Panic at the desk — a 90-second CR protocol you can run in a meeting

A specific category of patient I see often: senior professionals whose first panic attacks land mid-meeting, mid-pitch or mid-board-call. Leaving the room is not always available. The protocol below is what we drill until it can be run silently, in any chair, with no equipment.

Seconds 0–10: Plant both feet flat on the floor. Press them down deliberately for three seconds; release. Seconds 10–40: Run six paced breaths — 4 seconds in through the nose, 7 seconds out through gently pursed lips. Keep your face still. The slow exhale is the part that triggers vagal braking; do not skip it. Seconds 40–60: Soften the jaw, the shoulders, the space between the eyebrows, in that order. Seconds 60–90: Widen your peripheral vision deliberately — without moving your eyes, notice the edges of the room. Then return your attention to the speaker.

The chemical wave of a panic spike peaks at roughly 90 seconds. If you can outlast the peak with regulation, the rest of the wave dissipates on its own.

Every component is internal. No visible breathing, no posture change, no hand gestures. The two visible components — soft jaw and peripheral vision — read to others as a person who is composed and listening, not a person who is dysregulating.

Within an hour, walk for 10 minutes and run a 4–7 breath cycle for 4 minutes. Discharge the residual adrenaline before it stacks. Make a note of the trigger pattern — what was being said, what the body did first, what the mind predicted. The next attack is much easier to pre-empt with that data.

If panic is happening more than once a fortnight, or if you have started to avoid certain meetings, take the GAD-7 on this site and please book a consultation. Panic disorder responds extremely well to a structured 8–12 week course of Cognitive Regulation, occasionally with short-term pharmacological support. Untreated, it generalises; treated, it usually clears.