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Dear Dr. Batya,
I am scheduled to go into the hospital for an operation in just over a month, and I am paralyzed by fear at the thought of it. I am eating too much and am sleeping poorly. A friend told me that cognitive behavior therapy worked for her and suggested that I find a psychologist who does this. Can you please tell me more about it? Thank you.
- Paralyzed Patient, Herzliya
Dear Paralyzed Patient,
I and many other cognitively-oriented clinical psychologists provide short term solution-focused behavioral therapy. Cognitive behavioral therapy (CBT) is just this. While focusing on the patient's strengths through the use of various behavioral techniques and objectives, the goal is to work systematically to address problems. CBT uses evidence-based techniques that work. I like CBT not only because it is effective and simple, but because a patient can feel quite good in a relatively short period of time. While not every issue can be resolved with CBT, it is indeed a fast, cost-effective and efficient approach for many. It is particularly helpful for fears, anxiety, depression, trauma, obsessive-compulsive problems, weight loss, smoking cessation, most behavioral problems with children and many other issues involving individuals, couples and families. One can often be helped completely with maybe a half dozen sessions or so, and the benefits are often maintained. From what you describe, you sound like a great candidate. Let's look at your concerns.
You have said that you need to go into the hospital for an operation. If indeed you have over a month in which to work on your fear, you have lots of time. I would suggest a multi-focused treatment. For example, I'd like to know more about your fear. Are you fearful in general, and if so, what types of things are you frightened of, and why? Are you afraid of pain, either before or after the operation? With respect to this operation, what exactly are you afraid of? Are you afraid of what they will find, or that it won't help your underlying problem? Are you afraid of bleeding? Are you concerned about anesthesia, and if so, what aspects frighten you? Is there something specific in the procedure itself that is frightening for you? Do you know of others who have had a similar procedure? If so, how did they do? Often, we only hear the horror stories and not the successes. Finally, what aspects of your pre- and post-operative care or recovery have you the most concerned?
Often, our major fear is the fear of the unknown. We anticipate, imagine and expect the worst outcome, forgetting that we often find ourselves saying afterwards, "Well that wasn't so bad." Our fears of a disaster can cause crippling anxiety and may even prevent us from going through with the surgery. CBT attempts to understand just what it is that you are imagining, and, with your help as an active participant, to change "the story" and create a happy ending. Desensitization, thought-stopping techniques, rehearsal, visualization and imagery, effective breathing techniques, relaxation exercises and positive reframing are just a few of the tricks that a psychologist may use so you can feel you are back in the driver's seat, prepared and in control. Your coping skills will be amazing and your outlook very positive. A good example of this is the Lamaze labor and delivery technique, which has enabled women to have a more natural and prepared childbirth experience.
Not feeling in control can cause tremendous anxiety, so one of the more immediate goals of CBT is to enhance your perceived sense of control while enabling you to feel well-prepared and ready for your procedure. This not only feels good but is very empowering. First-time parents are a perfect example of this. Often they are so focused on just getting through the pregnancy that they don't think twice about caring for their newborn after delivery. As new parents, they suddenly feel overwhelmed and unprepared. Helping parents know what to expect can greatly aid their postnatal adjustment. This is true for your procedure as well. People who are less anxious require less medication for pain management and generally have a better post-operative outlook. What can you expect afterwards, and what can we do to reduce your anxiety? Often just knowing what's involved at each step of the process will reduce your anxiety, since you'll feel your concerns have been addressed and solutions found. While one can't entirely plan or predict a certain outcome, providing a reality-based treatment helps one focus on achieving a positive outcome. If, for example, you are a young woman in good health, a realistic and rational analysis suggests your procedure is likely to be completely uneventful. We tend to forget this and focus on the rare exceptions and the "what ifs," or the worst case scenarios.
By getting some much needed help through CBT, you are giving yourself and others the message that there is nothing to fear but fear itself. I suspect that after some good CBT you'll be very pleasantly surprised by how well you feel. Good luck.
The writer is a licensed clinical psychologist in Ra'anana. This column offers general psychological advice and is not intended to replace treatment by a mental health professional.
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