Question: I am even afraid to ask my question, because I don’t think I want to hear the answer. But lately, I can’t drive in tunnels. I work in Manhattan and I always drive there. A few weeks ago, I got stuck in a tunnel for a few hours. Now, there is no way I take the tunnel. I don’t really mind because I can take the bridge, but now I realize that I avoid going to the grocery store and rather send my daughters to buy what I need. I was always a normal person, not a worrywart at all, but lately I am not feeling myself. I told my doctor and he said he could prescribe a pill for me to take. I really don’t know what is wrong with me.
Answer: You are a perfectly normal person. Great spouse, great parent. Good job. Lots of friends. Knows how to have a great time with your siblings, with your kids or spouse or friends. You love life, enjoy the good it has to offer, and appreciate how wonderful everything is. Maybe you married off children, maybe you are head of dance in school. Maybe you are a business owner with fifteen workers, maybe you are a teenager looking forward to camp. Whoever you are, whatever you are, you are perfectly normal.
And then some kind of switch flips in you. One day you are functioning fine, the next day you are struggling with a phobia or fear, struggling with anxious feelings or obsessive thoughts that just seemed to be holding you hostage no matter how hard you try to break free. Suddenly you are afraid of driving through the tunnel to Manhattan. Suddenly you find yourself not wanting to leave your house. You don't want to go in an elevator, you don't want to stay alone in the house. You don't want to sleep over at a friend's house, you find excuses not to go to work. You don't know what is wrong with especially since you are so essentially normal. You feel heart palpitations, you feel dizzy. You feel nauseous, you feel lightheaded. You have headaches, you have sweaty palms.
You wake up in the morning and dread the day you need to face, when just yesterday you whipped up a storm for yom tov, yesterday you drove to Manhattan and back, yesterday you had a blast with your friends at a sleepover after dance practice. It makes no sense to you and you just want your old, functional, normal self back.
Okay, it's true that you are not generally the calmest person in the world. Okay, so maybe in the past you once felt anxious. Maybe when you were getting engaged, you needed to take a regent, you didn't want to climb the mountain in seminary, or you didn't like the crowds Lag B'omer in Meron. Maybe you remember having a panic attack as a child, maybe you remember going through a phase in which you were afraid of the dark, you refused to go to school or camp, you decided you only wanted to drink liquids because otherwise you may choke on a piece of chicken or pizza. Okay. Maybe. But that was a long time ago and since then you have been fine. Just fine. And now you are very successful. As a teacher, as a rebbe, as a parent, as a student, as a friend, as a sibling, as a community activist. For goodness sake, you run a multi-million dollar business that is the most stressful job in the world and you manage just fine!
What you are feeling has a name. It is called anxiety. And when you suddenly have a fear of something very specific, then you are feeling phobic. And you wonder if you need help. Real help. Because you don’t feel like yourself, although nobody around you suspects anything; because you are a master of pretending that everything is fine. Except when you are so not.
There are many types of phobias, but not all of them necessitate therapy. If you are afraid of the dark, you can just use a night light to sleep. If you are afraid of cockroaches, get an exterminator to get rid of them (let your husband dispose of the dead ones!). If you are afraid of flying, then just don't fly anywhere. If you are afraid of heights, don't go mountain climbing; don't look down from the Empire State Building. But sometimes, it's not possible to find solutions. Or solutions are possible but interfere with your quality of life. It's okay not to fly for the first twenty years of your marriage, but then your son is in yeshiva or your daughter is in seminary and you realize that it's interfering with your quality of life if you can't visit them; or, if they move there after they are married you won't be able to visit your grandchildren whenever you want. So something that was never a problem, or was ignored and denied, may then becomes an issue.
What many people don't realize is that the ambitious, successful people out there are usually those who experience anxiety. Because anxiety is a good thing. It what drives people to succeed; it's what motivates people to do, to create, to achieve. Anxiety only becomes a problem when it rises to a level where it impairs functioning. So right now, your anxiety does not feel like a very good thing at all.
Your friends tell you that you are fine. You know you are not. Your spouse tells you to stop obsessing because everything is fine and nothing bad is going to happen to you and anyway it doesn't help to think these thoughts. You try to take your spouse's advice, but your anxiety doesn't go away. You read a mussar sefer, you read books about positive thinking and improving yourself. You focus on the wonderful things in your life: your adorable niece, your son's wedding, your main part in the play, your many talents and abilities and accomplishments. And sometimes you feel a little better, but not for long and not for much.
You are getting desperate. It's more than a month, more than a year, sometimes even longer than that. You call the doctor. He says it's normal, lots of people are anxious. “Take some anti-anxiety meds,” he advises. You take them and they help. A little. But you don't want to rely on meds to help you feel better. And anyway, they don't totally help. You tell the doctor you just want to feel better again, to wake up and just feel normal. He says, “Go see a CBT therapist.”
And you are reading this article and thinking, “Yes, you are describing me, but I'm not going to no therapist because I am not crazy (even though I feel crazy) and anyway, what's a therapist going to do that the meds and my doctor and my hard efforts couldn't?”
Good question.
