The crushing cost of fear
By P.L. YOUNG
Special to The Globe and Mail
Wednesday, April 14, 2004

Phobias affect more Canadians than heart disease or diabetes. Like most disorders, they don't stay home when sufferers go to work.

How much does fear cost? Michael Brown knows. Seven years ago, he had a promising corporate career. Now he drives a truck. It wasn't incompetence that forced him to leave the multinational firm. It was a crippling fear of public speaking.

"By the time I stood up in front of a group, I would be sweating uncontrollably -- thank God for dark suits -- shaking and my voice quivering," says Mr. Brown, who spoke on condition his real name not be used. He remembers sitting in staff meetings so paralyzed with fear he was unable to speak. Adding any meaningful feedback required working up the courage just to open his mouth. "When I had formulated what I wanted to say, the discussion would have already moved on. I was so busy preparing to speak that I didn't even notice. It was horrible for me. I can only imagine what it was like to watch."

Although he was successful at his job, the stress of having to give presentations to even a small group of peers or clients was debilitating. The week before a meeting, his anxiety would build to the point where he couldn't control his physical reactions. It was a shattering ordeal that left him a wreck.

Like most people dealing with mental health issues, those with phobias try to keep them secret from co-workers. They would rather be seen as snobby, shy or quirky than fearful. Mr. Brown says there was no one he could turn to at work to discuss his phobia or even try to explain it.

Phobias affect 6.6 per cent of adult Canadians, according to Statistics Canada's most recent health survey. That is a stunning number when compared with the 5 per cent of the population with diabetes or heart disease. The Anxiety Disorders Association of Canada estimates half of all cases are undetected and one-third of these are misdiagnosed.

Martin Antony, director of the Anxiety Treatment and Research Centre at St. Joseph's Healthcare in Hamilton, Ont., believes phobia sufferers are under-reported. "If you add up all the types of phobias, it would affect about 15 to 25 per cent of the population."

Dr. Antony has treated physicians who had a consuming fear of needles. And he counselled one student who was on the verge of dropping out of medical school because of her blood phobia.

Many joke about being a technophobe, but there are people who cannot face using the telephone, standing in an elevator or using their computer.

Phobias can be grouped into three general classifications:
o Sociophobia is excessive and persistent fear in a social setting or when it is necessary to perform in public. This could lead to avoidance of a job interview.
o Agoraphobia literally means "fear of the marketplace." Agoraphobics try to avoid crowded or enclosed places, like a mall or elevator.
o Specific phobias are extreme fear of an object or situation out of proportion to the actual danger. Even someone who is aware of this cannot stop the fear from taking control. This is most commonly seen in fears of blood, needles, animals or creepy-crawlies like spiders.

What separates phobia from manageable fear and the low-grade anxiousness we all experience under stress is the level of terror and the inability to control that fear.

The closest thing non-phobics will experience is when a dentist administers too much freezing, too quickly. The body reacts with a massive surge of adrenaline that causes the person to shake or even cry uncontrollably. No matter how you try to calm yourself intellectually, the body is on its own careening path of sheer animal reaction. And, like all disorders, phobias do not stay home when you go to work.

"Many people don't even know they have phobias because they spend their lives avoiding the thing that causes them the stress," says Linda Hirsekorn, a Vancouver occupational therapist who helps clients overcome phobias. "If someone has a driving phobia, they won't take a job that requires they use a car and will only accept a job where they can take a bus to work. It limits their choice of careers."

Mr. Brown tailored his life to avoid his fear. His first love was music but his fear of singing in public was so great his neck would spasm until his head was wrenched and frozen to his shoulder. He moved to the corporate world, thinking he could insulate himself from his phobia. It didn't work.

Telling a phobic co-worker to "straighten up" or "just calm down" is no help, says Dr. Neil Rector, head of the Anxiety Disorders clinic at the Centre for Addiction and Mental Health in Toronto. He says that everyday tasks become monumental. "All anxiety disorders have the potential to impact on your ability to work."

Dr. Antony says employers and co-workers should be sensitive to those with phobias, but shouldn't accommodate those fears forever. Instead, they should encourage the person to seek help.

The cost of treatments are "most often picked up by insurance," Ms. Hirsekorn says. But more employers are willing to foot the bill themselves if insurance won't cover it.

