More threads by David Baxter PhD

David Baxter PhD

Late Founder
High Anxiety: When everyday problems take on immense proportions
Saturday, October 21, 2006
Janet French, The StarPhoenix

Lesley Buhay was in a job interview for a waitressing position at a Saskatoon arena last year when the walls of the tiny offi ce seemed to bear in on her. The next thing she knew, she was dizzy and hot and lying on the fl oor.

"I was terrifi ed, and I said, 'I'm sorry, I think I have the fl u,' and fl ew home," said Buhay. "Ever since then, I was just terrifi ed to leave the house." That was 13 months ago.

Now Buhay, 25, almost never leaves her Saskatoon trailer home.

She has panic disorder -- a type of anxiety disorder where coursing adrenaline brings on panic attacks. Buhay also has agoraphobia -- a life fraught with anxiety about leaving her home for fear she might get sick or panic while she is out.

"It's hell," Buhay said. "This is hell on earth, to be trapped. You really realize how much you miss the small things." Health Canada estimates at least 12 per cent of Canadians, or 3.7 million people, suffer with anxiety in any given year. An estimated 1.2 per cent are severely afflicted, with anxiety controlling most of their activities.

Dr. Melisa Robichaud, a psychologist at the Anxiety Disorders Clinic at Vancouver's University of British Columbia (UBC) Hospital, says everyone has worry, stress and anxiety, but when symptoms become debilitating -- stopping someone from carrying out normal daily activities -- that's when it becomes an anxiety disorder.

Symptoms of these disorders often surface in the late teens or 20s, and are more common in women.

Anxiety is the body's overreaction to situations that are not dangerous, Robichaud says.

"When you're in front of a real physical danger, for example, near a bear, or in a near-car accident ... you have a huge rush of physical symptoms, which is the fi ght-or-fl ight (response)," she said. "It's the body preparing to defend itself, which is a very normal, necessary, and adaptive system in the body. Without that, you wouldn't have that splitsecond reaction to get away from danger." Anxiety is the body's threat response kicking in when there is no real threat, she said. "It's like a fire alarm going off at the wrong time."

I know all too well how that feels.

Since 2003, at age 25, generalized anxiety disorder, panic attacks and bouts of agoraphobia have intermittently ruled my life.

The problem became especially apparent last March, while at work, pounding away on a keyboard trying to meet a deadline. My anxiety is about my health, and when I started feeling sick to my stomach from a lunch gone bad, I fainted in the office.

It was humiliating. My co-workers didn't know what had happened.

I awoke to the room spinning and a gaggle of faces leaning over me, mouths agape. They insisted I go for a check-up in an ambulance, although I've fainted periodically all my life. The doctor checked my blood sugar and sent me home with a purse full of sedatives, should the sensation of panicked doom return. The sedatives still sit in my purse -- I'm too anxious to take them.

After that, it was impossible to relax. Sitting in front of my computer at the office, the room would spin. When an unusual bodily sensation came on, I became convinced it was a sign of serious illness or imminent fainting. My hands shook and sweated and I couldn't sit still. At media events, only willpower and a sense of responsibility kept me from fl eeing the room in a panic. Soon, I woke up every morning feeling nauseous at the prospect of spending the whole day on the job with the guaranteed return of symptoms. I was having anxiety about the possibility of being anxious. An unbreakable vicious cycle had started, and it kept getting worse.

Untreated anxiety can take over life Anxiety left untreated can box you into a corner and leave your life stipulated by rules you're afraid to break.

As we tend to avoid unpleasant experiences, people with anxiety may increasingly limit their lives to stay in situations where they feel safe.

Buhay said she's too anxious to leave her house because she fears she may throw up.

"I haven't thrown up in seven years," she said. "I never do. But it's such a fear." The embarrassment of others looking at her panicked, fl ushed face and shaking hands is enough to keep her inside.

"I know my mannerisms and stuff change when I'm panicking, and you can tell when its happening," she said. "I think it's the fear of the embarrassment, and people kind of looking at you, 'wondering, what's wrong with this girl?'" Buhay said she relies heavily on her sister to run errands for her and fetch her groceries. She hasn't worked for more than a year and lives on social assistance. As her debt accumulates, she's frustrated, because she wants a career, but can't fi nd a job she can do from home.

"I just want the simple things," she said. "A job. Being able to grocery shop -- and those are huge goals for me. And everyone else takes it for granted." Buhay's experience is common for anxious people. One 1995 study found people with anxiety disorders had high rates of unemployment and dependence on disability, welfare or unemployment payments.

Susan Halbach, a social worker with mental health and addictions services at the Saskatoon Health Region, said getting help for anxiety before it takes over your life is crucial.

