Centre intégré universitaire de santé et de services sociaux de l’Ouest-de-l’Île-de-Montréal
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Ask the expert

What can we do to help adolescents hang on while they wait for months to have access to therapy?

Obviously, there are issues of access to services, and governments are constantly trying to address them. What we’re trying to do is transfer quite a number of professionals from the Douglas Institute to what we call “front line services” (CLSC’s – community health clinics – and so on). In the old system, your family doctor had to refer you to a psychiatric institute where they would evaluate you and then, if you got lucky, you could get some therapy there. With the mental health reform, the family doctors will be able to refer people directly to the CLSC where we’re going to have mental health teams consisting of the people who used to work in the psychiatric institute. So, we’re transferring a number of resources to the community. I know it certainly isn’t adequate. There’s a lot of demand and, even if we put all of the available resources into the community for free, we’d still be overwhelmed.

Sometimes there are private referrals that you can go to. If people have insurance, occasionally the insurance will cover a few sessions. There are University clinics and training clinics, and they’re usually pretty good because these are graduate students who are being supervised by experienced professionals, and they tend to charge very little, maybe $10 to $25, depending on your means.

There obviously is information on the Web. For exemple, I have my own blog where people have information they will hopefully find useful. There are support groups as well; in Quebec, Phobies Zéro is a self-help group, and they have a youth section for the younger people suffering from anxiety disorder. So there are a number of these organisations that try and fill the gap. So we all contribute as best we can and, unfortunately, that’s the reality of it.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009

How can you help someone who is having a panic attack?

What I tell people is very simple: when you panic, don't do anything. I also try to explain that a panic attack is like a wave: it comes and goes. Of course, the first time that a panic attack occurs, it can be difficult to understand, as people in a state of panic cannot be rational; they may even think that what they are feeling is a heart attack. I therefore suggest that people ask themselves whether they are feeling anxious during the attack. If yes, they need to understand that they are not in a position to think normally and need to wait until the anxiety has subsided.
-Camillo Zacchia, PhD, Mini-Psych School 2010

How do I help a friend who is anxious, won't leave her home and doesn't want to consult a psychologist?

It is always a challenge when someone refuses to be treated or does not believe in treatment. There are medications that are nevertheless effective. If the person does not want to see a psychologist, she might agree to see her family doctor or another health care professional. Fortunately, there is a lot of information available on the Internet; for example, there is the Douglas Web site, as well as support groups, such as Phobies-Zéro. These support groups help people see that they are not alone. They can meet other people who have successfully dealt with their problems. For example, Phobies-Zéro founder Marie-Andrée Laplante did not leave her house for 10 years. Now, she travels everywhere and she even wrote books. She is an example of someone who is still able to enjoy life despite a certain level of anxiety.
-Camillo Zacchia, PhD, Mini-Psych School 2010

What can be done for someone suffering from severe social phobia?

I touched on it briefly when I spoke of social phobia, which is a strong fear of being judged or looking nervous. Here is a little story of a client who was so afraid of blushing, she quit her job. Even though she had never remembered blushing in a meeting or anywhere else, she was paralyzed with the fear of blushing. This made her unable to function normally. For example, if it was her turn to speak during a meeting, she would walk to the kitchen and pour herself a cup of coffee and start talking with her back to everyone else. It was her way of coping with the situation without having to make eye contact. Another woman that she knew, who was a treasurer in the same condo association as she, actually had a strong tendency to blush but faced it in a totally different way. Before she had to speak to the group this other woman simply told everyone that she blushes a lot but to just ignore it. In this way, she relieved all pressure to perform and was able to function.

Social anxieties are more difficult to treat than others. For example, if someone is afraid of going on an elevator and you encourage them to take one, he can learn that there is nothing to fear. But if he fears what other people think and goes into a social situation, there is no way to know for sure if his fears are unjustified—since he can't read people's minds. This problem has a lot more to do with our interpretations of events, how we see ourselves, judge others and so on. Changing behaviour alone is usually not enough, these thoughts also have to be addressed. Thankfully, social anxiety can be very effectively treated through medication or psychological approaches.
-Camillo Zacchia, PhD, Mini-Psych 2006

What do you say to people who fear catastrophes such as pandemics or the end of the world?

We are all a little afraid of those things. When driving your car, you can have a serious or fatal accident, but you don't think about that every day. You have faced this fear so often, that it eventually disappeared. However, if a celebrity dies suddenly from an accident, we remember the inherent danger again and start paying a lot more attention. The media has the power to emphasize such fear, even though a lot of things are more important. The goal of life is to live with imperfection—to succeed in living with a certain level of risk. What I would say to people who fear catastrophes is that you have to live with a certain degree of uncertainty. However, if you take care of yourself, you can minimize the risks. But you need to realize that minimizing risks does not mean eliminating them altogether.
-Camillo Zacchia, PhD, Mini-Psych School 2010

What about propranolol for treating anxiety?

It is used for post-traumatic stress disorder (PTSD). Very recent studies seem to indicate that propranolol helps people separate their feelings from specific events. For example, a person may have certain memories of 9-11 that awaken strong feelings of distress. It may be helpful for the person to separate the event from these feelings, so he/she can react more calmly and rationally and function better in everyday life as a result.