And I plan on giving you a good answer by taking the mystery out of therapy and explaining what CBT is (cognitive behavioral therapy) and how a CBT therapist helps overcome anxiety as it manifests itself in specific phobias, fears, and/or resulting obsessive thoughts. And I'm also going to run the therapy business into the ground by revealing a deep, dark secret: if you are sufficiently motivated, you can actually buy yourself a self help book on overcoming phobias using CBT tools outlined in the book. And that will be lots cheaper than going to a therapist.
But the truth is, most people find it easier to tackle their anxieties and fears with a supportive and knowledgeable therapist who brings a human side to the therapy experience along with her expertise. It's kind of lonely using the self help book as there is no one to cheer you on, or to monitor you, or to help you objectively evaluate your progress or stuck points. But it is possible to work with a CBT-oriented self help book, but don't tell any of my colleagues that I said so!
The good news is that CBT addressing specific fears and anxieties as described above in usually a time-limited therapy that produced rapid and remarkable results in a relatively short amount of time. And even better news is that it is not mandatory to uncover the reasons for the anxieties, or why and how the phobias began in order to effectively reduce the symptoms. So if you are afraid of snakes, and it's interfering with your job (which which may be a snake charmer in a circus) CBT can help reduce or take away your phobia and symptoms of axiety without delving into what triggered the phobia to begin with (for example, you watched your favorite pet mouse being devoured whole by a snake you were supposed to be charming). Meaning, it's not necessary to know why you are phobic in order to to address the symptoms of the anxiety feeding your phobia.
Treatment is behavior-oriented more than insight-oriented; although there is a psychoeducation piece involved as well as a cognitive one.
Firstly, let's define a phobia. A phobia by nature is irrational. Although a person who is phobic about leaving the house can rationalize it by saying, “If I leave the house, I can be hit by a car,” it is still irrational because although there is a chance such a thing can happen, overall, statistically, we are able to leave our homes in safety. This statement is just as irrational as a person who refuses to stay at home alone and rationalizes it by saying, “If I stay home by myself, I am afraid a truck will crash into my house.” And of course, that is probable; but it is, overall, statistically improbable (although I have read a newspaper article detailing one such story!).
Someone who is afraid of flying may be afraid of the plane crashing, but will have no fears about walking in the streets or driving in a car, where statistically many more deaths occur than in plane crashes. So in essence, the phobia is irrational even if the rationalizations seem rational. And on some level, the person experiencing the phobia is aware of its irrationality simply by observing most of the people around him who function easily and without fear.
Obsessive thoughts are usually fueled by irrational fears. Images of knives and blood intrude; of babies being pushed out the window. All of us experience these kind of crazy thoughts once in a while. We are driving and we get this sudden fear of swerving into oncoming traffic and the ensuing images terrify us. However, for the most part, these flashes are few and far between; and then we continue our merry way without thinking twice. For a person suffering from obsessive thoughts, that casual thought becomes a loop that cannot be broken. And the loop become a pattern out of which there seems no recourse.
So CBT must address the cognitive distortions that maintain the phobias and obsessive thoughts.
Then there is psychoeducation to inform you of the mechanics of the three responses to danger: fight, flight, and freeze; and how your body is reacting to perceived danger with apparently no ability to return to homeostasis once the perceived danger has passed. Even more, the body continues to fuel itself with the anxiety, creating a vicious cycle of heightened arousal with no relief. Simply put, if a person is on a dark street late at night and meets a person who appears to be carrying a gun; the brain bypasses the rational part of the person and makes a decision to either fight, flee, or freeze. In fight and flight, the person experiences arousal of senses, heightened awareness, a rush of adrenaline, and increased heart rate all in the service of protection and safety. It's what enables a person, for example, to exhibit superhuman strength at times, swiftness of foot, and increased abilities mentally and physically. When the person passes you by, and you realize what you thought was a gun is a rolled up newspaper, your brain registers that the danger is over and the body returns to its normal levels before arousal; the body returns to its normal state of functioning.
A person who is caught in the cycle of anxiety, finds that his body cannot read signals accurately anymore and therefore does not return to homeostasis. He remains in a state of heightened arousal that is experienced as all the symptoms of anxiety described earlier. Even worse, his body reacts as if there is danger, when the rest of the world around him does not percieve any at all.
So CBT helps you understand logically what is happening to your brain and body and why.
The most crucial part of the therapy, however, is the behavioral piece.
Anyone entering therapy to do CBT must be highly motivated to engage in the structured, required activities. The work usually consists of carefully designed homework assignments targeting the phobia or obsessive thoughts in ways to desensitize the person to the phobia and/or decrease the symptoms of the fears and/or anxiety. Often, homework will also be to chart daily and weekly entries to develop and maintain awareness of triggers of the phobias, fears, or anxieties; their duration and intensity; and to notice positive or negative changes in functioning as well as plateaus.
So yes, you are a normal, sane person. But the switch that flipped in you needs to be flipped off. And CBT can do it; it can flip the ON switch back to OFF and give you your life back. It also allows you to live with your personality that may be an anxious one by nature without it creating the never ending looping of anxiety. It gives you the tools to be able to turn that switch off even if it may be turned on again. It empowers you to take control of your anxiety that it remains a positive aspect of your character instead of a dreaded one.
CBT is not magic, but sometimes, somehow, it sure feels like it.
NOTE: This article was originally published in a revised form by Jewish Echo Magazine
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