Facing Your Fears

I’m not sure why it’s being touted as the latest, greatest thing in therapy, but the Wall Street Journal is reporting that the Mayo Clinic has started to treat anxiety with exposure.

Therapists have finally overcome the idea that they can cure anxiety by teaching a few mental tricks. They now believe that immediate, though gradual exposure to the object or situation that is causing the anxiety is the most helpful.

More precisely, therapists are training their anxious patients to overcome their fears by facing them. Think of it, a great new idea: don’t run away from your fears; meet them head on.

If your child is suffering from anxiety, you do him no good, the report continues, by sheltering him from situations that would provoke anxiety.

Children gain confidence by learning to deal constructively and effectively with what they fear. They lose confidence when their parents make it impossible for them to do so.

When they lose confidence, they become depressed and are put on anti-depressants.

As I say, this is not news. In days of yore, people who refused to face their fears were called cowards. Thus, they were shamed into working to overcome them.

It was properly considered an ethical, not a clinical issue. It was fundamental to the ethics of courage. Protecting a child from dangerous situations does not enhance his courage. This much should be self-evident.

As it happens, this has all been part of the armorarium of behavioral and cognitive therapists for quite some time now. It is, or should be well enough known that behavioral therapists have had good success with some phobias by offering gradual exposure to the dread object or situation. Gradual exposure desensitizes the phobic individual to the potential danger and thus retrains him out of his phobia.

It does not take too much of a leap of faith to apply the same technique to various kinds of anxiety.

While a phobic individual can identify the object or situation that triggers a panic attack, an individual suffering from anxiety might tell you that his anxiety is more diffuse.

Psychoanalysts have jumped on this description as an excuse to try to cure it with insight. If you do not know why you are anxious, then the cause must be buried deep in your unconscious mind.

Freudians believe that all of your anxieties derive from the castration anxiety a child feels when he fears his father’s wrath. Obviously, castration anxiety threatens an offending and sinning organ.

Psychoanalysis has never had any great success treating anxiety or phobias. As everyone knows cognitive and behavioral treatments are far more effective and far less costly.

Yet, Freudian theory is based on anxiety. Freud saw anxiety as the most important human emotion.  Since he saw human motivation in terms of detective fiction, he placed a special emphasis on the anxiety you feel when you are anticipating punishment for a crime... of word, thought, or deed.

In particular, that type of anxiety is called guilt.

If Freudian treatment cannot cure a problem that falls within its bailiwick, what good is it?

Psychoanalysts erred in assuming that an anxious patient who was not phobic was not afraid of anything in particular. An anxious child might be afraid to take a test, might be anxious about social interactions or might be anxious about trying out for the football team.

Some children are anxious about local and world events, especially the kinds that are likely to threaten them.

In most cases, therapists should question their patients until they gain a clearer idea of the nature of the threat, real or imagined.

Second, they should recognize, as Aaron Beck noted many years ago, that when children and adults are anxious they are not anxious about nothing. Nearly everything that people are phobic about is potentially dangerous.

Third, therapists and parents need to develop a plan that allows a child to be exposed to anxiety-laden situation gradually. If a child demonstrates avoidant behaviors in situations that are less fraught, these should be addressed and overcome first.