This spring, thousands of fun-seekers will flock to amusement parks, baseball games and a multitude of other outdoor events to shake the winter doldrums.
Yet others dread the idea of going to such places. The thought of traipsing through an amusement park or a sports stadium or shopping mall surrounded by thousands of strangers paralyzes them with fear.
Included in this group is Palm Springs, Calif., resident Marilyn Gellis, who had her first major panic attack at The Happiest Place on Earth.
As she and a girlfriend strolled through Disneyland with their moms in tow, Gellis started thinking that both their fathers were dead.
"Then it hit me at (the ride) It's a Small World," recalls Gellis of that day in the 1970s. "I wondered what would happen if we all got wiped out right there. It was like a tape playing over and over in my mind."
Her friend's mother gave Gellis some Valium. Resting at the Red Cross station for a half-hour also helped.
"But I was still shaky," says Gellis, now a well-known authority on anxiety and panic disorders and founder of the Institute for Phobic Awareness in Palm Springs. "It was like suddenly getting the flu. I had no idea what it was. I felt completely isolated."
Panic attacks which involve a sudden surge of intense apprehension, fear or terror affect about one in 75 Americans, according to the American Psychological Assn.
Usually they come without warning, for no obvious reason. But why would an amusement park, which many people enjoy, strike fear in someone?
"A lot of things are going on in a theme park," says Gene Berg, a clinical psychologist with the Inland Southern California Psychotherapy Assn.
"There's a thrill and anticipation, but also a degree of fear and anxiety about getting hurt. It can be overwhelming (to some)."
Many folks have difficulty dealing with everyday routines like shopping or getting to work, Berg says.
"Going to a theme park can be a major concern for them. Just the idea of taking the freeway to Disneyland can stress them out."
Panic attacks can cause shortness of breath, chest pains, racing heartbeat, dizziness, nausea, sudden chills, choking or smothering sensations. Victims also fear of "going crazy" or losing control. Symptoms may be coupled with feelings of impending doom.
These are the body's classic adrenaline-charged "fight or flight" reactions. However, during a panic attack there is no actual physical threat.
Usually the feeling peaks within one or two minutes, then slowly ebbs. Most attacks last less than a half-hour, says Roger Tilton, director of the Cognitive Therapy Center of Riverside, Calif.
"The experience can be so intense people not infrequently rush to an emergency room thinking they're in some mortal danger even though there's no need," Tilton says.
Underlying any panic attack, Tilton says, are body sensations that victims mistakenly believe are dangerous. Amusement parks can be so exciting that overanxious visitors misconstrue their physiological arousal as something threatening and the onset of an attack.
"Then they react with fear and panic," he says.
Terrifying as panic attacks are, they aren't dangerous in themselves. Although the exact causes aren't completely understood, researchers speculate panic attacks are triggered mainly by psychological factors, along with some intertwined biological influences.
Attacks usually begin during adolescence or early adulthood. Twice as many women as men experience anxiety, and the disorder seems to run in families. Studies of twins have shown there's a possible genetic predisposition to the disorder. All ethnic groups are at risk.
The problem often is associated with stressful major life changes such as marriage, college graduation, having a first child or a death in the family.
About 30 percent of all adults experience at least one episode with symptoms resembling a panic attack. But psychiatrists define a true panic disorder as unexpected recurring attacks. Each is followed by a month or more of persistent worries about it happening again, having a heart attack or losing control.
Before treatment can begin, therapists must eliminate the possibility that attacks stem from some other mental disorder such as a social phobia (a fear of being humiliated in a social situation); the effects of a medication; drug abuse; too much caffeine; abnormal blood sugar levels or even exercise.
Because a budding panic problem may have a variety of causes, it's important to see a mental health professional who is qualified to make a proper diagnosis, Gellis says.
Most people respond well to cognitive behavioral therapy, Tilton says. Anti-anxiety or anti-depressant medications may help some patients, although Gellis terms prescription drugs a short-term "quick fix" providing mainly symptomatic relief.
Few patients require long-term psychotherapy.
"You don't need to figure out why your mother didn't love you when you were a baby," Gellis says. "You just need to learn how you'll handle things tomorrow."
Therapists try to help patients understand the nature of their panic attacks and that they're not alone, "going crazy" or on the verge of a heart attack, Tilton says.
The key is identifying situations, thoughts or other cues such as a racing pulse that may trigger an attack.
Understanding that the attack itself is distinct from whatever triggers it reduces that trigger's ability to spark an episode.
"Once people no longer believe that distressing body sensations are dangerous, they stop having attacks," Tilton says.
The best advice psychotherapists can give people predisposed to panic attacks or anyone a little anxious about spending time in a crowded public place is to mellow out. Don't take it so darn seriously.
"The idea is to focus on having a good time rather than on your anxieties," Tilton says. "You're there not to survive but to have some fun."