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March 12, 2013

Treating Anxiety and Obsessions: Nothing to Fear but Fear itself?

Written by Dr. John Carosso

Nothing to fear…?

Y’ know, Franklin Delano Roosevelt may have been on to something. You see, anxiety is considered to be based in fear and, more often than not, there really is nothing to fear but the fear itself. Anxiety can manifest in worry, obsession, irrational fears (phobias), compulsive behavior, school avoidance, fear of sleeping alone, and social withdrawal. Anxiety disorders can stand alone, but often accompany depression, autism, bipolar, and trauma.

Not sure I understand the ‘nothing to fear’ part?

Yea, I suppose that can be somewhat confusing. The idea is that anxiety is the great con artist; it cons people into believing that something is legitimately worrisome when it’s really not. Of course, sometimes we’re worried about real-life and legitimate issues, but far more often that’s not the case when it comes to phobias, OCD, and similar types of fears. Rather, I see children like the two I saw last week, washing their hands over and over for fear of germs, or checking locks before bed, over and over, for fear of being robbed despite living in a safe neighborhood, the doors clearly being locked, no history of being robbed, parents being dutiful and responsible, and having two big dogs in the home. Most fears of that nature are, by their very nature, irrational, silly, and nonsensical but, by the same token, profoundly troubling and bothersome.

Okay, so what’s the treatment

Like I said (okay, like F.D.R. said), there’s nothing to fear but fear itself; so, first we clearly identify the enemy. I often refer to anxiety as a ‘monster’ that whispers to the child any number of anxiety-provoking things. In treatment, we help the child to bolster their reasonable and rationale thinking to help them combat those anxiety-ridden thoughts. This is especially important because children (and adults too for that matter) who struggle with anxiety often have ill-equipped platoons to do battle. Meanwhile, the ‘monster’ is well supplied with an abundance of anxiety-provoking thoughts that can leave the child feeling overwhelmed. However, by the time we’re finished in treatment, the child’s army is fully prepared to counter those anxiety-provoking thoughts with self-soothing reminders that, for example, they’re safe, competent to problem-solve, and that whatever bad thing they think is going to happen, in reality, is extraordinarily unlikely to occur and not worth fussing about.

Anything else?

Yes, there is more. In some cases, it’s also vital to have the child actually be exposed to whatever scares them. This could include, for example, a spider, elevator, sleeping alone in their own bed, dirt (and not washing their hands right away), or whatever else. The exposure may be all-at-once, or gradual. At the same time, they are taught to use soothing self-talk to calm themselves and recognize that they’re going to be okay and that, really, there is nothing to fear. We also use deep breathing, imagery, reassurance, and ongoing parental support to ensure success. In those instances that the child is too overwhelmed with anxiety to allow for any exposure, there are medications that can be quite helpful.

Is this approach helpful?

Yes, it’s super helpful, with over 80% success rates. It’s used with phobias, OCD, generalized anxiety, isolated obsessions and worries, separation anxiety, fears of sleeping alone, social anxieties including public speaking, and frankly anything related to any anxiety or fear. If you’re interested in more technical terminology, the approach is referred to as exposure and response prevention.

If you want more information about these techniques, email me at:

Also, don’t forget to follow me on facebook (drjohncarosso) and twitter (drcarosso) for daily tips, suggestions, and research. God bless.

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