By William J. Cromie

Gazette Staff

A brief questionnaire can identify people at highest risk for experiencing panic attacks, psychologists at Harvard and elsewhere have found. Called the Anxiety Sensitivity Index, this questionnaire asks people to rate their fear of such anxiety symptoms as rapid heartbeat, shortness of breath, nervousness, and even stomach growling.

The index measures not anxiety, but a person's fear of these anxiety-related symptoms. Just as people vary in their proneness to feel anxious, so they differ in their fear of feeling anxious -- their anxiety sensitivity.

"People with low sensitivity regard symptoms like a rapid heart rate as unpleasant but not much to worry about," says Richard McNally, professor of psychology. "But those with high anxiety sensitivity respond with alarm, often fearing they may be having a heart attack."

People who worry about what they think will happen -- fear of fear -- aren't mentally ill but they are at increased risk for panic attacks.

These attacks are sudden, unpredictable bursts of fear. Victims experience rapid heart rate, breathlessness, and may think they are about to lose control, faint, or even die. An estimated 20 million to 50 million people in the U.S. alone are affected.

Some of these people go on to develop panic disorder, that is, recurring attacks coupled with a persistent dread of panic. People who suffer from the disorder may severely restrict what they do and where they go to the point where they can't leave their homes. An estimated 6 million to 10 million Americans suffer from this problem.

Hypersensitivity to anxiety can be successfully treated with what is known as cognitive-behavioral therapy, which reduces fear by correcting unreasonable ideas about the meaning of body sensations like breathlessness. Those in the grip of panic disorder can be treated with cognitive-behavioral therapy or drugs. Once people start either treatment, the index questionnaire, in conjunction with other tests, can be used to judge the success of the therapy by measuring reductions in anxiety sensitivity.

Fear of Fear Itself

McNally and Steven Reiss of Ohio State University first proposed a link between angst sensitivity and panic attacks in 1985. McNally latter demonstrated the connection by conducting laboratory experiments in which he gave subjects harmless "respiratory challenges" that produced shortness of breath.

"People with high anxiety sensitivity but no history of panic attacks responded just like people with panic disorder," he notes. "This suggests that elevated anxiety sensitivity constitutes a psychological risk factor for the disorder."

McNally's colleagues confirmed these results with tests in a real-world situation. A team at the Uniformed Services University of the Health Sciences in Maryland measured anxiety sensitivity in 1,172 cadets at the Air Force Academy. Cadets with the highest scores on the questionnaire were more than six times more likely to have spontaneous panic attacks during five weeks of basic training than those with the lowest scores. A total of 152 highly anxious cadets panicked compared to only 23 of those at the bottom of their anxiety sensitivity class.

"People going into high stress situations, such as military combat or flying an airplane, may want their anxiety sensitivity assessed so that it can be reduced through cognitive and behavioral training," said psychologist Norman Schmidt, who led the study.

Presumably, the test could be used to check anyone applying for a stressful position. It has not been used in this manner, and McNally maintains that it should not be given to weed out job candidates but to help employers get employees' anxieties under better control.

"People with high anxiety sensitivity are not doomed to develop panic disorder," he points out. "Such a temperament is only one risk factor, albeit an important one, for panic. These people are psychologically healthy, but they can profit from training that corrects misperceptions about bodily symptoms."

Preventing angst sensitivity from blowing up into panic could also save health-services dollars. Anxiety drives people into emergency rooms in fear of nonexistent heart attacks or brain tumors and it results in some people going from doctor to doctor thinking something is physically wrong with them.

Memories of the Worst Times

McNally and his colleagues have also used the anxiety sensitivity index to identify memory and attention preferences that might underlie the tendency of panic patients to react with terror in certain situations.

These experiments show that people with panic disorder attend more to threatening than nonthreatening information. And they recall frightening memories more readily than pleasant ones. McNally wants to determine whether these abnormalities, like high scores on the sensitivity index, can predict the development of panic.

There are no results to report yet, but McNally sees the research as another way to understand how the minds of anxious and panicky people work.

"Cognitive-behavioral treatments for panic disorder aim to reduce anxiety sensitivity in order to prevent recurrence of panic attacks," McNally explains. "Corrections of misconceptions about the harmfulness of anxiety symptoms, and blunting fears of these symptoms, alleviates panic attacks in 80 to 90 percent of patients. For those who have not yet developed the disorder, treatments that reduce fear of anxiety make it less likely that people will panic in response to stress-related anxiety in everyday life."