In the last 20 years the behavioral approach to therapy has revolutionized the treatment of persistent phobias and obsessive-compulsive rituals. This approach is based on old principles, but these are applied with a new thoroughness that can bring reliable relief of suffering that previously might have continued unchanged for decades. Behavior therapy does not assume that phobias and rituals are symbolic transformations of hidden difficulties. Instead, it regards the phobia or ritual itself as the main handicap and tries to eliminate this handicap directly—not by uncovering unconscious meanings, but by teaching the sufferer how to face those situations that trigger discomfort and how to eventually come to tolerate them. For some people, problems that have been present for 30 years or more have been overcome in a few hours of exposure over a couple of days.

Effective treatment usually taxes somewhat longer though— perhaps several weeks to months.

Not all behavioral methods are equally effective. Relaxation for anxiety is often called a behavior therapy, but it does not reduce phobias or rituals. The many variants of behavioral approaches that are effective have in common the principle of exposure to that which frightens you until you get used to it. Once you confront your fear with determination, it will diminish. We don’t know quite how or why this method works. But it does work, provided that exposure continues long enough.

In fact you can observe the process at work even with very simple animals. If you touch the antennae of a snail, they will quickly retract; after a minute or two the snail will put out its antennae once more. Touch them again and they will be drawn back a second time, but on this occasion a bit less quickly, and after a shorter interval they will creep out again. Touch them a third time, and a fourth time, and a fifth, and progressively the snail will get used to your touch and its antennae will eventually stop retreating from your finger. Through repeated exposure to this provoking activity, the snail’s “anxiety” has been extinguished. This simple process, called habituation, is similar to the way that phobics and ritualizers react during exposure therapy. Habituation has been shown to last for weeks in snails and for many years in humans. In other words, improvement in phobic and ritualizing behaviors can endure, provided that the habituation by exposure has been sufficiently thorough.

You may be getting impatient at the testimonials from patients. “That’s all very well,” you might think, and not without justice, “but we all know about miracle cures that can’t be repeated. Will it work for me? What’s the scientific evidence that exposure treatments work reliably for most people with my kind of trouble?”

In many controlled studies, behavioral exposure treatments were found to be significantly more effective than other anxiety treatments in improving phobias, rituals, and sexual problems. They worked better than contrasting methods, such as relaxation or analytic types of insight psychotherapy. Moreover, the improvement doesn’t disappear after a few weeks. Patients who improved tended to stay that way over the two to nine years they were followed up after discharge. Improvement in their anxiety freed them and their family from the restrictions that formerly hemmed them in.

One thing may not change with exposure treatments. Before treatment many sufferers from phobias, panic and obsessions have a tendency to get depressive spells. Even after they lose their specific anxieties, this tendency to depressive spells may not change. If and when it happens to you, it can usually be dealt with adequately by antidepressant medication from your doctor.

Self-Help Clubs

Sufferers of many different kinds find it helpful to join lay groups of people who have problems similar to their own, so that they can share common experiences, learn helpful tips about how to cope, and have an additional social outlet. People with anxiety are no exception. In Britain a national correspondence club called The Open Door at one time had about 3,000 members.

Similar organizations exist in the United States, Canada (Vancouver), Australia, and Holland. Agoraphobics can club together for outings, help run children to and from school, arrange programs to retrain themselves out of their phobias, and organize many other activities. A few people are reluctant to join because they are afraid that listening to other people’s troubles will make their own worse. In general this does not happen.

The important point is not to make the club a complaint or grouse group just out to swap complaints, but a mutual aid society devoted to overcoming problems. This has been done in many ways. People with phobias about eating in restaurants went to lunch together, supporting and encouraging one another as they ventured out together. Others with flying phobias banded together in an organization called Air Fraidy Cats, chartered an airplane, and after preliminary instruction went for a group flight together. Club members can help one another even if their phobias are not the same.

A driving phobic and a walking phobic worked closely together, together driving on various highways and walking in several stores, thus helping both themselves and each other.

Yes. While many Anxiety Disorders can be effectively treated by primary care physicians, general psychiatrists, psychologists, and by patients themselves, some require a more specialized approach. There are individuals and groups who deal with Anxiety Disorders as a specialty area. For example, the Anxiety Disorders Center at the University of Wisconsin specializes in the evaluation and treatment of these disorders, provides information to professionals and the general public, conducts educational programs, provides speakers, and does research on Anxiety Disorders. The Anxiety Disorders Center attempts to keep a list of reputable anxiety therapists in different geographic areas and provides this information without charge (see page 247 for the address).

There is no simple answer to this question. Sometimes, individuals can accurately identify and treat their own problems. However, we recommend that the initial evaluation of a person with an anxiety problem be done by a professional who is experienced in diagnosing and treating anxiety problems. Many nonpsychiatric physicians are not fully aware of recent advances in the diagnosis and treatment of Anxiety Disorders. Some professionals avoid certain treatments simply because they cannot provide them. The information provided in this website should help you make an educated choice of professional. Also, there may be an Anxiety Disorders treatment center in your area or a support group that could recommend qualified therapists.

If medicine is used to treat your Anxiety Disorder, it will have to be prescribed and supervised by a medical doctor (M.D. or D.O.). If treatment involves behavior therapy, qualified therapists can include physicians, psychologists, nurses, social workers, and others. It is important to know whether an individual therapist has had special training in behavioral techniques; this may be as important as the actual degree held by a therapist.

But from whom should I seek help first? When should I go to a minister, social worker, psychologist, or physician?

People are most likely to go to a member of the clergy if they feel that their anxiety is “spiritual” in origin and to a doctor if it seems “medical.” It is impossible to pinpoint a physical cause or drug remedy for anxiety, and there is no hard and fast rule about whom to consult when. But if self-help and nonmedical professional aid has failed to relieve your anxiety, and if persistent life troubles are not obviously behind the worry, then you ought to see a physician to check that some medical factor has not been overlooked. When in doubt, see a doctor.