One of my very first clients when I was a student had a needle phobia. He had had root canal work done without freezing. The guy was the president of his own company and a very smart man, around fifty. He needed a blood test but he couldn’t go. The last time he had tried to have blood drawn, he had had a respiratory arrest in his doctor’s office and had to be revived. So, would you say he’s mentally ill? Well, he has a diagnosable condition. He has what we call a specific phobia. Do you consider that an illness? Well, the issue here is that it certainly affects his ability to function normally. And it might not be a big deal to some people, but, if he has an illness and he needs a blood test, or he’s avoiding going to the doctor because of it, then he could actually die because of this. So, in this particular case, the fear seriously affects his functioning. So we call that a “phobia” and it is a diagnosable condition. I don’t necessarily like to use the term “mental illness” because I don’t think that a person necessarily is sick, but it depends on how you define it. The bottom line is that there are clear treatments for it. In fact, I was able to get him to have his blood test and a number of other injections before the end of my internship. That’s a perfect example of using functioning as a criterion.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009
 

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
 

Impostor’s syndrome is a psychological phenomenon in which people are unable to feel worthy of their accomplishments. I think, as a psychologist, one of the advantages I have is that people tell me what they really think. And the most common response I give people, and it’s an honest one, is that their thoughts are completely normal. The truth is that we all have anxieties and self-doubts. But, because we can only read our minds and not the minds of others, we tend to think that everyone else who projects a very confident image is very confident. The truth is that they’re not.

So yes, I think that it’s really just an issue of self-confidence, and, in almost any therapy, all we really work on is self-confidence. I always say that, if there were a self-confidence pill, I’d be out of a job. So the impostor’s syndrome is really just an issue of self-confidence. Some of us have problem areas that we can work on. It doesn’t make us inadequate. I think we all have strengths and weaknesses and sometimes we can strengthen our weaknesses so to speak. More often than not we’re not very different from other people and I think it helps to understand that.
-Camillo Zacchia, Ph.D., Mini-Psych School 2009
 

The answer to this question depends on the definition of “overwhelmed,” as this can involve too much stress and anxiety about confidence levels. Sometimes anxiety is appropriate and normal. For example, let's say that your boss asked you to write a letter and said that you had all day to do it. If you are like most people, you would not be too threatened or overwhelmed by this task. But what if you lack confidence in your writing skills? Then one letter becomes very threatening. We often have to ask ourselves whether the stress comes from our way of reacting to a situation or the situation itself.
-Camillo Zacchia, PhD, Mini-Psych School 2010

It is treated just like any other anxiety. Usually, children will grow out of most of their fears over time. If they do not want to go to school or talk to anyone, you need to help them make small steps in that direction. What is really debilitating is not anxiety itself, but rather the fear of anxiety. Ultimately you want to teach children that it is okay to be scared. If you encourage them and give them tiny steps, they can usually face their fears.
-Camillo Zacchia, PhD, Mini-Psych School 2010

First of all, PTSD should be distinguished from a normal stress reaction. Recovery from such traumatic events as the loss of a loved one, rape, or even a severe car accident varies from person to person, and so there is no standard. In true PTSD, the person starts to get better but then starts to relive the trauma and may start having nightmares or become debilitated from trying to avoid a recurrence of the event. This can last their entire lives if not treated. Normal stress and normal trauma will generally go away for most people. Only a small percentage will develop a more severe disorder.
-Camillo Zacchia, PhD, Mini-Psych School 2010

The transition generally happens at the beginning of adolescence, maybe a little sooner. The exact moment may not be so categorical, as we all have a certain degree of empathy. When teens get to high school though, they are more worried, they suppress their opinions more, they pay more attention to how they look; this is when we start to see a difference.
-Camillo Zacchia, PhD, Mini-Psych School 2010

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
 

Not particularly. Some fears get worse over time and some get better. Our circumstances change as we get older. For example, sometimes our health starts to be an issue. If you have always been concerned with your health, you could become increasingly anxious as you get older. On the other hand, if you are concerned about social anxiety, you might have a harder time when you are younger—for example, at school. Generally speaking, every age group and every challenge we face can bring on new anxieties, depending on our circumstances.
-Camillo Zacchia, PhD, Mini-Psych School 2006

The more you are afraid, the less you think of yourself, and people with low self-esteem are going to have more social anxiety. They worry about what people think of them, and they are more threatened by exams and by being graded. The ultimate goal of almost every treatment is to try and build a person’s self-esteem.