The recommended treatment for phobias is cognitive behavioural therapy or drugs. But one of the newest and most highly successful treatments meshes virtual-reality technology and traditional therapy. For example, to treat someone who has driving phobia, Ms. Hirsekorn and her colleagues at the Community Therapists Inc. clinic use a PC-based program and a virtual-reality headset. The therapist can monitor the situations that trigger the phobia. "Virtual reality is a good treatment for many because they can build up their confidence without risking their safety."

Occupational therapists also work in conjunction with employers, analyzing the workplace to determine the stressors, modify them or find a job that may not spark a phobic episode. But this type of treatment does not come cheap. To do the basic assessment of a client costs about $750. An environmental (home or workplace) assessment costs another $500 and you can add an extra $85 an hour for extra work.

"It may seem like a lot, but a survey done by the Vancouver Coastal Health Authority estimated that about $10-billion is lost in stress-related absenteeism in this province," Ms. Hirsekorn says. "This is a significant problem in the workplace," she says. More employers are approaching her clinic to find help for employees who have phobias or other anxiety disorders, Ms. Hirsekorn says.

One large bank had a problem with an employee with an anxiety disorder. By assessing the workplace, Ms. Hirsekorn was able to determine the employee should not be dealing directly with the public. He is still happily employed, but not working on the front line.

While most people with phobias are ashamed, Earla Dunbar, 49, will gladly rhyme off her shopping list. "I have sociophobia, agoraphobia, depression and panic disorders. At work, even making a phone call was terrifying. I had to make sure that no one was listening," she says. "I was terrified of people. I would shake, blush, my stomach would become upset and my hands would sweat. If someone new came [into the office], I was always hiding."

The Toronto architectural firm where she worked for six years closed down in 1992. For years, she left the house only to shop for food. Even her family had to have a coded phone signal so she would pick up.

But sessions with a psychiatrist helped her overcome her phobias. She is still searching for work but three years ago, Ms. Dunbar started a support group for sociophobics. "People with phobias become the best actors in the world," she says. "While they are working. they can play the role of nurse, or a teacher or doctor. But when they have to go to lunch with their colleagues, the façade drops and the terror returns. One nurse worked the midnight shift so she wouldn't have to deal with family or so many colleagues."

Mr. Brown was finally able to conquer his phobia through emotional freedom techniques, or EFT, a treatment that combines talk therapy with tapping on acupuncture points. It's part of a cluster of "energy therapies" gradually gaining acceptance.

With his phobia under control, he is determined to get back on his original career path. Instead of knocking on corporate doors, he is off to pursue his first love of music.

"With help, my whole personality is changing."

Fear factors

SOCIOPHOBIA
Symptoms

Anxiety, fear, or panic immediately upon encountering a feared social situation; recognition the fear is excessive, unreasonable, or out of proportion to the actual risk; attempts to avoid social situations; intense stress.

Stress situations
Public speaking; talking in meetings or classes; participating in sports or working out in front of others; performing music or acting on stage; writing, eating or drinking in front of others; using public restrooms when others are nearby; making mistakes in front of others; being in public areas, such as a mall or bus; talking on the phone; being assertive; talking to people in authority.

Treatments
Anti-anxiety drugs, antidepressants and beta blockers are proving effective for some people.

Psychological treatments, such as cognitive behavioural therapy, can help the person replace the fears with more realistic thoughts and responses. Exposure therapy puts the person in a controlled and safe situation to help them slowly confront their fears.

AGORAPHOBIA
Symptoms

Extreme anxiety about being in a setting where escape might be difficult or help might not be available in the event of a panic attack. Agoraphobics think their panic symptoms are a sign of danger. Many first notice their symptoms after a high-stress period in their life.

Stress situations
Being more than a short distance from home; leaving home alone; shopping in a crowded supermarket; being on an elevator; walking through a crowded area with no exits nearby; taking a bus, train, subway or plane; walking alone in own neighbourhood; standing in long line.

Treatments
Drugs or psychological therapy.

SPECIFIC PHOBIAS
There are five recognized categories:
o Fear of animals or insects;
o Fear of the natural environment (such as water);
o Panic because of blood or injection;
o Panic about a specific situation;
o Specific fears such as choking after eating certain foods, fears of loud sounds or fears of clowns. The most common : fears of spiders, snakes and heights.