Fear Not!
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In many
cases, the brain may think it's doing the child's psyche a
favor by developing a phobia. The world is a scary place,
and young kids are inherently fearful until they start to
figure it out. If you are living with a generalized sense
of danger, it can be profoundly therapeutic to find a single
object on which to deposit all that unformed fear - a snake,
a spider, a rat. A specific phobia becomes a sort of backfire
for fear, a controlled blaze that prevents other blazes from
catching. "The thinking mind seeks out a rationale for the
primitive mind's unexplained experiences," says psychologist
Steven Phillipson, clinical director of the Center for Cognitive-Behavioral
Psychotherapy in New York City.
But a condition
that is so easy to pick up is becoming almost as easy to shake,
usually without resort to drugs. What turns up the wattage
of a phobia the most is the strategy the phobics rely on to
ease their discomfort: avoidance. The harder phobics work
to avoid the things they fear, the more the brain grows convinced
that the threat is real. "The things you do to reduce anxiety
just make it worse," says Barlow. "We have to strip those
things away."
And that's
what doctors do. A patient visiting Barlow's Boston clinic
is first assessed for the presence of a specific phobia and
then guided through an intensive day or two of graduated exposure.
People who are afraid of syringes and blood, for example,
may first be shown a magazine photo with a trace of blood
depicted in it. Innocuous photos give way to graphic ones,
and graphic ones to a display of a real, empty syringe. Over
time, the syringe is brought closer, and the patient learns
to hold it and even tolerate having blood drawn.
None of
this is remotely easy for the phobic person, and the body's
anxiety Klaxons may go off the instant the therapy begins.
Gradually, however, as each exposure level is reached, the
alarms start to quiet; they sound again only when the intensity
of the exposure is turned up. "Just as people become habituated
to the noise of traffic or background chatter, so too can
phobics become nonresponsive to the thing that once frightened
them," says Phillipson.
With that
habituation comes profound recovery. In studies recently conducted
by Lars Goran Ost, a psychology professor at Stockholm University
and one of the pioneers of one-day phobia treatments, a staggering
80% to 95% of patients get their phobias under control after
just one session. And when symptoms disappear, they usually
stay gone. Patients, he says, rarely experience a significant
phobic relapse, and almost never replace the thing they no
longer fear with a fresher phobia object.
Given the
apparent simplicity of exposure therapy, phobics may be tempted
to try it themselves. That can be a mistake. It is important
that exposure take place under the care of a professional,
since it takes a trained person to know when patients are
being pushed too far and when it's safe to go further. For
some situations impossible to re-create in a doctor's office
- like heights and flying in airplanes - virtual-reality programs
are available to provide simulated exposure under professional
supervision. Software for other fears is being written all
the time. "Not all people respond to virtual reality," says
Barlow, "but on average, it's just as effective for treating
certain phobias." If specific phobias were the only type of
phobias around, things would be decidedly easier for doctors
and patients. But the two other members of the phobia troika
- social phobias and panic disorders - can be a little trickier.
Of the 50
million Americans who have experienced or will someday suffer
from a phobia (and many will have more than one), 35 million
will suffer from social phobia, and the battle they fight
is a harrowing one. Richard Heimberg at Temple University's
Adult Anxiety Clinic often thinks of the 50-year-old patient
who talked frequently about getting married and having a family
- a reasonable dream, except that his terror of rejection
had kept him from ever going out on a date. After much encouragement
and counseling, he finally screwed up his courage enough to
ask a woman out. The next day, when Heimberg asked him if
he'd had a good time, he said yes. But when asked if he were
going to invite her out again, the patient slumped and said
no. "She's only going to give to charity once," he explained.
For this
patient, the problem wasn't mere low self-esteem but outright
terror. To a social phobic, the mere prospect of a social
encounter is frightening enough to cause sweating, trembling,
light-headedness and nausea, accompanied by an overwhelming
feeling of inadequacy. For some sufferers, the disorder is
comparatively circumscribed - occurring only at large parties,
say - making avoidance strategies seem easy. But social phobias
can encroach into more and more areas of life, closing more
and more doors. As sufferers grow increasingly isolated, they
grow increasingly hopeless and risk developing such conditions
as depression and alcoholism.
But things
don't have to be so bleak. While social phobias do not respond
to a single intensive exposure session as specific phobias
do, therapy can still be relatively straightforward. A successful
treatment regimen may involve no more than a dozen sessions
of cognitive-behavioral therapy, in which patients slowly
expose themselves to the places and circumstances that frighten
them and reframe the catastrophic thinking that torments them.
They are taught to tone down their "attentional bias," a tendency
to stress their supposed social stumbles, and their "interpretation
bias," a habit of picking up neutral cues from other people
and interpreting them as evidence of failing socially. Often
group therapy works better than one-on-one therapy. It provides
more than a supportive circle of fellow sufferers: the very
act of gathering with other people can serve as a first, critical
rebellion against the disorder.
MORE>>
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April 2, 2001 | No.
13
COVER
STORIES
Dread
Heads
Scared? You're not alone-millions of people suffer from debilitating fears.
But science is devising cures for every anxiety, from ablutophobia (fear
of bathing) to zoophobia (fear of animals).
THE
ARTS
CINEMA: In the Mood for Love delights and
mystifies
A gender-bending Thai film takes on the
world
BOOKS:
Calling from Carverland
TRAVELERS
ADVISORY
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