-Camillo Zacchia, PhD, Mini-Psych School 2010

Some people who suffer from an anxiety disorder may also be depressed because something is wrong with them. It’s hard to be anxious and not be depressed about it, just as it’s hard to be depressed and not be anxious. Anxiety is a little more geared towards specific things, as in “such and such a thing scares me.” Depression is more of a judgement, and your personality will make you down about something and afraid of things.
-Camillo Zacchia, PhD, Mini-Psych School 2010

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

Sometimes, aggressive behaviour is simply aggressive behaviour. However, an anxiety disorder can influence patience levels and other behaviour. If people are very stressed, they tend to lose patience more quickly and become more aggressive than normal. There are of course people who develop drug problems, and we see a lot more dependence in anxious people than in the general population. This is often because they self-medicate because they feel bad or need medication as a crutch, i.e., a sleeping pill to go to sleep, a tranquilizer to calm down, or alcohol to lose their inhibitions. The tendency is therefore to have more problems, but not all drug problems are caused by anxiety.
-Camillo Zacchia, PhD, Mini-Psych School 2010

Sometimes the problem is difficult to pinpoint and we don't really know the cause. Sometimes the reaction is purely physical. The child can be afraid of this physical reaction and associate it with school. If the child is afraid of school for a specific reason, the child will still be afraid even if I remove that reason, due to months of association. The reason for the fear is no longer important—it is a fear that the child simply needs to face. For example, people who are afraid of elevators do not need to take the elevator alone; they can face the fear with a supportive friend. Eventually, they can get into the elevator with the door open to get used to it, and so on. This is a bit how it works with young people; it's a gradual process.
-Camillo Zacchia, PhD, Mini-Psych School 2010

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

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

I have noticed from personal experience that medical students become very anxious when I modify my courses too much, as this detracts from their ability to learn. I believe that the same goes for children. Day care workers always tell us that it is very important for children to have a routine. This doesn't meant you can't change things once in a while, but generally speaking, routine has a lot of value for children. I think that this is key.
- Johanne Renaud, MD, Mini-Psych School 2010

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

Anxiety is an emotion, so it can simply be a symptom and not always a disorder. For example, if someone is actually trying to kill you, you will be terrified. The real question is whether the threat is real or imagined. You cannot become psychotic by being too anxious. Paranoia, on the other hand, is a biological disease that affects a small percentage of people. The difference is generally that people who are socially anxious are more afraid of what others think of them, whereas paranoid people are more afraid of being harmed by others.
-Camillo Zacchia, PhD, Mini-Psych School 2010

Although people experience different things during a panic attack, some common symptoms are headaches, dizziness, and tightness in the chest. These symptoms are your body's response to stress—a response that can also be triggered by perceived stress. Focusing on a single body part can sometimes make the symptom worse. For example, if you feel tightness in your chest, you will try to breathe harder to calm down or get more air. The problem is that this reaction soon leads to hyperventilation, which in turn leads to panic. The paradox is that your efforts to calm yourself down will give you symptoms that are extremely scary.
-Camillo Zacchia, PhD, Mini-Psych School 2010

There always is a certain overlap between psychiatric problems. Attention deficit disorder (ADD) is different from anxiety. You can be anxious no matter what your attention level, but if you are hyperactive, you have more energy and therefore will question yourself more or attempt to have greater control when things aren't going well. A young person who is hyperactive and anxious might have more difficulty managing situations than someone who suffers from anxiety alone. One thing is certain: children with ADHD tend to be misjudged by their peers. They are ostracized and therefore at a greater risk of developing social phobias. But the relationship is not a direct one.
-Camillo Zacchia, PhD, Mini-Psych School 2010

Are they really? We don't know if people have more anxiety disorders than in earlier times or if we simply are more aware of it. We do know, however, that educational events such as this conference tonight are important because we can learn about and discuss our anxieties. In the past, people used to be ashamed, especially in cases of anxiety, of telling others what was going on in their minds. An anxious person might have been terrified of ending up in a psychiatric hospital. We want to welcome people to our institution if they need help and not be afraid. People will only reach out for our help if they are not ashamed–if they understand the illness.

The Douglas Hospital invites the public to come and learn about mental illness so people will know that if there is a problem, they can get treatment and it won't be a horrifying experience. Certainly, in recent years, there is growing awareness. We talk about it more. There are television documentaries about phobias, depression etc. (Mimi Israël, MD) We are less threatened by predators than our ancestors, but we have more day-to-day stressors. We live longer, more complex, lives. There may be good reasons for becoming anxious because we're always having to juggle new things. Unpredictability is one of the things that causes anxiety.
-Camillo Zacchia, PhD, Mini-Psych School 2006

We know that genetic factors contribute to anxiety disorders. Factors in the environment, such as an unstable family environment, can also be important. We don't have good studies in this area. However, based on my clinical experience, I see that children with strong anxiety problems have a lot of instability in their home life.

