TREATMENT OF ANXIETY, GAMBLING, AND PHOBIAS
by Jurriaan Plesman BA (Psych), Post Grad Dip Clin Nutr
We will try to show how best we can treat ourselves of the debilitating afflictions of anxiety and phobias. If problems arise the assistance of a psychologist or counsellor should be sought.
Anxiety and phobias have this in common that they are driven by the fear response. We can learn to be fearful of any object if it is accompanied with a negative experience, like an electric shock, or heat. This is how children learn to avoid stoves, heaters, hot irons, boiling water and other dangerous things. Fear is essential to our survival, when we think about the dangers of driving a car and making sure the brakes work properly. Such fears cause us to think of methods to overcome the threat. A soldier’s survival in war may depend on how cautious he is. Many war heroes were in fact very cautious people.
When the object of fear becomes less specific and a person cannot identify the cause of the fear response, then we speak of a free-floating anxiety. It is free-floating, because it tends to occur from one situation to another, not generated by external happenings but from within.
Anxiety attacks may also follow allergic reactions to food items or environmental toxins and sensitivities. Often specific sensitivities tend to spread out over time to a wider range of substances in the environment as the immune system weakens further. Allergic reactions generalize to more and more substances. If you want to find your allergies please read:
Anxiety may also emerge from stressful social conditions, our workplace environment, problems in the home, worries about the future or stressful relations with loved ones, constant worries about children.
When blood sugar levels crash from high to low - mainly in response to stresses and to refined carbohydrates (sugars) or allergic reactions - the body produces adrenaline to convert stored sugar (glycogen in muscle tissues and liver) back into glucose. This prepares the body for action. But adrenaline is also a fight/flight hormone. Thus it is important to stabilize the blood sugar levels by having frequent or three hourly snacks (depending on how fast your reaction to sugar intake is). One way of providing a slow but regular release of glucose is by taking glycerine. Glycerine is a sweet tasting substance, obtainable from your chemist, that bypasses the pancreas and it is converted to biological energy in the liver, thus providing a source of normal physical and mental activity.
This should be considered a temporary measure until blood sugar levels settle down. The herb fenugreek is also a glucose stabilizer as are many other herbs. Perhaps a herbalist can help you out there.
In addition to the hypoglycemic diet there are many antistress herbals which may be beneficial such as Withania somnifera (Indian ginseng, Winter cherry), also Korean and Siberian Ginseng, Damiana, Gotu Kola 2500mg pd, Wood Betony, Skullcap, Vervain and Zizyphus.
A herbalist or naturopath should be able to help you to choose the proper remedies.
Psychologists - called behaviourists - have another theory that clearly explains the power of compulsion in behaviour. This is based on studies that show that a certain behaviours can be reinforced by reward or non-reward. The latter leads to extinction of that behaviour. This can be illustrated by Skinner’s experiments with pigeons in 1968. They in fact can be taught a gambling addiction, by a series of what is called a schedule of reinforcement.
Let us suppose a pigeon pecks at a red button, and is then immediately rewarded with food (a seed). Every time it hits that button it is rewarded with food. We can increase the rate of pecking by presenting food after say every ten hits of the button. This is called an intermittent reinforcement schedule. Note that the pigeon can maintain a rate of pecking of about 4,000 responses per hour for as long as 15 hours. Studies have shown that by reducing the number of rewards we increase the rate and number of pecks by the pigeon.
If we vary the intermittent reinforcement schedule, that is we reward the pigeon at an average of say fifteen hits, then we can increase even more the intensity and number of hits by the pigeon. Strangely enough it means that we can make an organism respond more by reinforcing him less!! A gambler has learned to respond in the absence of previous reinforcements!! He has learned to continue to bet when his previous bets has been rewarded only a fraction of the time. Thus he has learned to be loser, a psychologically proven fact on which casinos and gambling organisations depend. It is interesting to speculate, whether the negative self-image is the consequence or the original cause of the gambler’s disease.
Like an alcoholic, a compulsive gambler usually hits his rock-bottom - the red line beyond which he won’t go - before he is ready to seek help in psychotherapy. The location of this red line, depends on his values system. “Where are his priorities?” His struggle with control over his behaviour - and over the demon of luck - is a major prop in his self-image.
As in alcoholism, there usually is an ‘alcoholic wife’, to whose controlling character he is strangely attracted. The gambler often satisfies the wife’s need to control, and often both need to undergo therapy. But it is also this wife and children, who usually are the source of motivation to undertake this psychotherapy, because they often become major victims of his addiction. Again treatment should start with the adoption of the hypoglycemic diet, followed by a course of psychotherapy with a chief emphasis on the self-image and “values clarification”.
