Defusing the Panic Button : Health: Anxiety is the most common mental health disorder in the U. S. Improved treatment techniques mean that up to 90% of those who seek help can overcome the problem.

It was a typical stressful situation--the kind experienced by people every day.

Brent, an artist, then age 40, was in rush-hour traffic on the San Diego Freeway heading north from Irvine with just enough time to make his son’s awards banquet in Los Alamitos. Traffic slid to a halt.

Brent remembers the scene vividly. Two large trucks towered on either side of his car. He heard a traffic report describing a 12-car pileup ahead. He would arrive late for the banquet. His foot, pressed to the brake pedal, began to numb. He was flooded by a sense of terror.

“I immediately went into a panic attack,” he says. “It was the same kind of fear as someone hopping into your car and holding a knife to your throat.”

He nudged his car over to the nearest exit--”I think people nearby could sense I was pretty frantic”--and found a telephone to call for help.

But, after 10 years of occasional panic attacks, inconclusive medical tests and psychiatric therapy, the incident led Brent to an expert in the treatment of anxiety, the most common type of mental health disorder in the United States.

Now he says, “Basically, I don’t have a problem. I recognize what it is.”

Improved techniques for treating anxiety disorders have made the success rate up to 90%, experts say.

Also encouraging, treatment can almost always be accomplished on an outpatient basis within a few months--a relatively short duration in psychological therapy.

“We have made progress to the point that, 25 years ago, we didn’t know anxiety disorders even existed,” says Dr. Lewis L. Judd, director of the National Institute of Mental Health. “Now we can diagnose it with a great deal of skill. We even have a sense about what areas of the brain (the disorder) comes from.”

Although the progress is cause for celebration, mental health officials say they have a long way to go to reduce the phenomenal number of Americans struggling with untreated anxiety disorders.

To bolster the field of treatment, NIMH will begin a public education campaign this fall to explain panic disorders and encourage individuals to seek help. The agency will also invest $40 million in anxiety disorders research this year, a fivefold increase from 1980.

And, next year, the National Institutes of Health will hold the first major conference on anxiety disorders with the goal of disseminating more information on the illnesses.

According to Judd, interest in anxiety disorders has soared because of several factors:

* The numbers: A NIMH study found 24 million Americans will suffer from an anxiety disorder at some point in their lives. Eight million are thought to have the problem at any one time. But less than 25% receive therapy due to the cost of treatment and lack of mental health insurance, misdiagnosis or the stigma of having a psychiatric illness.

* The severity: Experts were stunned by a study last fall showing that people with panic disorders were 18 times more likely to have attempted suicide or thought about it than people with no mental illness. The study, reported in the New England Journal of Medicine, found 20% of people with panic disorder and 12% of those with occasional panic attacks reported that they had attempted suicide at some time in their life.

* The variety of treatments: Since anxiety disorders were only distinguished as a separate disorder in 1986, many cases are still misdiagnosed. And, partially due to emerging research, therapists don’t agree on the best treatment approaches.

Anxiety disorders were not well understood until 1984, when an NIMH study found that they were far more prevalent than first thought, says Jerilyn Ross, president of the Anxiety Disorders Assn. of America.

“What they found, much to everyone’s surprise, is that anxiety disorder is the most common psychiatric problem in the United States,” she says. “Everyone was kind of shocked.”

Anxiety disorders include several types of phobias or specific fears, such as fear of being in crowds or fear of heights. Panic disorder--defined as having four or more panic attacks in a four-week period, at least one of which is unexpected--is considered a separate, related disorder. But panic attacks--which are characterized by a feeling of doom, with heart palpitations, sweating, shaking, shortness of breath--often accompany phobias.

Usually, those affected start to avoid places that might cause anxiety. This restricts normal activity and people become reclusive, Ross says. The disorders tend to affect more women than men, and usually occur among people ages 20 to 40 although anxiety disorders have been diagnosed in teen-agers and children. The illness tends to run in families.

But individuals are still misdiagnosed because they or their doctors don’t understand the symptoms, Ross says.

“Maybe they think they are having a heart attack and they go to the emergency room,” she says. “Then they are referred to a cardiologist. They might be sent to an endocrinologist. They might end up being told it’s just nerves. Or they are seen as being a hypochondriac. The average person has spent a minimum of eight to 12 years before they have a correct diagnosis.”

Some people don’t know where to go for help, Ross says.

Sherry, 28, from Colton, says her mistake was trying to keep her anxiety problem to herself.

