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Brewing Trouble

Coffee-induced anxiety.
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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."

If patients ending treatment announce they still don't intend to drink coffee, Schmidt knows they haven't overcome their unfounded fear. So there's one more test they must pass. He tells them to down a triple espresso without triggering a panic attack.

Says Schmidt: "We call it the 'Starbucks challenge.' "

Rebecca A. Clay is a writer based in Washington, D.C., whose articles have also appeared in Psychology Today, Modern Maturity, and The Washington Post.

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