Helping people deal with situations that provoke in them extreme anxiety isn’t easy, but it is relatively straightforward. The affected individual has to learn to deal with the phobic situations and also how to deal with the panic attack itself. One way to treat this type of situation is through ‘exposure therapy’ or ‘cognitive-behavioral treatment’. Once the person has learned, by experience, that the panic attack, like all feelings, is not in itself destructive, the condition begins to become controlable.
Arguably there is something more important that underlies extreme anxiety; an attitude to life itself that needs to shift or change. Such an alteration needs more than a limited exposure therapy or any other brief method of treatment. It requires a change of perspective on the way life can be lived. The tendency to worry unnecessarily can make everything in life – work, marriage and especially bringing up children – a struggle. This outlook on life can be summarised thus:
Since the world is treacherous, I must always be alert to the possibility of injury or illness. I must forsee disaster everywhere: new business ventures are likely to fail; new relationships likely to founder; new places threaten vague and shadowy dangers rather than promising excitement and the chance to learn something new. Children must be guarded against all the physical and emotional dangers that loom in imagination. Hidden not very far below the surface of these ever-present fears are more profound fears of helplessness and loneliness.
The sort of life brought on by these attitudes is a narrow, constrained existence in which the individual strives primarily to feel secure. Everything else is subordinated to the wish for safety. Relationships with parents, often ambivalent, are maintained very closely into the years of adulthood, although sometimes marked on both sides by guilt and resentment. A spouse is chosen sometimes solely because he or she seems ‘stable’. Employment is chosen because it is safely within the individual’s capacity and therefore does not threaten failure, or simply because it is nearby. Often such a job is kept long after it has proven to be unsatisfactory, unchallenging or uninteresting. In all matters, the familiar is chosen over the unknown.
This is by no means necessarily a miserable life. There is room for satisfaction, achievement and pleasure. But it is not everything life can be. It is not an adventure.
No one is entirely free of self-doubts or anxiety. To that extent it is natural to want to seek out safety. But the struggle to be safe and secure, to be free of anxiety, is not enough to justify living.
This is an argument, then, for continuing therapy past the point of recovery from a phobia. The practice of challenging one’s fears that is the basis of exposure therapy is a reasonable strategy for coping with other more realistic threats. The danger of getting fired from a job, for instance, is managed best by confronting it directly, by talking to the employer and, perhaps, by looking for other work. Whether it is learning how to swim or learning how to address a group, both scary in their own way, a determined step-by-step effort usually brings success – as it does in overcoming a phobia. Being open with others, crucial to the success of exposure therapy, is important also for everyone in developing close relationships and in being able to see oneself accurately through the eyes of others.