The inverse relationship
As anxiety rises, everything you offer gets smaller. Sentences get shorter. Your voice gets lower and slower. Choices get fewer — two, not five. Your physical presence gets steadier and closer. The one thing that gets bigger is how long you stay.
Physiology is the script. When a person says “I feel like I am dying,” they are reporting a real catecholamine surge, not exaggerating. Say what you see: “Your heart is racing and your hands are shaking. That is adrenaline. It is intensely unpleasant and it is not dangerous. Breathe out with me, longer than you breathe in.” Explanation plus a paced exhale does more in ninety seconds than reassurance ever does.
Anxiety is a diagnosis of exclusion. Chest pain, breathlessness and doom at severe or panic level are also the presentation of an infarction, a pulmonary embolism, hypoglycaemia and thyrotoxicosis. Grade the level, calm the person, and still take the vital signs.