"I t's a big piece of their lives," she said of anxiety. "I could give you a million examples. Socially, physically, economically -- in every aspect with relationships, with jobs, with health. Long-term untreated (anxiety) can create depression and make things more complicated." A handful of studies that tried to quantify direct and indirect costs of anxiety show the economic impact of the disorders is staggering. Using data from 1990, one U.S. study found the annual cost of anxiety disorders in that country was $42.3 billion U.S. a year. More than half was spent on non-psychiatric medical care like doctor visits and laboratory tests.

Canadian data show people with anxiety disorders pay more visits to family doctors and specialists than those without the disorders.

Patients often see cardiac specialists gastroenterologists, or wind up in the emergency room, because they don't understand what's causing heart palpitations, chest pains, shortness of breath or diarrhea

A 2001 study of the costs associated with mental health problems estimated distress and depression cost Canadians 6.3 billion a year in direct health care costs and $8.1 billion in lost productivity from sick days and ineffi cient, nail-biting workers.

To complicate matters, people with anxiety are more susceptible to other health conditions. In addition to other psychiatric problems, like depression and addiction, there are cardiac and cardiovascular complications, said Dr.

Rudy Bowen, a psychiatry professor at the University of Saskatchewan. Many people with anxiety disorders are too nervous to exercise, leading to a higher incidence of diabetes and obesity, he said.

Other chronically anxious folks can't think clearly.

"Their memory and their concentration don't work as well," he said. "Some of it seems to be related to chronic stress." * Continued from E1 The most frustrating part of life with anxiety is you can't will yourself to get better. It's not reasonable to put my life on hold in the unlikely event of illness. I am a healthy 28-year-old woman, after all; however, the physical sensations caused by my surging adrenaline are a glaring red light fl ashing, "danger," and it's impossible not to listen to them.

This, too, is embarrassing. How can I be a reporter who's afraid to leave the house? Buhay said she fi nds it hard not to think of herself as craven or spineless.

"I'm having a hard time with the whole (idea that) I'm weak," she said. "I should be able to get over this and I just can't." "(I know) from all the stuff that I've read, it doesn't work that way," she said.

"It's not a mind-over-matter situation." Treatment is out there, and it works Research has shown a method called cognitive behavioural therapy (CBT) is the most effective treatment for anxiety disorders, according to Bowen and Robichaud.

"People with anxiety disorders are not broken," Robichaud said. "They're not diseased. They have a great deal of anxiety.

They have a little too much, or a lot too much, of a very normal reaction." An anxious person's pattern of thoughts and behaviours are the problem, she said.

Social worker Halbach said CBT works by trying to break up destructive patterns of avoiding anxiety-provoking places and situations by gradually exposing the anxious person to fear-provoking scenarios.

"Exposure always lessens the fear," she said. For example, CBT treatment for a person afraid of dogs might start by looking at pictures of dogs, then being in the same room as a dog in a cage, then eventually meeting a friendly dog they know.

CBT also teaches people about what is happening in their bodies and their minds when they feel anxious, Halbach said.

There's homework involved, though, which can be a drawback for the less motivated or time-crunched, Robichaud said.

A Vancouver-based CBT program I took two years ago for anxiety disorders had a weekly two-hour meeting, readings to complete, and exercises to practise, like breathing through a straw, or shaking your head, to simulate the physical sensations of anxiety in a controlled way.

David Baxter PhD

Late Founder
Although it sounds like a lot of work, it was worth the time. I learned to see the signs of panic as they came on not as a threat, but an annoyance.

Robichaud said about 80 per cent of people with panic disorder who try CBT leave counselling or a treatment group with "high-end functioning," meaning they can do most normal activities again.

For people with generalized anxiety disorder, about 50 to 60 per cent see signifi cant relief, she said.

"When you're talking about changing your thoughts or behaviours, it's not always realistic to say within 10 or 12 sessions of seeing someone, something that I've been suffering from for years is going to be gone," Robichaud said. "A lot of times, it's just time, and maintaining and continuing to practise the skills that you're learned." A doctor may also prescribe drugs to treat anxiety.

So-called selective serotonin re-update inhibitors (SSRIs), like Paxil, Prozac and Zoloft, and serotonin and norepinephrine re-uptake inhibitors (SNRIs), like Effexor and Cymbalta, are antidepressants that dampen the physical symptoms of anxiety. Another class of medication called benzodiazepines (this includes drugs like Valium and Ativan) are shorter-acting tranquilizers people can take in anticipation of an anxietyprovoking situation.

However, tranquilizers can be addictive and make you sleepy, Bowen warns.

Although many anti-depressants are well tolerated, he said, they can have numerous side effects, like nausea, dizziness, insomnia, dry mouth, and others.

Although I resisted taking drugs for many years for fear of the side effects or odd sensations they might add to my already stressful experiences, my anxiety had become so consuming I felt I had no other choice.