Unlike free floating anxiety attacks, a phobia is a fear response to an identifiable object in the environment but in the absence of any real danger. They are called phobic reactions. Common phobias are agoraphobia, fear of open spaces, claustrophobia fear of confined spaces.
Some other strange-sounding phobias are mysophobia fear of dirt, monophobia fear of being alone, arachnophobia fear of spiders, homilophobia fear of sermons, onomatophobia fear of names, melissophobia fear of bees, katelophobia stage fright, benolephobia fear of sharp objects and hydrophobia fear of water to name just a few.
Other technical names of phobias:
Phobias are sometimes difficult to treat, because the person is often persuaded to believe that it is a sign of weakness in one’s personality. Thus he forces himself to confront this ‘weakness’ thereby unwittingly reinforcing the phobia.
Any object or situation can become the subject of a phobia. Most of these may have been acquired from a frightening childhood experiences, but some developed in adulthood. Sometimes the object of fear has been generalized, as in a case when a person has developed an unreasonable fear of all furry animals or furry things after an attack by a dog in early childhood. Or the fear response is generated as a result of word associations. Fear of white things may have become associated with the snow white collar of a minister of religion instilling purity and high standards of morality in one’s childhood ridden with feelings of guilt.
Another possible and perhaps more plausible explanation for a phobic reaction is that an object may have been paired with the fear response during a free-floating anxiety attack.
Like free-floating anxiety attacks phobias are closely related to hypoglycemia and hence the first step in the treatment is the adoption of the hypoglycemic diet.
Agorophobia
To explain the psychological treatment of phobias, we will discuss the treatment of agoraphobia as an example as to how most other phobias can be treated.
Agoraphobia should be seen as a separate, or perhaps an additional condition to hypoglycemia. I had a client who had severe hypoglycemia, crashing half an hour after ingesting refined carbohydrates (in her case milk shakes) AND agoraphobia or fear of open spaces. On many occasions she had tried and forced herself to leave the house, which may have aggravated her condition.
It is important never to force yourself to leave the house if you are anxious, because this could reinforce the fear response. You should only leave the house if you are totally relaxed.
This technique can be extended to “Imaginal Systematic Desensitization” where a person’s mental image of the fear object is gradually introduced whilst in a state of relaxation. Here again we pair the fear object with the response of relaxation.
Sit and relax in an easy comfortable chair, close your eyes, and feel how heavy your body is, starting with your feet, gradually working up to your legs, your body, your arms, chest and head. Imagine that you are laden with lead and that you are sinking deep into the easy chair. Feel the pressure of your body against the cushions in the chair. Soon you should feel so relaxed that you cannot be bothered to get up and then enjoy the whole experience!!
Do this a couple of times until you can relax in a shorter period of time each time you sit down to relax.
Following a series of these exercises you should be able to relaxed in a fairly short period of time. These daily exercises alone should help you in free-floating anxiety attacks. The success of non-directive counselling is based on the fact that a person can relate traumatic experiences in an atmosphere of acceptance, understanding and relaxation in the presence of a counsellor, thus pairing anxiety arousing images with the relaxation response!
In phobias we are going to use your ability to relax by introducing images in your mind, whilst you are relaxed, on similar principles.
Thus the next step is TO IMAGINE that you walk around the house.
In your imagination, walk around in the house, go to the kitchen, to the corridor, to the bedroom, to the laundry, to the front door. Oops you feel a tension in your stomach when you imagine going to the front door. Walking to the front door could easily arouse the fear response and then you should lift the index finger indicating to the psychologist that the image of the door arouses fear. You may do this as well, although there is no real psychologist in the room. You are your own psychologist now! When you lift your index finger, the psychologist would immediately lead you away from the front door and guide you to a safer place in your home. Thus don’t go to places in your imagination that the first warning signs tell you may be dangerous.
This indicates that you get anxious, and immediately in your imagination return to the lounge room, the place of safety. Thus whenever you feel the first signs of anxiety you immediately return to the place of safety. Get to know this bodily warning sign, this is the first sign of the uncontrolled fear response! Never allow your autonomic nervous system to trigger an anxiety reaction because of your imagination! Gradually you will discover that you can leave the house and walk around in your garden in your imagination.
As an aside, some people may find it difficult to reach this state of relaxation, because they have been “trying” to relax. “Trying” implies “making an effort” which is the opposite of being relaxed. Trying to do anything at all, implies that you will fail to do whatever you are trying to do. Just relax!
Your exercises in relaxation should be pleasurable.
