SelfhelpMagazine

by Marc D. Feldman, M.D.

Anxiety: A Universal Experience
Anxiety is a sensation common to most people. Anxiety—at least when it is only mild—is not only normal but often desirable. It propels us out of complacency and, as long as it's not severe, enhances the way we perform.

The person who is a little anxious during a test, for instance, is more attentive and attuned, and so he or she is likely to score better. A little anxiety can be helpful, but too much anxiety can stop us from performing at all.

Anxiety is nonetheless a genuine problem for many of us. Over 12 million Americans experience such frequent or severe anxiety that they seek treatment. And across the world, anti-anxiety medications are the most commonly prescribed drugs.

Whenever you experience problem anxiety, a number of questions should run through your minds—and those of your doctors. First, is the anxiety related to a particular /situation/? Is there a /physical/ explanation? Or do you have a formal /anxiety disorder/? Within the last category are the /phobias/, and in this article I'll consider a subtype called /specific phobia/.

Specific Phobias: Discrete Fears
The fear of flying (aerophobia) is one of the most common forms of specific phobia, afflicting 25 million Americans. Many people who are otherwise self-assured are reduced to near whimpering at the thought of boarding a plane. As the term /specific phobia/ suggests, afflicted individuals fear /particular/ stimuli or situations.

For example, most of us have an undeniable distaste for things that creep or crawl, such as spiders (arachnophobia). But such fears are not necessarily phobias. Only for truly phobic people do such fears cause disruption of their lifestyles.

They may shop only on the ground level of a mall because of a fear of heights (acrophobia), refuse to walk on the street because of the risk of encountering a wayward cat (ailurophobia), or walk up 20 flights rather than get into an elevator (claustrophobia).

Such phobias tend to begin either in childhood or early adulthood, and they also tend to occur in multiple members of the same family. Although easy targets for humor or derision because of their odd and colorful qualities, phobias can actually be as disabling as any physical illness, such as diabetes, heart conditions or arthritis.

Solutions for Phobias
Behavioral therapies have a special role to play in overcoming all of the different types of phobias. "Systematic desensitization" is a time-honored technique that has been proven by research to be remarkably effective. In systematic desensitization, the therapist first teaches the patient muscle relaxation and deep breathing techniques, then aids the patient in imagining increasingly fearsome situations.

As anxiety increases, the person learns to calm themselves, step by step, until they can tolerate more and more thoughts about the previously anxiety-arousing object or situation. Anxiety is quelled by the new relaxation skills until the original stimulus is not nearly so frightening.

In contrast, another technique known as "graded exposure" presents the patient with the actual stimulus in the real world, but in small increments that he or she can tolerate. A person who is afraid of dirt on her hands, for example, is asked to identify a couple dozen steps that lead to greater and greater amounts of anxiety.

She then would be guided by the therapist to engage in each of those steps, one at a time until she can completely control the anxiety at each step. This continues for activities such as putting a fingertip into a little dust, then two fingertips, etc, until at the end of the therapeutic process, the psychotherapist helped the person tolerate anxiety of each of the steps the patient has indentified as difficult. The last step is the most anxiety producing, such as in this case, the worst step might be immersing both hands in a pile of dirt outside for 5 minutes.

Graded participant modeling/ is an indirect route that can be effective. Here, the patient observes a fearless person interact with the phobic stimulus (for example, by touching and holding a snake or dog) until he or she gains enough courage to try it firsthand. In /flooding/, the patient is exposed at full intensity to the stimulus or situation he or she fears most; because one can sustain peak anxiety for only so long, the panic inevitably begins to wane and with it the phobia.

Most recently, /cybertherapy/—using computers as therapeutic tools—has joined the list of treatment options in specific phobia. The software Spider Phobia Control, for instance, presents the arachnophobic person with computer images ranging from a genial cartoon spider to a video of an actual tarantula. Enterprising clinicians and researches will no doubt develop even more sophisticated techniques as they seek to conquer "fear itself."

References:

Feldman MD, Feldman JM. Stranger Than Fiction: When Our Minds Betray Us. Washington, DC, American Psychiatric Press, Inc., 1998

Pull CB. Recent trends in the study of specific phobias. Curr Opin Psychiatry 2008; 21:43-50

Ziomke K, Davis TE 3rd . One-session treatment of specific phobias: a detailed description and review of treatment efficacy. Behav Ther 2008; 39:207-223

About the Author:

Marc D. Feldman, M.D. is the author of "Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder" (2004) and co-author of "Stranger Than Fiction: When Our Minds Betray Us" (1998).