(Mimi Israël, MD) I believe this goes along with the fact that there is a very high percentage of children, even in Canada, who are maltreated and neglected. There is also a rising divorce rate, which creates instability in the family because children depend on both their parents to feel secure. In addition, some children are more susceptible to anxiety disorders for genetic reasons. With these combined factors, it's not surprising that anxiety disorders are common.
-Ridha Joober, MD, PhD, Mini-Psych School 2006

Selective mutism is extremely common. The signs are generally when children go to school and refuse to speak to anyone. For example, I have two adopted children; one of them, of Vietnamese origin, is very verbal. When I adopted him, he smiled a lot and was very friendly, but he did not reply to any of the interpreter's questions. When we came back to Montreal, he did not speak to anybody for several months and then gradually started talking. It was clear for me that he was in a very stressful situation; he was seven years old and was in a new country. Mutism is an indication that children are experiencing a lot of anxiety.
-Camillo Zacchia, PhD, Mini-Psych School 2010

Although we all experience anxiety, we call it a disorder when the person is highly preoccupied with it or can't function normally. If a person suffers from anxiety every day, and truly feels bad, I think it's certainly something that should be addressed. Again, this depends on what the person is worried about and the surrounding conditions.
-Camillo Zacchia, PhD, Mini-Psych School 2006

PTSD – Post traumatic stress disorder. You take these people who have experienced the horrors of war and bring them in and take care of them and then you send them home and, all of the sudden, they are waking up in the middle of the night screaming because they are reliving some of the horror experienced. The spouse has difficulty understanding their behaviour and wants to understand; however, the veteran is unable to explain it, thus creating certain marital issues. By using psychoeducation, we could possibly show them a way to live their lives with less flashbacks and trauma.

-Joseph Rochford, PhD, Mini-Psych School 2009

People are not necessarily afraid of “airplanes”, for example. They fear falling from an airplane (i.e. crashing) the way our ancestors feared falling from cliffs or tree branches. Therefore, it is normal to feel anxious when looking down from above. Others may be phobic of airplanes because of the fear of being trapped. If you're locked in an elevator, you'll struggle to find a way out. If you trap animals in an enclosed space, they'll panic. It's normal.
-Camillo Zacchia, PhD, Mini-Psych School 2006

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 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

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

There most likely isn’t a difference, and a person’s reaction will probably depend on the intensity of the trauma. Obviously if you are involved in the event, your experience will be quite intense; however, if you are very shocked just by witnessing it, you can certainly experience PTSD or develop it to the same degree.
-Camillo Zacchia, PhD, Mini-Psych School 2012

It’s not necessarily a conscious thing; it can just happen over time. For example, people in lines of work that are potentially traumatizing (i.e., people who work with dead bodies) can have a “switch” that helps them deal with death. There may be events that turn this switch off, but turning it back on again may not require anything else but time and dealing with the issues or circumstances that triggered the trauma.

If this doesn’t happen naturally, then the person may have to seek treatment. For a lot of people, antidepressant medication is an effective treatment for anxiety disorders, including PTSD, because it tones down the intensity of the emotions so that you are more able to face your fears. The goal is always to face your fears in a less emotional state. This can be done through exposure therapy, with EMDR (Eye Movement Desensitization and Reprocessing), or with antidepressant medication to make the emotion less intense: it’s all the same idea. You need to gradually resume your life and face your fears.
- Camillo Zacchia, PhD, Mini-Psych School 2012

This is something that happens a lot, especially if the person you lost, perhaps in a car accident when you were driving, is a younger family member. This can make you feel partially responsible or completely responsible. Trying to convince people that it was just an accident and that it wasn’t their fault is very difficult. Unfortunately, a lot of people end up feeling bad, especially when the person was someone close and someone they loved. This is a common feature of PTSD and is one of the things that we deal with using a more collaborative approach to get people to face their emotions and fears and deal with their perspective.
-Camillo Zacchia, PhD, Mini-Psych School 2012

The fact is that fears are different for each individual. Some people are afraid of snakes, while others are afraid of spiders. What is medicine to one person is poison to another. It is also amazing how one person can be completely controlled by a fear but be unable to understand someone else’s anxiety. One person may be deathly afraid of taking the bus but can’t understand why someone else is afraid of needles. In general, these fears are a manifestation of our fear of dying, making a fool of ourselves or losing our minds.
-Camillo Zacchia, PhD, Mini-Psych School 2012

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

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

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

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