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It was a hard act for Dr. Michelle Warren to follow: It was almost exactly a year ago to the day that sports host Michael Landsberg held a large audience at the Shaarey Zedek in thrall as he talked about his personal struggle with depression.

Interestingly, clinical psychologist Dr. Warren was also there that same evening on November 3, 2016 - to respond to any questions about depression that were better suited to be a to asked of a professional psychologist. The event then, as it was this past Thursday, November 2, was part of the Jewish Child and Family Service series titled “Can We Talk About…?”

This time around Dr. Warren’s subject was anxiety. Like Landsberg, she was able to refer to her own personal experience in dealing with the evening’s subject, as she admitted from the outset that she too has suffered from an anxiety disorder. The way she approached the topic though was more lecture style than personal recollection and, as she rattled off so many points in a relatively hurried manner it was somewhat difficult to keep track of everything she was saying. For instance, at one point Dr. Warren began describing specific anxiety disorders. She listed them with such rapidity it was hard to keep track.
What is an anxiety disorder? “First and foremost,” Dr. Warren explained, “it’s a feeling of fear.”
“It wouldn’t exist,” however, “if it didn’t serve an evolutionary, adaptive purpose,” such as the “fight or flight response” which developed in our earliest ancestors and allowed them to survive.
“When the fear is too great for the actual threat that is present, we call it ‘anxiety’, Dr. Warren added. And, the most common manifestations of anxiety disorders, she noted, are “stomach aches” – something many parents have heard their children say they have when they’re overcome with anxiety.
In fact, Dr. Warren said, children experience anxiety disorders more than any other problem, including Attention Deficit Disorder (although she seemed to use the terms ADD and ADHD interchangeably).

Here are the specific anxiety disorders that Dr. Warren described: OCD – Obsessive Compulsive Disorder; panic disorder; social anxiety; GAD – Generalized Anxiety Disorder; and specific phobias. While she went into some detail describing each disorder space doesn’t permit me to do that here. (Also, during the question and answer session one member of the audience reminded Dr. Warren that she hadn’t mentioned PTSD – Post Traumatic Stress Disorder.)
Approximately one out of four people will experience anxiety on a regular basis (but not to the point where it could be labeled a “disorder”, Dr. Warren noted), while one out of every ten people will suffer from some sort of anxiety disorder, she added.
Since it’s not easy to distinguish between a general feeling of anxiety and what could be described an as an anxiety disorder, being able to talk to someone knowledgeable about the difference is very important, especially for children. “Every kid should have the opportunity to talk to a “Talk Doc”, Dr. Warren suggested.
For instance, if your daughter (or son) is afraid they’re going to fail a test the next day even though she may have a 94% average, and she is staying up until 11 at night studying, she’s probably suffering from an anxiety disorder.
Dr. Warren admitted that she, herself, suffered from anxiety as a child. “I come from a long line of worriers,” she said. “I inherited bad sleeping from my dad.”

But, she noted, it’s only quite recently that scientific research has been able to show that anxiety disorders are largely biological in origin. Until new studies were conducted, which have just “emerged in the past 13 years” and, with the aid of various brain imaging tools such as MRIs and CAT scans – were able to show the biological basis for anxiety disorders, most anxiety disorders had been blamed on “parenting modeling”, Dr. Warren said.
Most parents will have dealt with their children being anxious over such things as being alone in the dark, she cited as an example; however, when the fear becomes obsessive, Dr. Warren suggested that parents engage in rewarding children who suffer from excessive fears of that sort each time they are able to go through the night with just a night light on.
Dr, Warren spent a good part of her lecture referring to psychological treatments for anxiety disorders, especially Cognitive Behavioural Therapy (CBT). She was particularly keen on using “mindfulness” as a tool – “a way of thinking centred around acceptance”, she explained, that focuses on “slowing down by doing breathing exercises.”

While the methods she suggested that could be employed in dealing with anxiety disorders were all perfectly valid, by the time members of the audience were allowed to ask questions it was evident that many of those who were at the Shaarey Zedek who are suffering from anxiety disorders had been taking prescription medications for their situations. As a result, many of the questions that were posed were about dosages and whether they should be taking different medications.
Another expert in the audience who was there to answer those types of questions was psychiatrist Dr. Cara Kroft. When questions about medications were asked, Dr. Kroft would field them, although it was awkward for her when certain individuals asked highly specific questions about decreasing the dosages of certain medications they were taking.

At one point though, a particularly poignant moment occurred when a mother described her 36-year-old son’s tragic inability to cope with his own anxiety disorder. In the mother’s words, her son’s marriage broke up two years ago over his anxiety disorder and he came to live with her. “His anxiety paralyzes him,” she said. “He’s just lost now; he can’t cope.”
As his condition worsened, one day she couldn’t find him, she said. Finally – she found him, hiding out in the garage behind some paint cans, afraid to come out. What could she do, she wondered?
At that point someone by the name of Christie stood up and said to the mother that she works for the Canadian Mental Health Association and that she, too, had suffered from a “total anxiety disorder” that left her totally unable to cope. “At one point I lost 20 pounds in one month,” Christie said, and her husband also lost 20 pounds - as a result of trying to help her cope. “But my husband coddled me,” she continued. “He treated me like a child, so I became a child.”
Eventually though, Christie sought treatment from a psychologist who told her she wasn’t mentally ill (which is what she had thought) and she began a successful course of treatment. But, the mother of the 36-year-old responded to Christie: “You can’t help someone if they won’t agree to get help.”
Dr. Warren noted that there are a variety of agencies equipped to deal with situations like that, especially “ADAM” (the Anxiety Disorders Association of Manitoba). And, if someone is wondering how to navigate the mental health system, the CMHA (Canadian Mental Health Association) has something called a “Service Navigation Hub”, she said, which can help someone get answers to the question that begins with “How do I get to….?”
“How do you get someone to seek help?” someone in the audience asked.
“You can drop a pamphlet” somewhere that they will see it, Dr. Warren suggested. You can also engage in “role modeling” she said. For example, you could start to practice meditation and a family member who is suffering from anxiety disorder “could follow”. At the very least you should contact one of the several agencies that are available in Winnipeg and which can offer advice how to deal with anxiety disorder. If a particular episode calls for immediate intervention, you can call the Mobile Crisis Response Service of the WRHA (204-940-1781) or the Winnipeg Police Service.
But, what if you’re in the middle of an anxiety attack, someone else asked, and even if you’re aware you’re having an anxiety attack, how do you get over it?
Dr. Warren’s answer was that you should “overlearn coping strategies”. For instance, she said that if you know you’re experiencing an anxiety attack, “lock your eyes on the stopwatch function of your iPhone” and “lower your rate of respiration”.
Still, she admitted, “it’s really hard to control your thoughts” when you’re not sitting in some nice office with your psychologist. Nonetheless, Dr. Warren stressed, “you have to keep practicing” (controlling your thoughts). “You have to learn it and know when you’re on fire.”
And, if you’re someone who suffers from an anxiety disorder, learn to recognize the symptoms, Dr. Warren suggested. “Tweak the way you talk to that person,” she said. “If someone says they have a really bad stomach ache, instead of saying ‘oh no’, say to that person, ‘anxiety is taking over’.”
As it was during Michael Landsberg’s talk on depression, the first step is coming to terms with an anxiety disorder is admitting that you or someone you know has a problem – followed by taking steps to contact those in the field who might be able to offer help.