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HEALTH WISE danger or need to escape, heart palpitations or shortness of breath, sweating, dizziness and/or chest pain. Six million Americans suffer from this disorder, which is also twice as likely to affect women. • Social Anxiety: This disorder, estimated to affect 15 million people, stems from the fear of being scrutinized or judged to the point where the sufferer may not be able to engage in conversation. Physical symptoms may include blushing, sweating, shaking, shortness of breath or a rapid heart rate. • Obsessive-Compulsive Disorder (OCD): People with this disorder harbor intrusive thoughts they cannot control and that often compel them to repeatedly perform ritualistic behaviors. They are often obsessed with cleanliness, germs or contamination. About 2.2 million people suffer from this disorder. • Post-Traumatic Stress Disorder (PTSD): This disorder is a form of depression and anxiety that affects people who cannot recover from an event that happened in their past, such as involvement in war or a personal attack. Women are twice as likely to develop PTSD, which affects 7.7 million people. Causes of anxiety and panic vary, from genetics to individual disposition to outside factors. But physiologically, Freeman says that research points to the adrenal glands located on top of the kidneys. "Too much adrenaline seems to trigger anxiety," she explains. Whereas engaging in physical activity, deep breathing and relaxation exercises can sometimes alleviate stress, people with anxiety disorders may not respond to these methods. "For most people massage is a good way to relax, but for someone cleanliness. Or they might spend the whole time consumed with fear that they will have an anxiety attack." It makes for a complicated situation, to say the least. IT'S ALL IN THE APPROACH Early Diagnosis Judith Olsen, owner of Wax and Lash Bar in Denton, Texas, fetters out clients who might be suffering from anxiety disorders via a thorough intake form that directly asks guests to list their medication. "If I don't recognize a medication listed, I immediately look it up online," she says. Freeman points out that some anti-anxiety medications, such as Zoloft, might be used to treat anything from depression to OCD, so it's important not to jump to any conclusions—but a thorough intake will provide a clearer indication of what's going on with a client. Talk is largely considered the best strategy to comfort an anxious client. "That's what we do in therapy," says Freeman. "We work to change the pattern of thinking." When serving a client who is jumpy or whose muscles are particularly tense (or who complains of stomach problems or asks frequent questions for reassurance), Freeman suggests providing constant explanation of what is happening during the treatment. Start by sharing the entire treatment protocol, and then continue your explanation, step by step, throughout the service. "For instance, 'We're doing this procedure and it will last for about five minutes. What you'll feel is this; my hands will be doing this, and so on—and if at any point you want to stop we will,' " suggests Freeman. "That kind of talk is very reassuring." Start treating just a small section of the face or body so that the client can get used to what's happening. A client with anxiety is very likely to ask a lot of questions, and answering patiently will help assuage her fears. An intuitive spa professional knows when a client needs In Traditional Chinese Medicine, that excess energy created when the adrenal glands are pumping and pumping away is called "empty heat," which throws the body off balance. Not surprisingly, acupuncture can be very helpful for people with anxiety conditions. "Acupuncture works to quiet and rebalance the energy that's not being directed appropriately," Freeman explains. "The needles also have a sedating effect." with an anxiety disorder, it can be a cause for panic," says Freeman. In addition to the claustrophobia and strangeness they might experience on a massage table, these clients' worries likely run deeper. "The person might be lying there thinking the therapist is feeling a lump somewhere on their body and that it's cancer," Freeman explains. "If they have OCD they might not be able to let go of thoughts about the spa's 104 DAYSPA | FEBRUARY 2013 to be asked whether they're comfortable or need any modifications. Make sure your focus is entirely on the client throughout the treatment. For those with anxiety disorders, all types of spa services can arouse fear. These clients are vulnerable— they are literally putting themselves in someone else's hands. Judith Olsen, owner of Wax and Lash Bar (waxandlashbar.com) in Denton, Texas, always uses a caregiver's approach with her waxing clients, many of whom exhibit fear and anxiety. "I'm kind of like a mother," she says. "I gain their confidence by telling them exactly what to expect and how to take care of themselves afterward. I also make small © THINKSTOCK Pointed Treatment "For most people massage is a good way to relax, but for someone with an anxiety disorder it can be a cause for panic."