I am hanging out with a group of my friends before a Dave Matthews Band concert, four years ago. We are sitting around, drinking beer and playing games. It is a perfect fall day; the air is crisp and full of excitement and anticipation. Music is playing and we are having a great time. But then, out of nowhere, I am on a roller coaster. My head starts spinning faster and faster. I clench my teeth. Sweat beads form on my brow. I feel like I am having a heart attack.

My friends stand around me, still talking and laughing, unaware that I am exploding from the inside. I want to take myself out of the party, to get into my car and drive until I am safe in my bed. But my legs feel frozen and my body too stiff and frightened to move. Even the crisp, white cotton sheets, fluffy mattress and familiar sights and smells of my house seem too hard to reach. I feel as if something bad will happen if I move out of this stance and try to go home, but something even worse will happen if I continue standing in this spot.

Although I don’t know it yet, I am having a panic attack.

These days, I wake up every morning to a nice buffet of pharmaceuticals and go through my day with a slight fear of an attack residing in the back of my head. Panic — and more specifically, the fear of panic that leads to my phobias — will always be an unwanted friend.

And I’m not the only one.

A survey conducted by the National Institute of Mental Health found that six million adults 18 or older have panic disorder, which is related to panic attacks. Twice as many women as men suffer from the disorder.

What is a panic attack?

The Merriam-Webster Medical Dictionary defines it this way: An episode of intense fear or apprehension that is of sudden onset and may occur for no apparent reason or as a reaction to an identifiable triggering stimulus

Stephanie Koch, 2009 graduate, says her attacks began on a day right before a big test. She was a sophomore, sitting in her dorm room studying, when all of a sudden she started shaking and crying.

“I didn’t know what was happening it me. That was the most terrifying part,” Koch says. “I was light-headed, my heart was racing and I failed my test.”

What Koch didn’t know was that her fight-or-flight instinct was being signaled for no apparent reason.

David Holmes, professor of psychology, explains that the fight-or-flight response usually only emerges in life-threatening situations. When the fight-or-flight instinct goes off, many people feel as if they are going to die. For example, if a big bear jumped out in front of you, how would your body respond? Normally one will go into panic mode and the body will put up a defense mechanism. Now, imagine that same response happening, but out of the blue — no scary bear. It is terrifying and strange and people go to various lengths to avoid such attacks.

Panic sufferers often fear that these attacks will occur in front of others and that there will be no escaping. As a result, the majority of panic sufferers will be diagnosed with agoraphobia, a fear of crowds or large, open spaces. “Because panic attacks are so terrifying, some people who suffer from them stay home where they feel safe and where they won’t embarrass themselves if they have an attack,” Holmes says.

Why do we panic?

Panic disorder can be placed into three different categories based on the body’s reaction: cognitive, stress-triggered and physiological. Most people who suffer from panic attacks will suffer from all three of these reactions.

The cognitive approach, according to Holmes, is when an individual misinterprets some minor physical symptom as a sign of something more serious. A person could be sitting in a car, for instance, when out of nowhere his or her heart begins to pound faster. He or she starts believing that he or she is having a heart attack and the fight-or-flight instinct kicks in, sending the mind into hyper-drive.

Holmes also emphasizes the fact that individuals who respond to everyday situations with high levels of stress typically are more inclined to suffer from panic disorder. Usually this happens because a person tends to dwell on the unimportant and the more a person dwells, the more they seem to panic. Many cognitive therapists, Holmes says, have suggested that individuals who respond to any type of situation — even those that are not particularly stressful — with high levels of stress do so because they have a physical pre-disposition to over-respond. Many people who suffer from panic attacks do so because it runs in their family. More than likely it is passed down from the mother or father, or an aunt, uncle or grandparent.

The physiological reaction is related to an overly sensitive respiratory system. Holmes says people who suffer from panic attacks have overly sensitive respiratory control systems. The respiratory control system controls breathing, and tells your brain you need more oxygen when carbon dioxide levels are too high in your body. So, when you have high levels of carbon dioxide, the centers in your brain don’t just send a message saying, “Hey, you need a little more oxygen; take a deep breath.” Instead, the centers over-respond and essentially send a message that says, “YOU’RE SUFFOCATING!” So you panic.

What are the treatments?

Treatments for panic disorder are highly successful in helping people cope, however there is still no exact cure. The main treatments focus around therapy, behavioral modification and medication.

Many psychologists use this approach by employing a type of therapy known as cognitive therapy.

Anne Owen, a Lawrence psychologist who specializes in treating people with panic disorder, treats patients using this cognitive approach. Owen explains that her first approach is to “provide education about the biological response and to normalize what is actually occurring in their mind.” That is, when the fight-or-flight instinct goes off, people need to learn this is simply what the body does. Her second approach is to teach patients to stop being frightened by the body’s systems. In doing so, she encourages her patients to confront situations that may cause a panic attack. She wants people to go to places they might fear, while staying aware of what’s happening in their bodies.

Awareness of the body’s behavior and the ability to modify its reactions are goals of panic-disorder treatment. Many therapists work with people to help with overactive body reactions. Jeff Lewis, a licensed specialist clinical social worker in Lawrence, works with a certain type of therapy for patients called biofeedback. Biofeedback is a study of a person’s electrodermal response (EDR). EDR is a measure of the skin’s response to stress. Lewis hooks up sensors to certain areas of the body that hide stress — normally the hands and sometimes the neck. If the places are cold, there is more of a chance that a person is anxious. The sensors attached to the stress-triggered areas then send the body a sensation that decreases the panic arousal. All the while, the patient is able to watch their levels of stress decrease on a computer screen. Lewis explains it like somebody looking into a mirror: “If you want to make changes, you have to see what you have to change first. You are able to see on a screen what you are changing when working with biofeedback.”

Medication, another part of panic-disorder therapy, comes in many different forms depending on one’s type of anxiety. Patients often have to try out a few before they can find the perfect one that will help their anxiety. Typically, patients who suffer from panic disorder are prescribed to a type of selective serotonin reuptake inhibitor (SSRI), such as Prozac, Zoloft or Paxil. These anti-depressants are used to level out the serotonin in the patient’s brain, which helps increase its “relaxation response.” These types of medicine, however, typically take about three weeks to set in. They have to get into the body’s system, and evenly distribute throughout one’s blood stream.

In the meantime, there are other forms of medication known as benzodiazepines, such as Xanax, Valium, Ativan or Klonopin. These medications are great if you need a “quick fix” or are having a panic attack and need to calm down. Owens warns, however, that they are highly addictive and easily abused. They have a lifespan of about two hours and are easy to abuse because one’s body will get used to them.

Koch says that her general anxiety grew a lot after her first attack and she still occasionally suffers from them. However, she has been seeing a nurse practitioner and taking medication and is becoming aware of what is actually occurring in her mind. She says that she has good days and some bad days. The bad days are still terrifying.

Along with Koch, I am taking medication. My doctor has given me Zoloft, and I have learned to cope very well.

Becoming aware of what is happening in my mind has helped me deal with my disorder. Yes, from time to time I will have a panic attack — probably half the time very discreetly. Regardless, I have come a long way since my first attack. It’s been about four years now, and that big red panic button … well, let’s just say it now collects dust.