Anxiety disorder can be an opportunity

A veteran Israeli clinical psychologist who treats sufferers of exaggerated fears using existential psychotherapy has written a Hebrew book explaining how it works

By JUDY SIEGEL-ITZKOVICH
Anxiety (photo credit: TNS)
Anxiety
(photo credit: TNS)
It is not a disease, but anxiety can make your life miserable.
Among its symptoms are shortness of breath, a pounding heart, hot flashes or chills, muscle tension, sweating, insomnia, tiredness, headaches, dizziness, an upset stomach, diarrhea, tremors and trembling.
As it is the body’s natural reaction to danger, moderate anxiety is not automatically a negative phenomenon.
It can keep you focused and alert, induce you to handle problems and encourage you to act. But if the fears are excessive or chronic, it can prevent you from functioning, disrupt your relationships with loved ones, friends, coworkers and strangers and cause you to act irrationally. It is often confused with serious physical or mental disorders. Panic attacks can make you freeze as the fears turn into an anxiety disorder that may even develop into depression. It has to be treated.
It is sometimes classified as generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, phobias, society anxiety disorder and post-traumatic stress disorder. While psychiatrists tend to treat these with prescription drugs and/or psychotherapy and psychologists with individual talk therapy, a Tel Aviv clinical psychologist who specializes in dealing with anxiety sufferers uses group sessions and “existential psychology” and teaches participants to “befriend” their anxieties and regard them as an opportunity.
DR. ODED Mevorach, who earned a doctorate in psychology from the Hebrew University, wrote a book called Sefer Hakolot (Book of Voices) about the internal struggle of “two voices” that create suffering, and developed “Opposing Voices Therapy” to deal with it. Now, he has written a 233- page, soft-cover Hebrew-language volume called Harada He Hizdamnut (Anxiety is an Opportunity). The new NIS 75 book, published by Triwaks Enterprises/Matar, gives a blow-byblow description of his therapy with five adults suffering from anxiety disorder.
The five participants are given first-name pseudonyms – Hagit, Noa, Erez, Alma and Nadav. He claims his clinic’s 12-session, two-hour weekly workshops (costing NIS 3,800 per person with a maximum of 10 patients) are very successful and help participants to lose completely – or at least cope significantly better with – their anxieties.
The patients are described in the book as a former Mossad agent; a beautiful hi-tech entrepreneur, a psychologist, an accountant and a medical student who suffer from panic attacks that interfere with their lives.
Although most are skeptical at their first session and even threaten to abandon ship, they gradually understand the technique, which helps them befriend what had terrorized them.
Mevorach decided to become a clinical psychologist decades before when, as he relates in a final chapter, he and his Navy colleagues were traumatized when a sailor named Pollack went missing on a mission and was never found.
EXISTENTIAL PSYCHOLOGY (psychotherapy), on which he bases his work, is a philosophical method of therapy that operates on the belief that inner conflict within a person is due to that individual’s confrontation with the givens of existence.
One of its premises is that life has meaning under all circumstances.
Its origins can be traced back to work of 19th-century philosophers Søren Kierkegaard and Friedrich Nietzsche, whom Mevorach often quotes at the beginnings of chapters.
As expressed by American existential psychiatrist Stanford University emeritus Prof. Irvin David Yalom, existential therapy begins with the belief that although mankind is basically alone in the world, people want to be connected to others and have meaning in each other’s lives. Nevertheless, they don’t want to be dependent on others for validation, and with that realization they finally recognize and understand that they are basically alone.
The result of this revelation is anxiety in the knowledge that our validation must come from within and not from others.
Yalom and colleagues argued that is possible for people to face the anxieties of life without fear and accept the human condition of aloneness and to enjoy the freedom to choose and take full responsibility for their choices. They are not bound to suppress their feelings of meaninglessness; instead, they can choose new meanings for their lives and live life as an adventure, accepting their mortality and overcome their fear of death.
IN ADDITION to existential psychology, Mevorach also uses the more conventional cognitive-behavior therapy (CBT), hypnotism (which he is licensed to practice), role playing, dynamic conversation and narrative ideas to make his patients lose their anxiety. The participants are even asked to prepare oral eulogies or condemnations of each other and themselves as if they had died.
Each of the chapters consists mostly of dialogue and participants’ reactions (including weeping; even Mevorach himself frequently has tears in his eyes), but the author also gives explanations of his treatment concepts and how he goes about treating them.
