Dealing with Christmas-time stress

By DITA DE BONI

Deck the halls ... with boughs of cheap tinsel bought from The Warehouse late on Christmas Eve as you queue with another 100 frantic people and realise you've left Grandma's scented bath salts off the list and have to turn back but a wall of clenched-jaw faces is forcing you forward, through the checkout and into the swarming mall mass ...

Fa la la la la, la la, la la.

If Christmas preparations do not give you the feelings of good cheer that the endlessly droning carols favoured by supermarkets and elevators tell you you should have, your experience is not unusual. Tight shoulders, migraines, a feeling that your head is spinning, and a severely lightened wallet that throws your usual lopsided jaunt out of whack are symptoms never mentioned in our festive songs, but are as much a part of Christmas as sleigh bells and Santa.

Now, imagine feeling this type of Grinch-spirited anxiety in non-Christmas times - say, when you get in your car, when you're sitting at your desk or attending a staff meeting. Picture how it would be to feel that doom is always on the horizon, that you were going to lose control or die, several times a week, without good reason.

If you do, you are in exulted company. Celebrities including Michael Jackson, Barbra Streisand, Johnny Depp, and Cher reportedly suffer times of acute anxiety, while Sir Isaac Newton, Abraham Lincoln, Sigmund Freud and Robert Burns reported similar episodes in centuries past.

A conservative figure suggests 5 per cent of the population - or 200,000 New Zealanders - suffer from this type of general, uncontrolled anxiety, formally known as generalised anxiety disorder, or GAD. Typically, sufferers are anxious much of the time when a threat is not present. They can also suffer panic attacks - sudden and ostensibly unexplained bouts of acute anxiety that throw the body into "fight or flight" mode: head spinning, difficulty breathing, tense muscles, trembling, racing hearts and excessive sweating.

Severe sufferers report the feeling of being completely dislocated from their bodies, a kind of natural, nasty, outer-body experience.

These attacks can come at any time but are generally precipitated by a stressful event such as a looming deadline, an important meeting, or, at this time of year, tension-filled Christmas preparations. As well, GAD sufferers tend to be restless, easily tired, irritable, insomniacs and prone to hypochondria and phobias.

While the condition is serious and debilitating, it has not always been viewed that way by medics or society at large. Part of the reason may be that the behaviour of the GAD sufferer can simply seem neurotic to the unaffected. For example, one woman left an entire basket of groceries in aisle 8 of her supermarket once because she had passed the frozen fish, which reminded her "of trichinosis, which reminded [me] of [my] upset stomach last week, which led [me] to think must have a strange food-related disease, which left [me] feeling woozy, which further proved that it must be botulism that had and still have, which made [me] panic and run to the car".

As zany as this must seem, it's no joke to those whose thoughts and fears run riot.

"Excuse the pun, but this disorder can really drive you nutty," says Sue Akin, who works in advertising. "Particularly when there's really no reason for them [panic attacks] to happen. I'm a balanced person, I'm not depressed and have never suffered either depression or phobias. I'm neither high nor low - I'm pretty level most of the time."

Akin - attractive, fit and a highly successful 30-something - would not appear, to the outside world, to be someone with a debilitating disorder. And thanks to medication, she is capable of holding down a very high-pressure job and overseeing a large staff without problems. But it was not always that way.

Several years ago, without any warning - but at a time when several life events came to a head all at once - Akin woke up and couldn't breathe.

"I was clawing the air and stood straight up in bed and thought I was going crazy. That lasted for five minutes, and then there was a secondary anxiety of, 'If I go back to sleep, am I going to die?"'

She went to the doctor, who told her to get more sleep. Clued up enough to know her symptoms were more than just the result of sleep deprivation, Akin consulted a second doctor who diagnosed GAD and panic attacks, and gave her Anafranil, a drug that allowed her to carry on a normal life, free of acute anxiety.

Akin has tried to have spells off the drug, with disastrous results - holidays ruined from excessive worry, meetings disrupted. Without the drug, she reckons she might suffer up to six attacks a day.

Cindy (not her real name), a writer, also describes herself as pretty level - except when she's beset by panic attacks. A major move and relationship breakdown, which seemed fairly manageable at the time, exploded into bouts of mind-numbing anxiety several months later.

