Fear and the Treatment of Phobias with the Palo Alto Model
by Béatrice Giraudeau - Therapist and coach / LACT research partner - firstname.lastname@example.org - Blog: Sculpting your life
"Fear averted, fear increased"
Fear is an emotion.
It is more precisely the emotion of danger , which very paradoxically keeps us alive. Fear is inherent to our survival, and acts as a warning signal . The stakes are high and its spectacular symptoms (accelerating and racing heartbeat, tense muscles, sharp tension, cold sweats, etc.), are up to what is at stake, quick to prepare us to escape or to push back the greatest predator threatening us. It is our reptilian brain, via our cerebral amygdala located in the limbic system, which takes control of our survival.
Its essential function is to decode the stimuli which could be threatening for the organism. Our brain is programmed like a powerful computer and its job is to find solutions to keep us alive, every moment of it, for as long as possible. It is capable of making billions of calculations based on the information it receives from outside through our senses and thought. It is better to experience false alarms than to ignore them at the expense of our lives. If I hear or see a car at high speed coming towards me when I cross a road, my heart will panic in my chest to better oxygenate my muscles in a survival reflex, and allow me to take a powerful leap. backward. And if in reality, I had ample time to cross safely, then I would recover from my great fright, but still alive.
According to Henri Laborit (Praise of flight) , there are three great archaic programs of survival, flight and, if this is not possible, aggressiveness which will prepare for combat. If we can neither flee nor fight, then we fall into a state of bewilderment . This third archaic program is all too often overlooked, especially regarding its usefulness: being totally paralyzed and paralyzed by fear is a sort of
ultimate solution The giraffe knows it well when the lion is going to devour her, the danger is upon her, she can no longer escape it, but she can, in a state of involuntary amazement, no longer feel anything to soften her death. I remember having experienced this state of amazement. I was in the car in a great state of exhaustion, and at a crossroads, I do not calculate a truck coming straight at me. I can still see myself looking at him, dazed and totally paralyzed thinking of my programmed end; fortunately the heavyweight stopped before crushing me. Looking back, I'm still sweating...
A phobia is a fear that has become disabling and pathological.
Fear is a normal reaction as long as it does not systematically paralyze any action or block the actions of everyday life.
If so, it becomes a phobia. When fear prevents us from living our life and having new experiences, when reality becomes threatening even in the most common acts of daily life, then phobia has taken precedence over fear.
Fear is a way of adapting to our environment , phobia prevents us from doing so and limits our adaptation .
The list of phobias is as long as your arm. Here they are listed in Wikipedia and tell us about the inexhaustible imagination of our brain.
Let's remember that there are monophobias (fear of flying, fear of spiders, fear of taking an elevator, etc.) and generalized phobias (fears that completely block the individual in all acts of their life such as agoraphobia: fear of public places with inability to leave home, panic attack syndrome, obsessive compulsive disorders, hypochondria...)
Monophobias still leave a space of freedom and adaptation to the individual , as long as he stays away from the object of his phobia; generalized phobias gradually invade the life of the individual, slyly eating away at his autonomy day after day.
"I carry all the wounds of the battles I avoided"
In brief systemic and strategic therapy , it is important to understand and identify the construction of the phobia more than the trigger, knowing moreover that there is not always one. Phobia is a construction of our brain and understanding why will not give us the keys to healing.
Both phobia and fear are not rational. This fear-based disorder builds itself with its own attempt at a solution , which gradually raises the walls of a prison. It is by systematically wanting to avoid his fear and asking for help that the person enters the hell of a vicious circle. The more she avoids, the more she is afraid, the more she sends herself the message: "I am not capable", the less she adapts and the circle is closed. Ditto for asking for help: The more I ask for help, the more I sabotage my self-confidence, the more I learn to become dependent, the more I am afraid and the more I build a phobic perception of reality. Watzlawick says , the problem is the solution.
Certainly the person finds immediate relief in avoidance and asking for help , but he prepares for the next crisis. The more she wants to control her fear by avoiding it, the more she loses control. A fear must be overcome in order to learn courage , the only antidote to phobia.
Run away from the ghost and it will chase you, touch it with your finger and it will disappear. Facing fear allows you to go beyond your own limits.
Treatment of a phobia with the model of Giorgio Nardone
Giorgio Nardone Italian psychologist and psychotherapist, he is one of the main representatives of brief, systemic and strategic therapy in Europe. He directs the Strategic Therapy Center in Arezzo , which he founded in 1989 in collaboration with Paul Watzlawick , as well as the Mental Research Institute in Palo Alto (California).
He has worked for more than 15 years on phobic disorders, successfully applying the results of research focused on faster and more effective therapies. See his book: Exceeding the limits of fear
The intervention logic of this model will focus on the attempts at solution (avoidance and seeking help) in order to break the vicious circle which maintains the phobia. For this, the therapist will have to use therapeutic stratagems to bring the person to break his unsuccessful attempts at solution, by allowing him to learn new things about overcoming his fear, without even being aware of it at first.