In some ways, propranolol is a pharmaceutical equivalent to relaxation therapy―which is a form of psychotherapy that has been used for quite a while to treat PTSD. The idea is to try to get people to relax when they think of a traumatic event. Since you can be calm and afraid at the same time, if people relax when they think of 9-11, by implication they won't be as traumatized by the thought.
-Joseph Rochford, PhD, Mini-Psych School 2006

Propranolol has also been used for performance anxiety, since it decreases trembling. It is sometimes given to violinists who don't want to shake too much while performing.
-Mimi Israël, MD, Mini-Psych School 2006

What do you think of of natural products to treat moderate anxiety and depression?

Anything that works, works! When St. John's Wort was first introduced, there was some evidence that it was about half as effective as psychiatric medications, but still had a positive impact. More recent studies have shown that it is not really very effective at all. But that's the beauty of science! Someone has a hypothesis and tests it. If it's shown to be effective, then great! The problem with a lot of natural products is that they haven't all been tested. Just because a product is natural doesn't necessarily mean it's good. Certainly, any product whose effectiveness has been proven can be used and I would encourage this. Sometimes, the effect is more based on your belief in the product, or it can be the result of a combination of your beliefs and the actual medicinal effect.

I would like to add something very important. Margot Kidder was here in Montreal recently and spoke to the media about how she overcame her mental illness using herbs or natural products. A little while later I was called by a patient suffering from schizophrenia who asked me if she should stop her medication and take herbs. My answer was no. Even though one person may have had a positive experience with herbal treatment, that is not proof—especially in the case of schizophrenia. It is a serious illness which needs to be treated with medication in almost all cases.
-Camillo Zacchia, PhD, Mini-Psych School 2006

I have always suffered from generalized anxiety, including the fear of not being good enough. What should I do if I am anxious 80% of the time?

I try to help people to let the emotion come and not fight it. I would treat generalized anxiety a bit like I treat grief. If I lose someone close to me, no one can convince me that the person's death doesn't matter or is for the best. I have to learn to deal with my grief and go on with my life despite painful emotions or memories. Instead of experiencing the pain and panicking, you need to get through the feeling and let it pass.
-Camillo Zacchia, PhD, Mini-Psych School 2010

Can nutrition, rest and exercise help with your level of anxiety?

The answer is yes and no. In fact, we used to treat anxiety with relaxation exercises, but now we have to be very careful about doing so. Relaxation is good, eating well is good, and exercising is good; however, a problem arises when you use these as a means of control. In fact, people with a phobia need to realize that nothing will happen if they do not calm down. You are not going to fall because you are afraid of falling. You should relax for your mental well-being, not to fix your anxiety. Meditation is more useful than physical relaxation in this case, because it is more a way of letting go and not controlling your thoughts.
-Camillo Zacchia, PhD, Mini-Psych School 2010

When someone takes leave from work because of harassment, is it a good idea for the person to return to same workplace?

For a specific event, such as being sexually assaulted by someone, the treatment is not going back to spend time with that person. Obviously, you have to protect yourself first and foremost. Although you don’t have to go back to the threatening place or see the person again, you do have to go back to the memories. Most of the time, these memories come and go on their own, and you don’t have to force them. In the case of PTSD, however, the person may have to relive the experience, as perhaps they haven’t done this enough or have avoided the memories altogether. To get over a trauma, you have to deal with the cause. If you are scared by a specific place, you need to face that place again. You need to gradually go back to either that place or a similar one.
- Camillo Zacchia, PhD, Mini-Psych School 2012

A family member recently discovered that she experienced childhood trauma and has developed a major anxiety disorder. She is also addicted to marijuana. How do you treat this person?

The problem with childhood trauma is that it affects relationships. Not everyone is an abuser, but if you are terrified of being abused or being hurt or rejected, then you become hypervigilant. The key here is to learn to dissociate the two things and try to judge individuals for what they are. In the case of marijuana use, the question is whether the person enjoys it or uses it as a way to manage stress. If the person can’t face normal life without it, then eventually the condition can get worse.

The problem for family members is that we tend to respond to something that bothers us and not to something that bothers the other person. It should be the other way around. For example, if my son sits in the basement all day long smoking marijuana, I may become angry and say, “You need to get a job!” However, in response, he may ask to be left alone, and he may not be receptive. But when you wait for someone to express discomfort, i.e., “I have no money; I can’t deal with everything I’m going through,” then you can ask the person to consider help at that point. You need to provide encouragement when the person expresses a need or difficulty.
-Camillo Zacchia, PhD, Mini-Psych School 2012

What can I do to help someone who has had a car accident, and who seems okay but who is affected by insomnia?

It takes a while to overcome the event. When to seek treatment certainly depends on how long it’s been. If there is gradual improvement over time, then we should let the person take the time it takes. If the person’s emotional state starts to become overwhelming or if he or she starts taking alcohol or tranquilizers before bed, this is a sign of deterioration, and professional consultation is probably warranted in this case. The problem is that at some point, insomnia itself becomes a worry; at first, you may have trouble sleeping because of memories, but then you start worrying, “Am I going to sleep tonight?” The best way to sleep is not to care whether you sleep. As soon as you say, “I have to sleep,” you won’t.
-Camillo Zacchia, PhD, Mini-Psych School 2012

How much emphasis is placed on the “holistic” treatment of adolescent mood disorders? For example, yoga, meditation, a balanced diet, etc.?

Some teenagers ask whether they can get massages to support their treatment for depression and so that the therapy is covered by their insurance. Massage therapy is positive and part of psycho-education, a healthy lifestyle and good habits. Relaxing is good, because a lot of people are anxious. But massage can be expensive, so we can provide other types of relaxation training that are free. Some simple techniques are available on the Internet and are accessible to everyone.
-Johanne Renaud, MD, Mini-Psych School 2012

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