Going back to work after panic attacks: a step-by-step return ladder
After a panic attack at work, the building, your desk or even the commute can start to feel dangerous. This example ladder has fourteen steps, from picturing your arrival to a full, busy week. It is a starting point: fit it around any return plan you have agreed with your doctor or employer, and rate each step yourself. Repeat a step until you have tested what you feared would happen.
Going back to work
Easiest first. The suggested steps, their order, times and distances, and the fear numbers are illustrative examples, not a tested program. Rate each step yourself from 0 (no fear) to 100 (the most afraid you can imagine), change the wording to fit your life, and add your own steps.
Picture your workday for 5 minutes, from leaving home to sitting down at your desk or station.
Travel your usual route to work on a day off, stop outside the building for 5 minutes, then go home.
Meet a friendly colleague for coffee near work, outside working hours.
Start here — uncomfortable but doable
Walk into the lobby or reception, stay for 10 minutes, then leave.
Go to your desk or station before most people arrive and stay for 30 minutes.
Work a half day at a quiet time, using only your usual breaks.
Work a half day at the busiest time, with colleagues all around you.
Go into the room or area where the panic attack happened and stay for 10 minutes.
Do an ordinary task in that same area, such as a meeting or your lunch break.
Work a full day without leaving early to "be safe".
Do the task you were doing when the panic started, such as a call, a meeting or a shift at the till.
Travel to work at rush hour, the way you did before you stopped going in.
Work a full week on your normal schedule.
Get through a high-pressure day, like a deadline or a packed shift, and stay to the end.
Keep your ladder
Stay safe while you practice
- If you feel chest pain, pain spreading to your arm or jaw, or you faint, stop and call 911.
- Don't practice after alcohol, cannabis, or medication that makes you drowsy.
- If your fear goes above 80 and stays there, stop safely, breathe out slowly, and pick a lower step next time. Stopping is not failing.
- If a panic attack starts, get somewhere safe first, then use the free Panic Reset. If you are driving, pull over and park where it is safe to do so: after a tunnel or bridge, never inside or on it.
- Keep taking any medication as prescribed. Talk to your prescriber before changing anything.
- If you are on medical leave, do not use this ladder to return earlier than your doctor and employer have agreed.
- If your job involves driving, heights or machinery, ask your doctor whether it is safe before you go back to those tasks.
A self-help tool. Not a medical device or a substitute for professional care.
Why going back to work can trigger panic
A panic attack at work links the fear to a place you have to return to every day. NIMH describes how people can develop an intense worry about when the next attack will happen and start avoiding the places where attacks happened before. For many, the fear is not only the attack itself but having it again in front of colleagues or a manager.
Work is also hard to leave. There are meetings you cannot walk out of, shifts that run for hours, a commute that may feel far from home, and people watching. The Job Accommodation Network notes that triggers at work vary, and can include crowds, enclosed spaces, sudden changes to routine or confrontational situations.
Every day away can make the next one harder. Staying home, or leaving the moment you feel anxious, brings relief, and teaches you that you only got through because you escaped. Going back in planned steps, and staying for the part you planned, is how you find out what happens when you do not leave.
Predictions people make about going back to work
Before an exposure, it helps to name what you expect to happen. Here are some predictions you might recognize:
- •“I'll have another panic attack at my desk and everyone will see”
- •“My manager will decide I am not up to the job anymore”
- •“Colleagues will ask why I was away and I will not know what to say”
- •“I'll be stuck in a long meeting or shift with no way to leave”
- •“I will get halfway there and have to turn back”
- •“Being back in that same room will set the panic off again”
Safety behaviors that keep the fear of going back to work going
Safety behaviors give quick relief, but they convince the brain that you only survived because of the crutch. As you move up your ladder, aim to drop them gradually. Only drop what anxiety adds; anything that genuinely keeps you or others safe stays:
- 1Calling in sick on days that feel risky, even when you are physically well
- 2Sitting where you can slip out unseen, and planning an exit from every room
- 3Leaving early the moment you feel the first sign of anxiety
- 4Avoiding the room or floor where the panic attack happened
- 5Asking a colleague again and again whether you seem all right
- 6Only going in on quiet days, or only when a trusted colleague is there
- 7Keeping your phone in your hand all day in case you need to call someone
Tips for going back to work
- If you are on leave, agree the order of your steps with your doctor and employer. Steps 1 to 3 need no one else's permission; the rest depend on your workplace and any return plan you have agreed.