The dental assistant was 19 when she experienced her first panic attack while driving. Reluctant to tell anyone, Sherry continued to experience the attacks until she suffered a panic attack so severe while driving home from work one day that she returned to the office and called her mother for help.

“I tried to handle it on my own for a couple of years,” she says. “The mistake I made was to be afraid to tell someone.”

Because everyone feels occasional anxiety, the public tends to trivialize anxiety disorders, Judd says.

“Anxiety, in its most benign sense, is part of the common human experience. We all have anxious moments in the course of a day. But what we’re talking about are highly specific mental disorders that cause dysfunction to the brain, are genetic in cause and manifest themselves in very specific kinds of disorders. Anxiety disorders create a serious amount of suffering and erosion of the quality of life.”

Little is known about the cause of anxiety disorders, although research suggests that both biological and environmental factors play a role, Ross says.

“(Experts) think it’s a genetic predisposition, usually (triggered) by a period of stress due to a change or separation,” she says. “We see the onset after a death in the family or a change of job. We think that a certain number of people are vulnerable, and given the right psychological environment, it will trigger a panic attack.”

In studies, chemicals that stimulate the nervous system, such as caffeine, can induce a panic attack in subjects who have a panic disorder while others remain uneffected, says Dr. Jack Gorman, a Columbia University researcher who is studying the biological basis for the abnormality.

“A common denominator appears to be that people with panic disorder are hypersensitive to anything that stimulates the nervous system,” Gorman says. “Their central nervous systems are triggered by less stress than the normal (person). But there seems to be evidence that these people experience more stress in their lives, too.”

It’s important to consider both the biological and environmental factors, says Jerry Kasdorf, a psychologist and director of PhobiaCarein Tustin, and the director of the new Anxiety and Mood Disorders Program at College Hospital in Costa Mesa.

“If someone looks at it totally biologically, it makes no sense to do anything about it,” he says. “But there are a number of contributing factors, and we try to get people to look at both environment and biology.”

The most popular treatment for anxiety disorders is desensitization, in which the patient is forced to repeatedly confront the object or situation that provokes fear. A person afraid of driving on freeways, for example, would eventually begin driving again as part of therapy.

A new technique requires that a patient also confront the body responses experienced during a panic attack, says Michelle Craske, an assistant professor in the department of psychology at the UCLA.

“Panic disorder is sudden rushes of fear or terror that often seem to come for no apparent reason. It doesn’t seem like they are coming from anywhere. That is (thought of) now as fear of one’s bodily sensations,” Craske says.

Patients fear the rapid heartbeat, sweaty palms and shaking that comes with an attack, Craske says. In treatment, therapists try to help patients adjust to their body sensations by having them deliberately hyperventilate or become dizzy.

“Then, if they did experience a mild fluctuation (in stress levels), as we all do, it wouldn’t bring on a major panic attack,” she says.

But other experts prefer a more gradual approach to confronting the panic.

“We try to educate people that your body will respond to this flood of hormones in a natural way,” Kasdorf says. “We identify it as non-dangerous and try to get them to focus elsewhere.”

Both approaches have high rates of success, Kasdorf says.

Medications are also used to treat people with more severe panic disorders, Ross says. Drugs can be particularly helpful in certain cases, such as obsessive-compulsive disorder, which is marked by repetitive, compulsive behavior to relieve anxiety. In January, the U.S. Food and Drug Administration approved the use of a drug, clomipramine, that appears to disrupt the compulsive urge.

According to Ross, most experts offer a variety of treatments, such as drugs and behavior modification.

While duration of treatment varies, most people complete therapy in 12 to 20 weeks at a cost of about $2,000, Ross says. Many therapists encourage patients to attend a support group once a week in addition to weekly private therapy.

They are also encouraged to practice techniques to cope with fear and to use relaxation to combat stresses that trigger panic attacks. Family members are asked to provide support.

For Sherry, the road back to good health involved climbing into her car and driving around the block, with her husband trailing her in another car and coaching her over a walkie-talkie.

Now Sherry is venturing farther from her home on her own.

“I’m going to beat this--definitely,” she says. “It’s going to take some time, and I’ll always have to work on my goals. But my circle gets bigger and bigger.”

“There are some people who completely get over it and are fine,” Ross says. “More commonly, people don’t completely get over it, but they still do fine.

“So much of what keeps it so bad is this terror about ‘What is wrong with me?’ Once somebody goes through treatment and they understand what’s going on--that it’s a spontaneous reaction based on genetic makeup and it’s not their fault--it’s OK.”