Almost everyone has something that can cause him or her to feel anxious. Maybe it’s making a public speech, taking a test, encountering an unfamiliar dog, or riding in a crowded elevator.
For many people, that feeling quickly passes. For others, the fear can become chronic and debilitating.
To make sense of anxieties and obsessive compulsive disorder, KET’s Connections talked with Kevin Chapman, a licensed clinical psychologist in Louisville. He discussed anxiety disorders and therapy options for treating them.
Although it doesn’t feel good to experience anxiety, Chapman says some amount of it is normal.
“Anxiety by definition is supposed to help us meet the demands of our environment,” he says. “It’s supposed to help us prepare for things that may or may not occur.”
If a person has a strong physiological reaction to an uncomfortable experience, such as speaking to a large crowd or having a turbulent airplane flight, then the brain establishes a powerful negative memory around that event. Chapman says the next time that person encounters that situation, or even just thinks about it, they are likely to feel the emotion of anxiety.
But it’s important to note that fear, anxiety, and panic are not the same things.
“Fear is a true alarm – I’m really in danger. Panic, on the other hand, is what we call a false alarm – it’s the fear response out of context,” Chapman says. “When I’m anxious, fear and anxiety can go hand in hand and culminate to having a panic attack… because I’ve convinced my body that that situation is dangerous when in fact it isn’t.”
Chapman says that if there is no external threat, the person can turn their panic inward, causing them to focus even more intently own their own reaction. He says that only intensifies the person’s feelings of anxiety and panic.
Social and Performance Anxieties
Another type of anxiety is social anxiety, or the fear of being negatively judged by others. Chapman says 15 million Americans experience social anxiety, making it the third most common mental health condition in the United States.
“The reason that it is (so common) is because any social situation you find yourself in has the potential of negative evaluation,” he says. “If I’m sensitive to negative evaluations, then social anxiety certainly can be chronic and be a problem.”
Young people are especially prone to social anxiety because they are at an age when they are trying to develop their own identities while they are also navigating intense peer pressures. Chapman says the problem is more pronounced among today’s youth because social media has made negative commenting and online bullying more accessible and widespread.
Students can also be prone to performance anxieties related to taking tests, playing sports, performing on stage, or making speeches before their classmates.
“It makes sense that the fear and pressure to perform is more pronounced in young people because there’s real and perceived pressures with that,” Chapman says, ranging from “being able to maintain grades to being involved in various extracurricular activities that matter early in life to prepare you for college.”
There can also be cultural and socioeconomic components to anxiety. For example, a situation that may be mildly unsettling to a white person, such as an encounter with a police officer, can be very threatening to a person of color. Chapman says people who live in high-crime neighborhoods with frequent exposure to violence can develop emotional problems as well as long-term health consequences like high blood pressure.
Although there isn’t a genetic component to anxiety, Chapman says children can learn anxiousness from behaviors they experience in their parents or other family members. He says children who have an anxious parent are three to seven times more likely to develop an anxiety disorder than a child of a non-anxious parent.
When a young person or adult is able to respond to their feelings in an adaptive way, the anxiety usually dissipates. But if the feeling lingers and becomes chronic, it can lead the person to avoiding the people or situations they deem as threatening. Such avoidance can impact relationships with family and friends and impede school, work, or social activities.
“If I’m withdrawing from those things for an extended period of time, for say a month or more,” Chapman says, “that’s typically a sign that my behavior and my activity level have declined to the point of needing professional help.”
Medications can help those who suffer from an anxiety disorder, but Chapman says the “gold standard” of treatment is cognitive behavioral therapy, or CBT. That teaches the patient that their emotions have three parts: thoughts (how they think about themselves or other people), physical feelings in the body (increased heart rate or shortness of breath), and behaviors. The combination of those three factors fuels the person’s emotional experience of a situation and their response to it.
By gradually exposing patients to a threatening or stressful scenario, Chapman can help them learn how to appraise those situations in new ways, and to learn how those new thoughts can foster new physical and behavioral responses. As these new actions become more ingrained, patients see that they are capable of handling things once considered scary in more productive, adaptive ways.
With some patients, Chapman uses virtual reality as part of his CBT treatment protocol. The patient wears a special headset that fills their field of vision, and headphones that provide an audio accompaniment to what they are seeing. A computer program manipulates a variety of stimuli so the patient can experience the fearful situation in a carefully controlled manner. Through the immersive nature of VR, the patient can experience flying in an airplane or standing before a crowd to make a speech, all in the comfort and safety of the therapist’s office.
“They would actually learn how to process that [situation] differently, so therefore when it’s time to do the real thing, they’re able to manage that a whole lot more effectively,” Chapman says.
CBT treatments can be brief and intensive, or more gradual, but Chapman says most patients find success in as few as eight sessions.
Another chronic condition that can be addressed using CBT is obsessive-compulsive disorder. Chapman describes OCD as a cycle: A person develops a fear that if they do x, then y will happen. That creates anxiety, which leads to a certain behavior they hope will alleviate the obsession.
“The next time I get triggered by the fear,” he says, “I engage in that same response or compulsion to make me feel better. But that distress always returns and I have to continue this vicious cycle.”
For example, if someone fears contamination from touching a stair rail, they may compulsively wash their hand afterwards to prevent themselves from contracting a disease. In therapy, Chapman says he would have the patient touch a railing but then not let them wash their hands. When the patient doesn’t contract a disease, they learn that the action doesn’t lead to the reaction they expect, and the hand washing becomes unnecessary.
“Teaching the person how to confront the stimuli that they deem as distressing in a way that forms a new learning experience in their brain – and therefore eliminating rituals or responses – is the way that you treat OCD,” he says.