- Prepare one short answer for "Where have you been?", such as "I was out for health reasons, and I'm glad to be back." Deciding it once is preparation; you owe no one more detail.
- Before each step, write your prediction in one line, such as "I will have to leave within an hour." Afterwards, write what happened. A step counts even if you felt anxious the whole time.
- Going back gets harder in different ways: hours on site, how busy it is, the room where the panic happened, the commute, the task you were doing. This ladder climbs mostly by time and by that room. If the commute is the hard part, a driving or subway ladder may fit better.
- An adjustment such as a later start or a place to take a short break is not a failure. If you use one as a bridge, you can add a step beyond it later, when you feel ready.
When to get professional care
Self-help ladders are helpful for manageable avoidance, but some situations call for professional evaluation and support:
- •No doctor has looked at your symptoms yet, or panic attacks come often, out of the blue or away from work as well. The NHS suggests seeing a GP if you have been having symptoms of panic disorder.
- •You have been off work for weeks and even the first steps feel impossible. A systematic review found that CBT focused on getting back to work helped people with mild to moderate mental health conditions return; ask a doctor or therapist about it.
- •The panic started because of a real problem at work, such as bullying, harassment or an unmanageable workload. Practice will not fix that; talk to HR, a union representative or another trusted person.
- •You feel low or hopeless as well as anxious. If you ever think about ending your life, call or text 988 in the US.
Questions about going back to work
Should I go home after a panic attack at work?
Sometimes rest is what you need. The Job Accommodation Network notes that panic attacks can be physically exhausting, and that some people need to leave work, or stay home for the day, to recover. The NHS says attacks are not dangerous and that most last between 5 and 20 minutes. If you can, take a short break somewhere quiet, then decide. Going home to rest is not a failure; before you leave, pick a small next step back.
Do I have to tell my employer why I was off?
The EEOC says that in most situations you can keep a health condition private. If you ask for a reasonable accommodation, your employer may ask medical questions and must keep the answers confidential, even from co-workers. What you tell colleagues is up to you; a short, true sentence is usually enough.
Can I ask to come back gradually?
You can ask. The EEOC gives altered break and work schedules and permission to work from home as examples of reasonable accommodations, and says to tell a supervisor, HR manager or other appropriate person that you need a change at work because of a medical condition. The Job Accommodation Network describes a temporary flexible break schedule and temporary telework for an employee with panic attacks. These rights come from the ADA, which covers employers with 15 or more employees and conditions that substantially limit everyday activities; the EEOC says many mental health conditions qualify.
What if I have another panic attack on my first day back?
It can happen, and it does not mean the plan has failed. Stay where you are if possible, breathe slowly, and remind yourself that it will pass, as the NHS suggests. Then rate your fear and note what happened around you. Next time, repeat the same step, or drop one step lower if it felt far too hard; there is no need to start again from the bottom.
- •Panic Disorder: What You Need to Know (National Institute of Mental Health (NIMH))
- •Panic Attacks, They Don't Always Wait Until After Hours (Job Accommodation Network (JAN))
- •Depression, PTSD, & Other Mental Health Conditions in the Workplace: Your Legal Rights (U.S. Equal Employment Opportunity Commission (EEOC))
- •Facts About the Americans with Disabilities Act (U.S. Equal Employment Opportunity Commission (EEOC))
- •Defining work-focused cognitive behavioural therapy (W-CBT) and whether it is effective at facilitating return to work for people experiencing mental health conditions: A systematic review and narrative synthesis (Health Psychology Open)
- •Panic disorder (NHS)
- •Maximizing exposure therapy: an inhibitory learning approach (Behaviour Research and Therapy)
A self-help tool. Not a medical device or a substitute for professional care.
Take your ladder with you
We're building a companion mobile app that keeps your ladder and practice log on your phone, so you can record each practice once you're done.
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