By William Schroeder, LPC and clinically reviewed by Teri Schroeder, LCSW
Breathing into a paper bag is one of the most recognizable images in film and television. Someone starts to panic, a bag appears, and they breathe into it until they settle. It made its way into real advice because the underlying physiology is not made up. The problem is what came next.
The short version: we no longer recommend it. Here is what is actually happening during a panic attack, why the paper bag idea caught on, and what to do instead.
What Hyperventilation Actually Does
People often describe panic as not getting enough air. The physiology usually runs the other way. When you breathe fast and shallow, you blow off more carbon dioxide than your body wants to lose. Low CO2 raises the pH of your blood, a state called respiratory alkalosis, and that is what produces the tingling in your fingers and lips, the lightheadedness, the chest tightness, and the sense that something is badly wrong.
Those sensations then feed the fear that started the cycle. That loop is the reason panic attacks feel self-perpetuating.
Why the Paper Bag Idea Existed
If low CO2 causes the symptoms, breathing your own exhaled air back in should raise CO2 and settle things. The logic is sound as far as it goes.
Why It Is No Longer Advised
Two problems, and the second one is the serious one.
- It can lower your oxygen too far. Research published in Annals of Emergency Medicine documented hypoxic hazards from paper bag rebreathing in hyperventilating patients. You are not only raising CO2, you are also limiting oxygen.
- Not everything that looks like panic is panic. Rapid breathing and chest tightness are also how asthma, a pulmonary embolism, and a heart attack present. If the cause is one of those, restricting someone’s oxygen is exactly the wrong move, and the delay while you try it matters.
A therapist cannot tell the difference from across a room, and neither can you in the middle of it. That is the whole argument.
What to Do Instead
- Make the exhale longer than the inhale. In for four, out for six or eight. Slowing the exhale does the same job of letting CO2 recover, without limiting your oxygen.
- Try a physiological sigh. Two inhales through the nose, the second one short and stacked on top of the first, then a long slow exhale through the mouth. Repeat a few times.
- Ground through your senses. Name five things you can see, four you can hear, three you can touch. This gives your attention somewhere to go besides the sensations.
- Let it crest. Panic attacks peak and come down, usually within about ten minutes. Nothing you do makes it last longer, and knowing that takes some of the fear out of the fear.
When to Get It Checked
If this is your first episode, if the symptoms are different from your usual pattern, or if there is chest pain, get medical attention rather than assuming panic. Get the physical causes ruled out once, properly, and then you can treat what is left as panic with some confidence.
If panic attacks are recurring, they respond well to treatment. Anxiety counseling at Just Mind is a reasonable place to start.