“In the modern world, threats have changed and they are spread over a long period of time, requiring mental reactions rather than physical ones,” he writes.
“The ‘survival-evolutionary’ mechanism that developed in the distant past is not s u i t e d for coping with a job interview, with the wait for medical test results, with dealing with the ups and downs of the stock market, with exams, airline flights, economic threats or even talking to [one’s child’s] kindergarten teacher. The physical symptoms of anxiety are not dangerous in themselves, but they cause much suffering. The individual exposed to them tries to avoid anxiety-producing situations, and thus develops anxiety from anxiety.”
Mevorach writes that he encourages participants in his workshop to befriend their physical symptoms to “neutralize” their threats that prevent them from a “free encounter with life.”
Thus, the participants are purposely exposed to their symptoms and experience them physically while learning that they do not cause immediate physical harm, do not persevere for more than a few minutes and don’t develop into extreme phenomena.
The symptoms themselves cause anxiety, as can enclosed places, flights, heights, insects, mammals, driving, the dark or large assemblages of people. But the biggest source of anxiety is “what’s in our head – thoughts, images, memories and ‘scripts.’ They constantly try to control their thoughts, but they fail again and again, causing the anxiety to get stronger.”
Before participants “befriend” their anxieties, they must first believe that thoughts are not reality. “A person who wants to escape his anxiety must deeply understand... that everything that passes in his mind is not a dangerous reality but only thoughts, images and feelings,” he continues.
Self-control instead of impulsivity, Mevorach writes, is also a vital tool for coping with anxieties and can be developed with exercises that the participant carries out when not at the workshop. The participants learn to accept the values and personalities of other people, be less critical of themselves and others and be open to new ideas, the author writes.
THE SESSIONS are actively led according to a prepared plan and according to the situations of the participants. From the first session, they are required to react differently than the way they are used to acting, and in a more controlled way than they had in the past. They are asked to identify the external stimulants for their anxieties, their physical and behavioral symptoms and the scenes in their mind that cause panic attacks. Slowly, the participants get to know each other honestly, relate their pasts and problems, participate in psychodrama and temporarily adopt other identities and be open to change.
The clinical psychologist maintains that group sessions are preferable to individual ones because they help normalize the problem; the advances of one participant leads others to advance; exposure of one to a technique is a model for others; mutual support is beneficial; and makes it possible to use humor as a liberating tool.”
At every session, the progress (or, if there is one, decline) of each participant is registered; each person reports what new tools he or she has mastered. At the final sessions, as anxiety attacks disappear, the participants are encouraged to look for opportunities that will change their lives.
In a follow-up chapter as long as two years after the end of the workshop described in the book, Mevorach notes that each of the patients significantly improved. Hagit started to work in the sales department of a pharmaceutical company and has no difficult going anywhere and anytime (which was impossible for her to do before the workshop). Her husband was accepted to medical school, and she was free from the daily anxiety of whether he would return from studies every day. She still suffered occasionally from unpleasant physical symptoms, but continued to do the mental exercise to “befriend” them rather than to fear them.
Noa reported that she had developed good relations with her former husband, with whom she previously was in a very tense relationship.
She also felt more comfortable around other men. She said that she no longer has frightening thoughts or nightmares about her small son, who she thought was at risk of being “killed” by her.
Erez, who is married, developed a much better connection to his wife and said his anxieties had dissipated completely. He was even able to go on foreign trips, which was unthinkable before.
Alma, who was tortured by the idea that pregnancy would make her body an undesirable wreck and that she would inevitably become unattractive and that she would inevitably become unattractive, had a baby 18 months after the conclusion of the workshop and decided to adopt a healthful lifestyle of a nutritious diet and regular exercise.
Nadav felt well inside his body – more than ever before – and was able to expand his business. Unable in the past to get out of the house due to his fears and enjoy an evening with his wife, Nadav set Wednesdays as the day of the week when they would go out to dance and go to clubs or have a drink. He even joined a biking club and went to a regular yoga and meditation class, which would have been only a dream before the workshop.
Even Mevorach confesses to having benefited emotionally from the workshop and previous ones.
“I have learned to accept my and others’ weaknesses. I know that I will always be sensitive, vulnerable and aggressive. Separation [from people] is always difficult for me, but as I learn to know other people in depth, they become more interesting and more beautiful in my eyes,” he concludes