Progress in treating panic disorder

By JESSIE MILLIGAN

Fort Worth Star-Telegram

She was anxious. Her heart rate increased. That frightened her, and the more scared she became, the more her heart raced. Before long, she was running down the dark alleys of her own fears. That's what it feels like inside the jagged edges of what we now know to be panic attacks, says Clark Vinson, the therapist who eventually treated the Texas woman at the Arlington-based Phobia Center of Dallas/Fort Worth.

But back then, 20 years ago, panic attacks weren't so well understood. The woman went through 64 electroshock treatments, and then sought Vinson's help.

''What we needed to do was treat her reaction to her own fear,'' Vinson says.

Doctors, therapists and the public have made great leaps in the understanding of panic attacks in the last two decades.

Everybody's favorite mob boss, HBO's Tony Soprano, suffered from panic attacks. Willard Scott has said he succumbed to them while readying his weather reports for the ''Today'' show. Nicole Kidman has said she has been hit with them before stepping out on the red carpet.

About 2 percent to 5 percent of Americans will have repeated panic attacks throughout their lives. Mental health specialists say that percentage is ''not'' increasing, and a study funded by the National Institute of Mental Health, and released last year, showed not even the terrorist attacks of 2001 boosted the rate of the nation's anxiety disorders.

Yet despite celebrity confessions and public awareness, the same study found the average sufferer waits 10 years before seeking help.

''Panic disorder is highly treatable,'' says Dr. Sanjay J. Mathew, an assistant professor of psychiatry at Mount Sinai Medical Center in New York City. Behavioral therapy and antidepressants are the most common treatments.

Panic begins in the neurotransmitter systems of the brain, Mathew says. Some of those systems, such as those that control adrenalin, are overactive. Others, such as the ones that work to slow down fight-or-flight instincts, are underactive.

Panic disorders can be inherited, Mathew says.

That lends credence to the claims of New Kids on the Block stars Jonathan and Jordan Knight, who told Oprah a few years back that they inherited their panic disorder from their father.

In the world of behavioral therapists, however, panic attacks begin and end not with brain chemicals but with thoughts and actions.

Therapists say particular types of people are most prone to panic attacks. Perfectionists and overachievers are more likely to have anxiety overflow.

No matter what causes panic attacks, doctors and therapists agree that the real trouble starts after the first panic attack. Singer Carly Simon once confessed not only to panic attacks but also to a secondary and just as crippling fear, the fear of more panic attacks.

A fear of an attack returning can cause the development of other phobias, such as performance anxiety, claustrophobia or the fear of the outdoors.

''I've talked to people who won't go to the dentist or go get their hair cut because they don't want to have a panic attack in a place where they cannot easily flee,'' says Margaret Summy, a Fort Worth therapist.

Often, those people assume their fear is of the dentist or of the hairstylist.

''That's not it,'' Summy says. ''After the first attack, they start analyzing it and say, 'I'm not going to do that again.' ''

One West Texas woman whom Vinson treated had refused to leave her house without her husband for 11 years, so fearful was she that another panic attack would occur.

She told Vinson that one day she left the house by herself and tried to spark another panic attack.

''You can't have one when you want to,'' he told her. ''You have to fear it or it won't appear.''

The woman has since left the house by herself.

One of the most common things sufferers say about panic attacks is: ''It came out of the blue.''

''It doesn't come out of the blue,'' Vinson says.

Often, people don't recognize the degree of anxiety that they live with daily. Left untended, it can lurk below the surface until finally we notice a physiological effect of the stress, such as a heightened heart rate. Then the fear starts.

People suffering panic attacks often visit emergency rooms and eventually undergo thousands of dollars worth of tests before realizing that their heart is not the problem.

Therapists focus on other behavioral changes, including ones that are simple and effective.

''In general, when a panic attack is coming on, the best thing to do is slow down,'' says Vinson. ''Walk more slowly, talk more slowly, breathe more slowly.''

Breath control is key in the therapy provided by Summy.

''People who have panic attacks hold their breath and are not aware of it,'' Summy says.

That lack of smooth breathing is associated with anxiety.

''Imagine what would happen if someone threw a rattlesnake in a room. Now imagine that in slow motion. The first thing people do is quit breathing.''

It is during that gasp, that breathless moment, that people decide to fight or flee.

Even when the rattlesnake isn't in the room, we subtly reinforce fight-or-flight instincts when we do not breathe smoothly, Summy says.

Treatment begins that simply, and few would argue that the electroshock of two decades past is a better way to go.