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Health & Balance

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Brewing Trouble

Coffee-induced anxiety.

Runaway Anxiety continued...

Drink more coffee than you're accustomed to, however, and that same stimulant can cause the jitters. And in people predisposed to anxiety disorders, caffeine can trigger a spiral of sensations -- sweaty palms, a pounding heart, ringing in the ears -- that leads to a full-blown panic attack.

What makes some of us feel panic while others feel pleasantly alert? Susceptible people experience caffeine's effects as signs of impending doom. Once that happens, anxiety can take on a life of its own. While many give up coffee, others give up whatever they were doing when struck by caffeine's disturbing side effects. Someone who downs coffee at breakfast and then hops on the freeway to work, for example, may attribute feelings of panic to rush-hour traffic rather than to caffeine.

No-Doz Cocktails

To help people with panic and related anxiety disorders, psychologists typically ask patients to taper their caffeine use while they learn how to respond appropriately to their own physiological reactions. At the Center for Stress and Anxiety Disorders in Albany, N.Y., psychologist John Forsyth, PhD, uses an approach known as cognitive-behavioral therapy. Gradually, patients learn to interpret their symptoms. A fast-beating heart, they discover, is the body's normal reaction to a stimulant like caffeine -- not a sign of an impending heart attack.

But not all psychologists think that avoiding caffeine is a long-term cure. Norman Schmidt, an associate professor of psychology at Ohio State University, is one who actually prescribes coffee as part of treatment. The goal? To help patients confront their fears head-on and learn to distinguish unfounded panic from a real threat.

After teaching patients to recognize caffeine's effects, Schmidt has them desensitize themselves by gradually increasing their consumption of caffeine over the course of a month or two. Patients start with sips of soda, then work up to a cup of coffee.

The final exam? A strong cup of coffee spiked with No-Doz. "They don't feel great, but they learn they can have these feelings and nothing terrible happens," says Schmidt. "We could tell them that over and over again, but they've got to know it in their gut."

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