To illustrate this mode of intervention, let's take the case of this young girl, whom I accompanied in the treatment of a panic syndrome . We will call her Catherine in order to preserve her anonymity.
Catherine is a 20-year-old student, just out of two years of literary preparatory classes. She is preparing to enter a business school. For the past few months, his life has become hell. She can no longer take the metro without having a panic attack. The fear of fainting or vomiting in the middle of the crowd paralyzes her and prevents her from going out. We are in July, and the anticipation of the prospect of his return to school in September adds an additional dimension to his fear and triggers constant anxiety, even far from the object of his phobia. Gradually the trap closes in on her, as she avoids and asks for help, especially from her boyfriend who systematically accompanies her on all her journeys. Every morning, her anxiety is stronger and causes tremors, a lump in her stomach and nausea which make her vomit (hence her fear of vomiting in the metro in front of everyone). Gradually and very insidiously, she refuses to go out at night, to drive a car and only takes public transport when her friend is present.
A panic attack is a paroxysmal crisis of anxiety with loss of control (sensation of very great immediate danger, fear of dying with very strong palpitations, dizziness, sweating, tremors, fainting, etc.), a consequence of too much fear and a feeling of helplessness.
Topo of his sessions
First session : It allows to create the link and to become aware of the situation and the problem.
Faced with Catherine, do not above all try to reason with her and rationalize her fear, but "join" her in her suffering. Then emphasize in a hypnotic way the construction of his phobia: - "And the more you avoid, the greater your fear, the more you ask your parents and your friend for help, the more you make yourself dependent and in the inability to go out, to take public transport....And the more your life becomes a hell....And the more you feel in danger...
In this first session, it is far too early to bring changes, and gradually get him through his fears. The idea is to get him to perceive help and its consequences as an even greater fear than his own phobia.
I will give him two prescriptions:
- Note down each time that 'she asks for help but above all do not change anything!
- Prescription of the logbook which must not leave her and which she will fill in at each start of a crisis. The logbook consists of noting in a small notebook purchased at this effect, and this from the start of a crisis, the day, the hour, the context, the symptoms, the thoughts,
reactions in the most conscientious way possible. It aims, among other things, to distract from the crisis. Second session : the little diary allowed Catherine, at the start of an anxiety attack, to regain control and gradually soothe her nausea and her desire to vomit.
Very proud of herself, Catherine has had her first corrective emotional experience and is beginning to sow the very first seeds of restored trust.
She plans to take the train alone for a long journey. - Prescription of the fantasy of the worst every day in relation to the fear of taking the train.
It's a daily ritual that consists of meeting your fear in your imagination in order to overcome it. Third session: Catherine was never able to catch her train.
Accompanied by her mother at the station, the crisis of tears catches up with her very quickly to mount a crescendo and be interrupted by a syncope. Obliged to make the trip by car with her mother (7 hours drive), she nevertheless decides, seeing the latter very tired to take the wheel at the cost of a great effort. Effort rewarded because Catherine managed to drive through her fear;
big win for her. This will be followed by many other small cascading victories: saying yes to all outings while being accompanied, doing work in a house, losing weight (which she wanted) etc. Catherine is gradually getting back into motion and a virtuous circle has taken the place of the vicious circle of avoidance and confinement.
With the back-to-school deadline approaching, we are focusing on being able to take the metro alone.
- Strategic prescription : Go every day in the direction of the metro and stop 50 m from it and above all do not take it . Turn around, but before turning back, take 10 steps back (unbeknownst to her, Catherine is going to get a little closer to the metro).
Fourth session to sixth session : Catherine will gradually overcome her fears and even transgress my prescriptions by taking the metro alone.... On the first day of school, she will be accompanied by her friend, because there is too much anxiety on this day J but will gradually manage to regain her total autonomy, even, she will tell me, a much greater self-confidence.
Seventh session : Consolidation session
Catherine's testimonial: " The anxiety attacks hit me when I least expected it. I had just had a wonderful year and yet, I started having an attack and the fear of this attack m made me have more seizures like a cascading chain. For two months before deciding to go to therapy, I stayed locked up at home, with a lump in my stomach, because I didn't want them to come back. The problem being that they always come back if nothing is done to stop them. After a month, I decided to take action. I couldn't stay locked into a life like this. I started therapy which consisted, without my knowing it, of regaining self-confidence through different exercises such as the half-hour of the worst, the logbook that I had to keep with me constantly, my reassessment, the abandonment of aid and of all my avoidances… I truly relearned how to do things on my own thanks to that, and through accompaniment with Béatrice Giraudeau, I was cured in barely 5 sessions. It wasn't easy and sometimes I thought I was going to let it all go, but gradually I started to see the light at the end of the tunnel of this hell. Today I am much better, even better than before my crises and I know that this kind of problem can be solved with a lot of determination and courage. "