She's not sure what would trigger her panic attacks--the racing heart, the sweaty palms, the dizziness. "To me," she said, "they just came out of the blue."
"I had a hard time breathing," recalled Tracy, who asked that her real name not be used. "I would hyperventilate, and I'd lose sensation in my hands and feet. My immediate thought was, for sure, I was going to die. I really thought I was going to pass out and stop breathing . . . Imagine the worst way you could ever feel, multiply it by 10, and that's what a panic attack was like."
Seated in a Costa Mesa restaurant, the attractive, outspoken 27-year-old graduate student in business administration was describing her year of living anxiously.
The panic attacks, which lasted from 30 seconds to a minute, hit once every couple of days in the beginning. Then they began occurring four or five times a day. Finally, Tracy said, she reached the point where she was afraid to be alone.
"I wouldn't drive anyplace or go anyplace by myself," she said. "I became totally dependent on my boyfriend. I had to give up all the things I love--backpacking and hiking. I've always liked being by myself, but I couldn't be by myself."
And even when she wasn't experiencing panic attacks, there was little respite: "I was," Tracy said, "anxious all the time."
Anxiety--in all its sweaty-palmed, light-headed, stomach-churning ignominy--has been deemed the No. 1 mental health problem in the United States by the National Institute of Mental Health. A recent NIMH survey shows that 8% of Americans suffer from anxiety disorders--an array of problems that includes generalized anxiety, panic attacks, phobias such as agoraphobia (an abnormal fear of open or public places), post-traumatic stress disorder, and obsessive-compulsive disorder.
In recent years, researchers have begun to focus on biological answers for anxiety disorders--some people may simply have "anxious genes"--and many anxious individuals have sought relief in a variety of anti-anxiety drugs.
Others, however, are finding a more natural way to overcome anxiety's hammerlock hold on their ability to lead a normal life.
It's called cognitive therapy--an approach to treatment that emphasizes the role cognition, or thinking, plays in anxiety disorders.
Simply put, cognitive therapy takes the view that anxiety is an emotional response to the thought that something terrible is going to happen: Anxious people tend to overestimate the degree of real dangers--or see dangers that do not exist--and underestimate their ability to cope with them.
Mary, a 26-year-old hospital admissions counselor from Costa Mesa, has had a lifelong fear of flying. Her anxiety had been manageable until last Thanksgiving when she flew to Philadelphia. On the way, the plane developed engine trouble and had to land in Indianapolis for repairs.
"That really kind of blew it off the roof for me," said Mary. "After taking off again, I was just sure that with every little noise I heard we were crashing. I'd look at the stewardess to see if she was worried. If she was not smiling, I'd think, 'Oh, oh.' It (her anxiety) didn't show on the outside, but inside . . . my heart was beating real fast, my mouth was dry and my hands would sweat . . . I couldn't talk and I was white-knuckling it all the way there."
Once the fear reaction starts, cognitive therapists say, it usually builds on itself. In the months that followed Mary's Thanksgiving flight, for example, she said, "any time someone even mentioned flying I'd get very anxious."
"Anxiety is a signal of danger, just like an alarm," says Dr. Aaron T. Beck, the 64-year-old founding father of cognitive therapy. "But the problem is people often will react to false alarms as though these are true alarms, so we have to teach them to discriminate between false and real alarms. We don't want them to react to a minor danger as though it's a major danger and just fall apart."
Cognitive therapy, Beck said, "is helping people to first think more realistically about the threats that they perceive. And, secondly, it helps them to cope more successfully with the inevitable anxiety that people experience."
The approach--which is also referred to as cognitive-behavioral therapy because it uses the behavioral therapy method of gradually exposing persons to the situations they fear--focuses on having anxious individuals examine their fear-producing thoughts and beliefs, and in correcting their erroneous or exaggerated thinking, they lessen or eliminate their anxiety.
It may take as few as 15-20 weeks to treat a normal anxiety such as a salesman who has started having panic attacks whenever he calls on a customer, say cognitive therapists. For more complicated cases such as a woman who had suffered panic attacks for more than 40 years and would only leave her home if her husband was with her, treatment may last from one to three years.