Two cases are presented in detail and two in summary fashion to illustrate a technique that can frequently he used instead of systematic desensitization to reduce the time needed to treat simple phobias. This method combines techniques developed by Strategic Therapy and Critical Incident Debriefing. Symptoms that the patient experiences as out of control are prescribed by the therapist and then normalized. For example, a 26-year-old woman with a fear of social Situations learns that it is not unusual for people to feel somewhat awkward and anxious as they try to reestablish themselves with friends after being away from them for a long period of time. Therapy taught her to accept rather than fight her initial anxiety in these situation. Another client with claustrophobia was taught to imagine himself getting anxious and telling himself, 'Yes, this is exactly what I expect. I am going to get anxious, and my anxiety will increase, but it isn't going to get higher than a '5' (on a 1-10 scale), and I can handle that." When these interventions are successful, the anxiety initially experienced in a phobic situation as a signal for panic is reinterpreted in new situations as expectable. This reframing renders the anxiety manageable. The treatment of two additional patients is briefly presented to further illustrate the application of this approach. Their phobias included a fear of sweating in public and a fear of sleep.
Cognitive Behavior Therapy (CBT) for the treatment of anxiety disorders (1,2) is widely accepted as safe and effective. Current debate has centered on the issue of when medications should be used as an adjunct to CBT and when they can be used instead of CBT (3).
The standard CBT protocol for treating simple phobias includes the following stetps:
1. Teach the client to monitor and then track his/her inner dialogue.
2. Jointly identify thoughts that are followed by anxiety. Oh God, I'm getting near a bridge.
3. Identify assumptions that underlie anxiety-provoking thoughts.
If I drive over the bridge, I will lose control of the car, drive off the edge, and get killed.
4. Systematically test key underlying assumptions.
5. Pose and test alternate assumptions.
I am a good driver I've never been in an accident, but I am uncomfortable with heights. I'll survive being uncomfortable.
CASE 1: MICHELLE
Michelle is a single 26-year-old woman, who holds a lower-level technical job in the electronics industry@ At intake, she is well-groomed and oriented in all spheres. Affect is marked by moderate anxiety and secondary depression. Until she went abroad for her junior year of college, Michelle describes a developmental and medical history that is unremarkable. She reports no legal problems or drug abuse. She lives in an apartment with a female friend and continues to have a positive relationship with both parents, who live in the area.
Client Problems List
1. 1 avoid conversations; they make me very anxious.
2. 1 can't think of what to say next when I'm in a conversation.
3. I'm afraid I'm losing my friends.
4. 1 feel like a failure. I used to be so good at this [talking with friends].
Anxiety interfering with ability to converse in social situation
In social situations, Michelle interprets normal anxiety as a signal that 94 panic" will quickly follow. Focusing on this possibility, Michelle becomes more and more fearful, to the point where she feels "panic." To shortcircuit this process, Michelle avoids social situations where she might experience any anxiety,
Relationship of Mechanism to Problems
Catastrophic self-talk in anticipation of social interactions causes intolerable anxiety that interferes with conversational ability, thus, reinforcing anticipatory fear. …