You probably met at least one person who had an anxiety attack. They saw a dog and started shaking even if the dog was at the far end of the street. You might have come across someone who comes into a closed room and runs straight to the window saying; “there’s no air here!” You may have met someone who won’t take an elevator even if they need to get to the 50th floor! Or maybe you met someone who will never get on a plane.
“Anxiety is a widespread problem in an otherwise healthy and functioning society” Says Merav Lavi a marital counselor and psychotherapist. “Statistics show that about 12% of the population suffers from anxiety attacks at least once in their life and it is the 4th most common disturbance. It should be noted that 50%-60% of those who suffer from anxiety also suffer from depression. Both of these mental ailments often come together,”Lavi says.
In truth, most of us experienced one fear or another in our life. Sometimes it can paralyze us and sometimes we can carry on. Is there any problem with that?
“Anxiety and fear aren’t exactly the same thing,” explains Merav, “we can feel fear in our hearts but anxiety will be felt in our bodies. A part of our brain called the amygdala is responsible for the body’s response to fear. When a person is truly afraid his hand will tremble and sweat, his heartbeat will speed up, his blood pressure will go up and other reactions happen. These reactions are part of our body’s protective mechanism and they are important. But when the amygdala sets off these reactions without being stimulated by fear the body still goes into its protective mode to fight off the threat that doesn’t exist. This is like a smoke detector that goes off to warn you of fire. But if you’re broiling a liver on the stovetop, the alarm will go off any way even though there is no threat or danger.”
Merav illustrates; if you rub on a string you may hear a faint sound. But if you stretch the string across a guitar then when you strum it you’ll hear it quite loud because the guitar is an echo chamber to reverberate the sound of the string and amplify it. The fear is our guitar string and the echo chamber that amplifies it is our thoughts. A person that feels fear in his heart and thinks he’s in danger will become more scared. His thoughts will amplify his fears which will bring on the body’s reaction to fear ‘fight or flight’ with all the symptoms we mentioned before.
When a person feels his heart was beating fast he’ll tell himself; “I must have exerted myself and that’s why my heartbeat is fast. It’s not pleasant but it will soon pass.” That thought itself is reassuring and brings calm. But someone else will say; “if my heart is beating rapidly I must be having a heart attack!” then his heart will start beating more rapidly and his breathing will speed up. They may feel they are going to die from this fear and, if it keeps up they fear they’ll go crazy.
“A person who becomes afraid to be afraid creates anxiety. He is afraid of a repeat attack and it becomes a self-fulfilling cycle which keeps the fire of anxiety burning the whole time. He won’t leave his house and he will avoid anything that may bring anxiety or he won’t go into a place he feels he won’t be able to escape from if he gets an attack. In this manner he ‘protects himself’ but he never lets go of the anxiety. He is convinced that if he is exposed to something that may cause him anxiety he won’t come out of it unscathed. As long as he avoids confronting the fear it will intensify and he will never find the remedy he needs.”
What kind of anxieties do people come to you with for treatment?
“Anxiety is a general name for many different things; post trauma after a traumatic experience or loss of a family member, social anxiety which paralyzes people who are afraid to look like fools in front of others, specific fear triggered anxieties like fearing dogs or the fear of blood and more. But there is a general anxiety where a person steadily believes that bad things will happen to him. Here’s where you’ll find the over-protective mother who won’t let her child go on a school trip or might call them many times each day to make sure they’re still okay. This general anxiety is defined as an anxiety that causes the person to believe his worrying is what is really protecting himself or his loved one from harm. And if G-d forbid, something happens it’s his/her fault because they didn’t protect them enough and that’s why it happened.”
If you ever asked yourself how to treat anxiety Merav points out that you don’t always need to treat it. “There’s a rule if it’s not broken don’t fix it”. Meaning that if this fear doesn’t disturb your daily routine and function then keep on going full speed ahead! You don’t need to treat this. For example, a woman who is deathly afraid of dogs but lives in a neighborhood where people don’t have dogs, she’s safe! She won’t meet her triggers and doesn’t need treatment. But if a neighbor right under her had a dog and she doesn’t leave her building because of it she should definitely seek treatment for it instead of suffering unnecessarily form her paralyzing fear. If she doesn’t she will potentially develop more and more anxieties and stop doing more and more things because of this fear. This will limit her abilities and options in life.”
Merav points out that if you do decide on seeking treatment, as opposed to the old method which entailed going to a psychologist for a long and drawn out treatment it is now accepted to use the CBT method which yields fast and effective results. CBT stands for Cognitive Behavioral Therapy which is based on the patient’s recognition that what he thought was fearful is not really so. The patient is assisted by the therapist to attack his assumption that something will happen / a dog will bite him/ there will be a terror attack/ etc. and to recognize that it isn’t so, on his own.
“The great benefit of CBT is that it is a short term treatment with long term results. It is based on the idea that gently and gradually exposing the patient to his fear he will eventually get over it bit by bit. The combination of facing the fear and logically understanding that it’s not as bad as he thought slowly minimizes the fear and he will have no reason to fear the fear. Even if he did nothing the fear would eventually subside. Many people think they need to stop the fear by breathing deeply or taking a pill or saying a verse of psalms, etc. The point here is to show the patient that even if he does nothing the fear will subside on its own.”
After that realization the patient together with the therapist create a ladder, a hierarchy of fearful things from lowest to highest. For example: if he is afraid of going into elevators so he will challenge himself with “going in a glass elevator 2 floors up accompanied by a friend.” On the top of his fear ladder may be going up 50 flights in a closed elevator unaccompanied by anyone.” There will be a middle of his ladder with different levels of fear leading to the most fearful. When the patient faces his fear, quite often accompanied by the therapist, and gets the support he needs he gradually overcomes those fears.
“Being exposed to the fear trigger is not simple but when you explain to the patient what you’re doing together with him every step of the way stressing the importance of each step you can win over his cooperation over and over again even when he wants to pull back.”
What about medications? Are there situations that warrant taking medications?
“There are definite situations where it is worthwhile to assist the patient’s treatment with medication. If there is such a need it is better to use short term tranquilizers as opposed to long term ones. The problem with the medication option is that it reduces a patient’s motivation to treat the fear by facing it; the medicine ‘took away’ the fear. We want the patient not to fear the fear. So if medication is used the patient will be told that the medication is temporary to minimize the fear initially until he is more ready to face it and ultimately not need the medication and let go of his fears.”
What is the success rate of these treatments? Can a person totally get over his fears?
“Definitely!” Merav informs us. “The success rate is very high and long lasting. The effectiveness doesn’t wear off long term. This can bring a person to live his life to the fullest, happy and healthy without the fears that used to paralyze him.”