Wednesday June 7, 2000 THE OAKVILLE BEAVER B5 Coping w ith anxiety,phobia By Barb Joy SPECIAL TO THE BEAVER Ever wonder why the man sitting beside you on the air plane never got up to go to the bathroom? M aybe his kidneys were in excellent shape, Or maybe he was suffering from a social phobia. "Fear o f going to the bath room is very common in social phobias," said Dr. Nabil Philips, a Credit Valley Hospital special ist in anxiety, panic and phobia disorders who spoke to mental health professionals and others at a recent seminar presented by the Canadian M ental H ealth Association, Halton, and Halton Healthcare Services. "I know o f people who drive home to go to the bathroom. Or they don't drink before they get on a plane ju st so they won't have to use the bathroom." A person like this could live their life wrestling with other phobias -- fear of being scruti nized and embarrassed in pub lic, fear o f signing a cheque because their shaking hands might distort the signature and the cashier might accuse them of stealing. They may even fear their own natural perspiration. "Some people get 10 or 15 showers a day, not because of cleanliness, but because they think an odor can be detected on them," said Philips. These are all symptoms of social phobias which com e under the heading of anxiety disorders affecting one in every five of the population. Although most of us experience anxiety at times to some degree, it is when it becomes so acute that it inter feres with our ability to function that we must take action to cor rect it, said Philips. Correcting it involves med ication, usually a mild tranquil izer, and psychotherapy. Looking at the person's back ground and probing genetic and environmental reasons for anxi ety led the psychiatrist to explore some interesting cases. Take Scott, for example. Scott was a 38-year-old sales manager. One evening, while watching television in his rec room, he suddenly felt light headed and experienced a warm sensation in his body. Heart attack? He was afraid so. An ambulance took him to hospital where he was given a mild tran quilizer and told "to take it easy" and not work so hard. Anxiously, Scott began to keep a close eye on his heart rate. He m easured his pulse every hour and stopped exercis ing to keep the rate down and this ultim ately increased his chances of getting an attack. He persistently asked his friends and doctor for assurances, but would not believe that he was fine when told so. Fear of not being able to get to a hospital in time, he was afraid to take the trips his boss ordered him to take. Finally, Scott lost confidence in himself and became obsessed with the thought that he would die of a heart attack. Scott's case was typical of the spiralling effect of anxiety. One panic attack led to more anxiety which, in turn, set off another attack. The tragedy of this mind-set lies in the patient's response to his environment. Often, he avoids places and peo ple that might "set off" an attack. This excessive anxiety often includes depression and could lead to agoraphobia, a fear of venturing outside the home. "Studies have shown that the quality o f life for panic patients is a lot worse than for those with other major psychiatric illness es," noted Philips. "And w e've found that these patients visit their family doctors on an aver age of 12 times a year as against once a year for the others." The frequency o f doctors' visits might stem from an inabil ity to quickly pinpoint the prob lem. He said it could take many visits to eliminate other causes before discovering the root o f it. The biological action in anx iety takes place in the prefrontal area of the brain, specifically the anygdale. It involves serotonin, a brain chemical which, in a panic attack, inhibits the activi ty o f breathing centres and affects heartbeat rates. Medication causes serotonin to work more efficiently, said Philips, while therapy explores reasons for the disorder. Together, therapist and patient can work toward complete reha bilitation. Angie Atanasoff, a mental health nurse at Oakville Trafalgar Memorial Hospital, also works with patients with anxiety disorders. She described the "cognitive wheel" which many mental health profession als use, that starts with a situa tion, a person, a place or a mem ory. This in turn leads to an automatic thought, then to a feeling and finally to a behavior. As an example, she related the memory of her own harrowing experience of being rear-ended. Today, when she gets into her car, she always looks in the rear view mirror, the result of her fear of a recurring accident. Atanasoff listed personality traits that can lead to anxiety. Perfectionism with unrealistic expectations of oneself or others was a major one. Often attached to it was a need to be in control without trusting others to do the job perfectly. As well, people who concern themselves with "small stuff' without being able to look at the whole picture are often anxious people. Perfectionists need time away from stress-filled tasks, she said. They need to rest, relax and seek out sharing relation ships. They need to learn to pri oritize their tasks and delegate some of them to others. Since procrastinators also invite anxi ety, starting a job is a step toward meeting that deadline. "Feelings are neither right or wrong," she said. "We were taught that feelings such as anger or sadness were wrong so we repressed them. 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