I started taking an antidepressant in April to curb my anxiety symptoms, and I don't regret it.

After spending several weeks writing stories from home, I was able to return to the offi ce and gradually, the anxiety faded from a deafening screech to a murmur in the background.

Wait lists leave some in limbo Getting counselling, CBT, medications and other therapies only helps when you can access the health professionals providing these services.

Buhay has struggled to get the help she needs because to meet with a counsellor or anxiety group, she needs to leave her house. She spent four months on the Saskatoon Health Region's waiting list for treatment, then received a call from a worker telling her she was "too sick" to participate in the outpatient programs.

Workers offered to admit her to hospital for treatment, but she refused.

Although she has seen a psychiatrist, it took months to get an appointment.

More than a year after she called for help, she's now waiting for a psychiatric nurse to visit her at home.

"I just want people to know that it's far more common than people realize," she said. "And something really needs to be done with the system, too." Dan Fofonoff, manager of the adult community mental health program with the Saskatoon Health Region, said the program doesn't have the resources to send outreach workers to agoraphobics.

Part of the therapy is also leaving the house to come to the meetings, he said.

"If we start providing them services in their house, that is not consistent with the direction we're wanting to move in therapy," he said.

In the 2005-06 operating year, 1,820 adults accessed community-based mental health services in Saskatoon, Fofonoff said. There were 220 people in the anxiety disorders program. The median wait time to be enrolled in an anxiety group is about three and a half months, he said. The health region has the equivalent of one and a half fulltime workers treating anxious people in Saskatoon.

Nearly a quarter of people who show up on mental health services' doorstep list anxiety as their most pressing problem, Fofonoff said. About 10 per cent say their main concern is panic.

Robichaud said access to health care workers with expertise in anxiety is poor in some rural areas. However, there are 100 sites across Saskatchewan with mental health workers equipped to deal with anxiety disorders, said Roger Carriere, executive director of the community care branch of Saskatchewan Health.

Wait times for a psychiatrist vary, Bowen said, depending on how severely affected a person is by their disorder.

Positive developments The good news, Halbach said, is people are better informed than ever about the signs of anxiety.

"There's not such a stigma," she said.

"This is almost becoming pretty common.

It's a good thing that the stigma * Continued from E6 isn't there as much anymore, and that there are resources there to help individuals." I want people to know I have an anxiety disorder because the public should understand how prevalent it is. When I became anxious about things that seem routine to other people -- driving, staying out late, or riding the bus, for example -- I ended up cultivating a web of excuses and lies to explain my strange behaviour. I thought I was crazy for being afraid to perform such simple tasks. I felt lonely, and was convinced I was the only person who felt this way.

When I joined an anxiety group and saw how many others saw the world like this, it was as if a dark veil had been lifted from my eyes. The more people I told about my anxiety troubles, the more anxious people I found.

There's also innovative studies going on to develop new ways to help people with anxiety disorders.

Researchers at the Universite du Quebec en Outaouais in Gatineau are experimenting with virtual reality goggles to help people with specifi c phobias, such as a fear of spiders, to overcome what terrifi es them.

The university is also experimenting with psychology sessions via teleconference to help get treatment to people who live in remote areas with no anxiety specialists around.

The B.C. Women's and Children's Health Centre hopes to curb anxiety early with their program, Taming Worry Dragons. The B.C. Children's Hospital distributes an educational book to help kids identify anxiety symptoms before they become overwhelming. The hospital also hosts workshops for fretting kids and their parents.

Canada is home to some of the leading anxiety researchers in the world, Robichaud said.

Buhay, meanwhile, is trying to focus on her accomplishments, like going for a drive just for fun, or a summer day when she spent fi ve hours outside at a pool party.

On one car trip she took, she rolled down the window to feel the wind on her face for the fi rst time in months.

"(It) was just an amazing feeling," she said. "How many times do you get in the car and roll down the window and feel the wind on your face and not think anything of it? It's the little things that you miss so much. It's like a roller coaster. Some days I'm fi ne, and other days, there's a lot of anger with it.

It's like, 'Why me? Why has this happened?' I don't get it."
It's hard to even read about anxiety, but this really is so true:

Untreated anxiety can take over life. Anxiety left untreated can box you into a corner and leave your life stipulated by rules you're afraid to break.

As we tend to avoid unpleasant experiences, people with anxiety may increasingly limit their lives to stay in situations where they feel safe.

It is SO hard.


Great article. I am always amazed at how 'different or weird' we all feel when we suffer from these disorders only to read them and feel like I could have written them verbatim myself. Same feelings, same fears....over and over again. If nothing else, it allows me to feel some connectedness and relief that I am in good company with this issue.
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