You will soon discover that you can remain relaxed by walking to the front gate in your imagination , or perhaps to the street in front of your house.
Now still imagining, make a trip into town, on the railways, bus stops and in shopping centres. The aim is to be able to walk into the street or anywhere you fancy in your imagination all the time sitting in the chair!!!! Remember to return home immediately into your chair whenever you feel the warning sign of anxiety in your stomach.
Repeat the relaxation exercises and imaginal trips at home over several days, even weeks if necessary, until you feel you have control over your autonomic nervous system. Here it should be said that individuals differ in their learning curves: some people are fast learners, others somewhat slower, but you all will get there in the end.
You are now ready to experiment in vivo, in real life, by walking to the door, into your garden, into street, always ready to return home when you start to feel anxious. My bet is that you won’t feel anxious and that in fact you will experience a sense of relief and exhilaration.
When you have gained total control over your ability to relax and walk anywhere in your imagination, you will soon find that you can get out of the chair and walk out of the house. But remember, if you feel tension (in your stomach) immediately return to the safety of your home and start all over again. Learning to respond in the correct way at the level of the autonomic nervous system requires repeated exercises, just as we learn to play the piano. Furthermore, we need to keep an eye on other causes of anxiety reactions when we are not on the correct diet!
If at this stage you still encounter difficulties, it would be wise to get help from a professional counsellor who is familiar wit Imaginal Systematic Desensitization.
I have been able to help car phobic people to drive a car. These are clients who have learned and know how to drive a car, may even have a licence, but have developed an abnormal fear of driving. This could have been exaggerated, by forcing themselves to drive a car under condition of extreme anxiety. They have been able to overcome these fears by imaginable desensitization by imagined trips whilst in a relaxed state. They visualized walking around a car in the middle of an empty paddock, getting to sit inside the car, then driving the car in the paddock - no fences or other objects - then introducing lonely country roads, then gradually introducing houses on the side of the road. When the client experienced the warning sign, there was always a side track leading back to an large empty paddock. Gradually more houses were introduced, then a dog or cat on the road, then a cyclist, then an other car in the distance, but fortunately he disappeared into a side road. You will have to have a vivid imagination, changing the scene immediately when the index finger goes up. Soon the client is driving a car in a busy city street, reversing his car for parking purposes....all in his imagination. Having done this several times the client is now ready to experiment in real life.
Other scenes can be created for people with stage fright, a very common phobic reaction. We can start off standing at the back of a hall full of people, or a hall with only one person. The possibilities are infinite. Then in one’s imagination we move the client progressively to the front, until he stands viewing a sea of faces staring at him. Imagining what people would think of you at this stage may point to a negative self-image - a useful tool of the “paranoid situation” as discussed in “Improving one’s Self-Image”. Apart from that, it is still important to prepare your speech and practise this at home in a safe surrounding, before embarking on your speaking engagement to a large crowd in a real life hall.
This is an outline of the program to give you an idea how people overcome their phobias. It is like the hydrophobic child playing with his toys which are gradually placed near the edge of the water. There are other methods such as ‘implosion’, where a client is exposed to a fear object without an escape route. Many counsellors - among them myself - are reluctant to use this method on ethical grounds.
If these attacks have taken place over a long period of time the possibility of adrenal exhaustion should be considered, which need to be treated with the hypoglycemic diet and special vitamins and minerals, plus antistress herbals as mentioned (i.e.,Withania somnifera).
In free-floating anxiety attacks the person needs to have a careful look at some of the sources of stress in his/her social life, apart from internal factors. These may be related to the environment in the home or work place, relationships with significant others such as family members, partners, children, or to ambitions in one’s career. These are usually centred around a poor self-esteem, and lack of social skills in handling people.
The most common source of anxiety is “perfectionism” or the striving for unattainable standards of performance by the self and others.
In “anxiety-seeking” behaviour a person is believed to be driven by an inner metabolic need for adrenaline, the energizing hormone, that can provide a high, just as a person addicted to caffeine derives ‘pleasure’ from the drug. Many ‘risky’ sports satisfy these needs. But addiction to adrenaline may be severely self-destructive in the case of compulsive gambling. The treatment for this has common features with the treatment of alcoholism.
Phobias are treated, 1) by learning how to relax (relaxation therapy), 2) and by gradually introducing the objects of fear in imagination, whilst in a state of relaxation.
Thus adopting the hypoglycemic diet and doing the daily mental exercises over a period of time will help you overcome the debilitating affliction of anxiety and phobias.
If these do not help, please consult a clinical psychologist.
See also:
Last updated 6 February 2008