"I feel as if I'm having an outer-body experience, almost," she says. "My heart starts pounding and my knuckles go white."

Belinda (not her real name), from Rotorua, says she has always been an anxious person and reached the end of her tether one day when her two preschoolers and husband's long hours away from the family caused her to start crying, and landed her in the psychiatrist's chair.

"I cried for several hours and was assessed as suffering from anxiety disorder - it was like the light was switched on," she says. "I can't imagine what would have happened if I had not been given medication."

A mixture of medication and behavioural therapy is usually prescribed for patients suffering from GAD. Medication works because it treats the physical response to acute anxiety by correcting the levels of serotonin in the brain - low serotonin levels are a factor in both depression and anxiety (drugs such as ecstasy create euphoria because they flood receptors with serotonin). Prescription drugs such as Aropax and Anafranil bring serotonin bring back to normal levels.

But non-medicinal therapies are also useful. Akin's doctor, Steve Culpan says "cognitive behavioural therapy" - or teaching sufferers to think and behave differently when they feel the onset of a panic attack - is highly effective and bolsters the success rate of commonly prescribed drugs.

"Because the panic itself is so frightening, you commonly see patients with the fear of the fear. Essentially that's why people need to talk though what might precipitate the attack," he says. "But [behavioural therapy] does require effort on the patient's part."

Culpan says that in the past anxiety was usually treated with drugs such as Valium, which was habit-forming. But the problem needed a better solution as it had become so much more a part of modern life, or "faster living".

Societal factors certainly exacerbate anxiety, with the US and Britain reporting many more GAD sufferers than Italy or Denmark, for example - a result thought to be related to the pace of life. British psychologist Oliver James says the largely Anglo-Saxon, fast-moving, competitive, youth-oriented and divorce-filled society may be to blame. "We question everything: our material circumstances, whether we have an attractive enough partner. We even find our own personality needs to be improved, adjusted, made better."

But societal stresses will more likely trouble someone with poor patterns of coping established in childhood, say other experts. This can include pe ople who had an over-controlled and protected childhood.

And while not a definitive portrait, doctors in Britain have come up with a blueprint of someone likely to suffer from GAD, which goes something like this: approaching 40; a worrier since their late teens or childhood; someone who notices anxiety intruding more and more into her life. Someone who probably talks and eats quickly; finds it hard to sleep or wakes several times during the night. If in a relationship, the GAD sufferer seeks a great deal of reassurance from her partner, and often has a low libido, if not retreating from intimacy altogether.

The "hers" are deliberate: women suffer GAD at twice the rate of men. British Professor David Nutt (yes, his real name), who is writing a book on GAD, thinks the sex imbalance may have something to do with oestrogen, which affects the serotonin and noradrenalin receptors in the brain.

"It may also, of course, be that women are more open about their anxiety," he says. "When men are stressed they tend to turn their worry into physical symptoms such as backache, or become irritable and controlling."

Of course, women are also very likely to be orchestrating Christmas and other family-related celebrations, the usual stresses of which can make this time of year especially fraught for GAD sufferers.

Christmas-related or not, people who suffer from GAD and panic attacks should seek medical help if they can, as new medicines and more sophisticated diagnoses of the plethora of 21st century anxiety disorders emerge.

But some events will continue to be stressful regardless, and for this, some general rules of thumb will help those prone to GAD or simple festive burnout alike.

Clinical psychologist Gwendoline Smith says the psychologist working with The Sopranos' heavy man Tony Soprano said it best when she described Christmas as "Stress-mas".

"I've spent so many years in this field seeing psychiatric hospitals fill up and relationships break down at this time of year," she says. "And for what?"

Smith advises people to check how rational their thinking is as festivities approach. We should ask ourselves, "Do I need to spend excessive amounts of money on gifts?"

"The financial stress undertaken for just one day of the year - a day which, to most people, is just a recognised holiday with a commercial message underlying it - is unnecessary. Even the religious symbolism of the day is nothing to do with buying massive amounts of gifts."

Another helpful strategy is to ask whether what you are doing is helpful to you or your family. There is no particular need for perfection on this day, but so many seem to knock themselves out to ensure a perfect day for their family and friends.

"Also, balance is very important, including balanced partying and alcohol consumption. It's good to remember that December 25 is not the end of the world, you will be able to catch up with your friends next year. Moderation is the key."