The Panic Button
The exact cause is unknown but many Americans, especially women, suffer anxiety attacks.

By Mike Schwartz
The Press-Enterprise

Thousands of fun-seekers eagerly anticipate the opening of Disney's California Adventure Feb. 8.

Yet others dread the idea of going. The thought of traipsing around an amusement park -- or a sports stadium or shopping mall -- surrounded by thousands of strangers paralyzes them with fear.

Included in this group is Palm Springs resident Marilyn Gellis, who had her first major panic attack at The Happiest Place on Earth.

As she and a girlfriend strolled through Disneyland with their moms in tow, Gellis started thinking that both their fathers were dead.

"Then it hit me at (the ride) It's a Small World," recalls Gellis of that day in the 1970s. "I wondered what would happen if we all got wiped out right there. It was like a tape playing over and over in my mind."

Her friend's mother gave Gellis some Valium. Lying down at the Red Cross station for a half-hour also helped.

"But I was still shaky," says Gellis, a well-known authority on anxiety and panic disorders and founder of the Institute for Phobic Awareness in Palm Springs. "It was like suddenly getting the flu. I had no idea what it was. I felt completely isolated."

Sudden, paralyzing fears

Panic attacks, which involve a sudden surge of intense apprehension, fear or terror, affect about 1 in 75 Americans, according to the American Psychological Association.

Usually they come without warning for no obvious reason. But why would an amusement park, which many people enjoy, strike fear in someone?

"A lot of things are going on in a theme park," says Gene Berg, a clinical psychologist with the Inland Southern California Psychotherapy Association. "There's a thrill and anticipation, but also a degree of fear and anxiety about getting hurt. It can be overwhelming (to some)."

Many folks have difficulty dealing with everyday routines like shopping or getting to work, Berg says. "Going to a theme park can be a major concern for them. Just the idea of taking the freeway to Disneyland can stress them out."

Panic attacks can cause shortness of breath, chest pains, racing heartbeat, dizziness, nausea, sudden chills, choking or smothering sensations. Victims also fear of "going crazy" or losing control. Symptoms may be coupled with feelings of impending doom.

These are the body's classic adrenaline-charged "fight or flight" reactions. However, during a panic attack there is no actual physical threat.

Usually the feeling peaks within one or two minutes, then slowly ebbs. Most attacks last less than a half-hour, says Roger Tilton, director of the Cognitive Therapy Center of Riverside.

"The experience can be so intense people not infrequently rush to an emergency room thinking they're in some mortal danger even though there's no need," Tilton says.

Underlying any panic attack, Tilton says, are body sensations that victims mistakenly believe are dangerous. Amusement parks can be so exciting that over-anxious visitors misconstrue their physiological arousal as something threatening and the onset of an attack.

"Then they react with fear and panic," he says.

Intertwined risk factors

Terrifying as panic attacks are, they aren't dangerous in themselves. Although the exact causes aren't completely understood, researchers speculate panic attacks are triggered mainly by psychological factors, along with some intertwined biological influences.

Attacks usually begin during adolescence or early adulthood. Twice as many women as men experience anxiety, and the disorder seems to run in families. Studies of twins have shown there's a possible genetic predisposition to the disorder. All ethnic groups are at risk.

The problem often is associated with stressful, major life changes such as marriage, college graduation, having a first child or a death in the family.

About 30 percent of all adults experience at least one episode with symptoms resembling a panic attack. But psychiatrists define a true panic disorder as unexpected recurring attacks. Each is followed by a month or more of persistent worries about it happening again, having a heart attack or losing control.

Highly treatable disorder

Before treatment can begin, therapists must eliminate the possibility that attacks stem from some other mental disorder such as a social phobia (a fear of being humiliated in a social situation); the effects of a medication; drug abuse; too much caffeine; abnormal blood sugar levels or even exercise.

Because a budding panic problem may have a variety of causes it's important to see a mental health professional who is qualified to make a proper diagnosis, Gellis says.

Most people respond well to cognitive behavioral therapy, says Tilton. Antianxiety or antidepressant medications may help some patients, although Gellis terms prescription drugs a short-term "quick fix" providing mainly symptomatic relief.

Few patients require long-term psychotherapy.

"You don't need to figure out why your mother didn't love you when you were a baby," says Gellis. "You just need to learn how you'll handle things tommorrow."

Therapists try to help patients understand the nature of their panic attacks and that they're not alone, "going crazy" or on the verge of a heart attack, says Tilton.

Cognitive restructuring helps patients change the way they think by replacing negative thoughts about their attacks with more positive, realistic ones, he says.

The key is identifying situations, thoughts or other cues such as a racing pulse that may trigger an attack. Understanding the attack itself is distinct from whatever triggers it reduces that trigger's ability to spark an episode.

Gradually exposing patients to actual panic attack symptoms such as rapid heartbeat, dizziness or sweating in a safe setting also can teach them that these sensations don't always lead to an attack.

"Once people no longer believe that distressing body sensations are dangerous they stop having attacks," Tilton says.

Relaxation training can teach patients to "short-circuit" an attack by breathing more slowly so they don't hyperventilate.

The best advice psychotherapists can give people predisposed to panic attacks -- or anyone a little anxious about spending time in a crowded public place -- is to mellow out. Don't take it so darn seriously.

"The idea is to focus on having a good time rather than on your anxieties," says Tilton. "You're there not to survive but to have some fun."

Although most folks wish their day at an amusement park never will end, others find the excitement, sights and crowds overwhelming and stressful.

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Here are some key problems the anxiety-prone encounter:

Panic attack: A sudden surge of intense apprehension, fear or terror that usually comes without warning and for no obvious reason.

Acrophobia: A fear of heights.

Agoraphobia: A fear of going outdoors or to public places from which escape might be hard or embarrassing or where emergency aid might not be available.

Claustrophobia: A fear of confined spaces.

 

Published 1/30/2001