January 31, 2011 A Home Treatment Kit for Super Bowl Suffering By BENEDICT CAREY Every year scientists report that watching the Super Bowl is somehow unhealthy, even dangerous. Large bowls of snacks encourage overeating. Traffic accidents may increase after the game, too. This year, a study in the journal Clinical Cardiology released on Monday warns that a loss by the hometown team in the big game leads to .increased deaths in both men and women, and especially older patients.. One of the authors said in a press release that .stress reduction programs or certain medications might be appropriate in individual cases.. Therapists in Wisconsin and Pennsylvania are prepared. Most have seen plenty of people who suffer from what could be called Football Attention Neurosis (F.A.N.), in their practices, in their living rooms, and sometimes in the mirror. .The belief that these patients have is that the world will end if the Steelers . uh, I mean, their team loses,. said Mark Hogue, a psychologist at Northshore Psychological Associates in Erie, Pa., who owns a trunkload of Pittsburgh Steelers paraphernalia, including a Snuggie. .As a therapist, you need to take that fear seriously.. .Many patients, it needs to be said, will be self-medicating,. said Ursula Bertrand, a psychologist in private practice in Green Bay, Wis. .This can be helpful, but in excess it can also make anxiety attacks more likely.. The causes of those attacks are very specific to the fan.s team, experts said. A patient with an attachment to, for instance, the Green Bay Packers may be especially symptomatic if he or she sees the team.s quarterback running unprotected with the ball, especially if that quarterback has suffered previous concussions. The same patient might also suffer heart palpitations .whenever the Packers go out to receive a punt,. said Bradley C. Riemann, director of the Obsessive-Compulsive Disorder Center and cognitive-behavioral therapy services at Rogers Hospital in Oconomowoc, Wis., who has tickets to the Super Bowl and often travels to follow the Packers. In contrast, a patient with an attachment to, for example, the Steelers might experience stabs of panic whenever he or she sees the team.s offensive line try to protect its quarterback from a surging defense. .They.ve had so many injuries on the line that it can be very hard to watch. for the patient, said Sam Knapp, a psychologist in Harrisburg, Pa., who records every Steelers game and watches only the victories. Clearly, there.s a need for guidelines to deal with such patients. The following are derived from years of observations in the field and conversations with hundreds of sufferers of F.A.N. No licensed professional had, or would have, anything to do with them. They are the therapy version of fantasy football. However, unlike many medical interventions, you can try these at home. Treatment Guidelines Football Attention Neurosis I. Establishing a Therapeutic Alliance (Pregame) Patients often arrive on the couch well before kickoff, agitated and highly resistant to treatment. Proceed with care. Attempts at small talk or queries about their mental well-being may at first be met with an irritated stare, a gesture toward the flat screen and insensitive remarks like .Do you mind?. or .The game.s about to start, O.K.?. This is the disorder talking, not the person. It also provides an opportunity to establish trust, by sitting with the sufferer and his or her feelings. A strong alliance is essential going forward, because it is often the case that treatment will involve asking the patient to do things that may be frightening or profoundly uncomfortable, like sitting quietly with eyes open as an erratic kicker attempts a late field goal. II. Evaluating the Severity of Impairment (First Half) The severity of the disorder will usually reveal itself early in the first half of the football contest. Some patients will exhibit physical symptoms, including flushing, heart palpitations, chest pain, even a choking sensation, when their team chokes. Others may show psychological signs, like disorientation, a numbed trancelike state, or disordered vocalizations like .What the...,. .How in the name of...,. .Oh, lord, no.. .Tell me that didn.t just happen!. is another characteristic rhetorical reaction to an undesired play in the contest, almost always followed by this remark: .I can.t watch this anymore.. Caution: Do not approach patients in these moments. They are fragile and prone to hurling nearby objects, including mini-bagels, plastic cups, pigs in a blanket . even themselves, in extreme cases, to the floor. The time to complete the assessment is during commercial breaks, which are frequent and lengthy. Be sure to determine the family history (sample question: .Was your mother buried in a Reggie White jersey?.) and to make a careful review of medications, including nutritional supplements, prescriptions and a rough count of the 40-ounce malt liquor cans arranged like a mini-Stonehenge around the couch. III. Formulating a Treatment Plan (Halftime) Patients ritually leap to their feet and disappear at halftime. This break allows the therapist time to develop an intervention for the second half, when symptoms are most severe and disabling. The goals of treatment are the same for all patients: to reduce anxiety, to eliminate avoidance behaviors, to soothe physical symptoms like sleep loss, chronic groaning and cursing at the TV and the pets. Yet each individual suffers at different times and for different reasons, and the treatment plan must be tailored accordingly. IV. Administering Therapy (Second Half) The first commercial break after the second-half kickoff is the time to explain to the patient that his or her suffering is rooted in cognitive misconstruals, automatic assumptions that do not stand up to scrutiny. For example, beliefs like a player .always fumbles. or .never makes late kicks. or .couldn.t cover my grandmother. represents an overestimate of risk. Each player is competent; each has succeeded in the past; all could cover Grandma, even on a slippery field. Likewise, the notion that world will end if the patient.s team loses . catastrophizing, as this sort of thinking is known . does not stand up to the evidence. Remind the patient: Life resumed after each previous loss that the team suffered. And, in time, taste returned to food, colors became visible, feeling returned to extremities. Breathing exercises are highly recommended and become increasingly important as the football contest nears the fourth quarter, when events on the field are likely to prompt strong physiological reactions, like a pounding heart, hyperventilation, even dizziness. These internal cues, as they.re called, can escalate the feeling of panic, a self-reinforcing cycle resulting in groans and cries that can be frightening to small children, pets and sometimes neighbors. In the final minutes of the game, be forewarned: Many patients will move beyond the reach of therapy. Their faces may change, their breathing appear to stop. Researchers have not determined whether this state is closer to Buddhist meditation or to the experience of freefall from an airplane. All that is known is that, once in it, patients will fall back on primal coping methods, behaviors learned in childhood within the cultural context of their family. Like emitting screams. Or leaping in an animated way, as if the floor were on fire. Or falling on their back and moving their arms and legs like an overturned beetle, in celebratory fashion. Important note to therapist: At this point, if you are rooting for the same team as the patient, it will not violate ethical standards to join in. -- ------------------------------ * Dr. James Ellingson, jellings(a)me.umn.edu * * mobile : 651/645-0753 * * Great Lakes Brewing News, 1569 Laurel Ave., St. Paul, MN 55104 * * james(a)brewingnews.com James.Ellingson(a)StThomas.edu *