to act in ways that make things better, not worse. Labeling how you feel is an important part of that.
HOW: Use one sense intensely (e.g., hold an ice cube, breathe in lavender oil, or hum a low tone).
WHY: Sensory input activates the parasympathetic nervous system, reducing fight-or-flight responses.
We live our life through our senses; our five senses - taste, touch, smell, sight, and sound. All send signals to the emotional brain, the amygdala, which tells us how to act or react in response to what is happening. Our family of origin teaches us to develop the inner critic, usually the voice of an unempathetic caretaker, or we learn to self-soothe and key ourselves down.
HOW: Remember the acronym: ACCEPTS when you start to disassociate: Activity that's meaningful to you; Contribute to something or someone meaningful to you; Compare how you're coping with a time you didn't cope so well; Emotionally focus on things that make you feel better (books, a movie, etc); Push away the urge to fight reality; Thoughts cause feelings so keep them in the present moment; Senses are how we take in our lives so use them to refocus in the present moment.
WHY: Anchoring you in the present moment silences catastrophic thoughts.
When anxiety and panic start to key us up the PC/thinking part of the brain shuts down, which causes a dream-like sensation. Smelling salts bring people back to reality through a strong smell. We can then refocus our energy.
HOW: Dunk your face in ice water for 10 seconds or press a cold pack to your cheeks or wrist.
WHY: Triggers the dive reflex, slowing your heart rate via the vagus nerve within 20 seconds.
Changing our body temperature is a sensory experience. Remember that the senses keep us grounded and in the present moment.
HOW: Mentally scan for tension spots (like your jaw or shoulders) and lightly whisper, "Unclench now."
WHY: Releases trapped muscle tension that fuels panic loops.
Learn how to do a progressive muscle relaxation exercise to release tension here:
Calm Is a Skill—And You Can Master It
Panic lies to you, insisting you’re trapped in chaos. But science reveals a different story: Your nervous system is trainable. Your mind is resilient.
These seven skills make up your toolkit for managing anxiety effectively.
✨ Remember This
Calm isn’t passive—it’s the brave choice to use skills over instincts when fear strikes.
Progress isn’t linear—some days, skills work instantly; others, you need to try harder.
Your brain rewires with practice—every time you engage a skill, you weaken panic's grip.
🚀 Your Next Step
Choose ONE skill that resonates with you (e.g., "When I feel tension rise, I’ll count three things I see.").
Download your 7 Panic Prevention Skills - free download link above!
Debrief after distress: “Did this skill reduce intensity by 10%? What might help next time?”
“Between the crisis and the calm is a choice. Today, you’ve gained more choices.” —Inspired by Dr. Marsha Linehan, creator of DBT.
You are not broken. You’re learning.
Every time you use these skills, you reclaim a piece of your peace.
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