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HOUSE CALL WITH DR. SANJAY GUPTA
Page Anderson Discusses Phobias
Aired May 15, 2004 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Good morning and welcome to HOUSE CALL. Are you afraid of heights? Do you tremble at the sight of a spider or freeze up in a crowd? Well, you may be one of the 12 percent of Americans who are living with a phobia. And for some of you, relief from this sometimes paralyzing disorder could be within sight.
GUPTA (voice-over): Fears.
UNIDENTIFIED MALE: Help!
GUPTA: Television shows prey on them and according to the surgeon general, 16 million Americans suffer from some kind of phobias. Most people learn their fears. But what if a little pill could help unlearn them?
For 30 years, Beth Cox has been terrified of heights.
BETH COX, FEAR OF HEIGHTS: As long as I remember being an adult, I remember being afraid.
GUPTA: Tall bridges, mountains, and elevators. Anything high, they all stopped her cold.
COX: And I'm hyperventilating, I'm crying. My hands are shaking. My legs are shaking. I was scared to death.
GUPTA: Tired of it, Beth joined a medical trial in Atlanta.
UNIDENTIFIED FEMALE: We're going up to the ninth floor.
GUPTA: Beth was part of a small study that focused on fear of heights. It involved a virtual reality elevator, combined with a little pill called dicylclosarin. The drug already approved to combat tuberculosis seemed to also affect the brain's fear center.
Dr. Michael Davis, a psychiatry professor at Emory University, conducted the study and found that patients who took the drug before therapy actually unlearned their fears faster.
DR. MICHAEL DAVIS, PSYCHIATRY PROFESSOR, EMORY UNIV.: And what this medication seems to do is speed up or improve your ability to get over your fear.
COX: I feel great.
GUPTA: Beth took one pill a few hours before her therapy. And after only two sessions, instead of the normal seven or eight, was able to unlearn her fear of heights going all the way to the top floor on the simulated elevator.
DR. BARBARA ROTHBAUM, PSYCHOLOGIST, EMORY UNIV.: It's, you know, one of the most exciting things, I think in psychiatry or psychology in decades. Give a pill right, before a therapy session, and make therapy work better and faster. And that's amazing.
GUPTA: And once you are done with therapy, you are also done with the pill. Not everyone is sold on the idea of the medication, however. Some experts believe therapy alone is still the most effective. Researchers caution dicyclosarin only works when combined with exposure therapy.
For Beth Cox, it gave her the courage to go to great heights.
COX: OK. I don't love it, but I can do it. I don't have to like it, but I know I'm safe. I could probably even stay on one of these floors. But I can do it.
GUPTA: Thanks to therapy, she's able to take long looks down.
GUPTA: That type of drug probably won't be available for 2 to 5 years, but it does give those suffering some kind of hope. Now, if you think you have a phobia, here are signs to look for. If your fear interferes with your work or your social life, or is persistent or irrational, also, if you get immediately anxious when exposed to you fear and you need to avoid the situation or object, then you most like have moved past fear and into a phobia.
Helping us conquer those fears is Page Anderson; she's a clinical psychologist and assistant professor at Georgia State University.
And you were involved in the study we just talked about as well, with these cyclosarins.
PAGE ANDERSON, PSYCHOLOGIST, GEORGIA STATE UNIV.: That's correct.
GUPTA: A pill to help you conquer fears. How does that work?
ANDERSON: Well, treating specific phobias is something that has actually not been in the purview of medication for a long time. Psychologically, the idea for treatment is to help a person unlearn a fear and this pill is supposed to speed up that process.
GUPTA: I mean you know, it's sort of interesting. Everybody has phobias of some sort, or some point or another. And a lot of people are trying different things to try and conquer them. This might be something down the line, you think?
ANDERSON: Could be. The treatments that we have available are already very effective, but something to help facilitate that process will be helpful.
GUPTA: All right. We told our viewers you were coming and we have lots of e-mails coming already. Let's start with Kimberly in Texas. She wants to know, "I grew up climbing trees and would climb on to the second story roof of my house to get away from it all. Now in adulthood, I have a fear of heights and can't figure out why. Looking down from high above or even seeing movies or television with heights involved," makes her sick to her stomach. So what's wrong?
What do we know about what causes a phobia like this, do you think?
ANDERSON: Well, there are different sorts of pathways to fear. Sometimes people describe experiencing a traumatic experience, like-- such as like falling out of a tree. Another pathway to fear is hearing about bad things. So hearing your mother warn you about, get down out of that tree you're going to hurt yourself. And finally, witnessing someone else who is fearful in that situation is another pathway by which a fear might develop.
GUPTA: You know, peep -- you think of kids sometimes that have may be irrational fears of going into the basement and things. But how many of these phobias actually develop in adulthood?
ANDERSON: Most of the diagnosable, specific phobias do develop in adulthood. You see it among children. But many fears among children are developmentally appropriate. And it's because their brain can't keep up with what's going on in the world around them. So they become fearful. And most kids outgrow fears.
GUPTA: OK. Let's get to another question now, as well. Kogel in Georgia writing, "As a child, I was bitten once by a dog and ever since, I have been scared of them. My daughters play with the neighborhood dogs. But I'm afraid to even step out of the house. I'm constantly in a state of fear that a dog might come running at me."
Page, so this fear was triggered by a specific event. What sort of advice would you give to Kogel?
ANDERSON: Well, that like her mother would probably tell her, in order to overcome a fear, you have to face a fear. But you want to do that therapeutically. There are three aspects to facing a fear therapeutically. One is to do it gradually. So, she might want to start off being near a dog but not right in a dog's face. You want to do it in a controlled way. So she doesn't want to be around a ferocious dog. She might be around a nice puppy dog. And you want to repeat the exposure to the dog over and over, and over again until her anxiety decreases.
GUPTA: Over what period of time do you think someone like her would be able to overcome their fear? ANDERSON: It really depends, but it's shorter rather than longer. Probably a few days at it intensively could put a big dent in her fear.
GUPTA: So fear of dogs. Would it be the same for fear of heights in terms of just a few days to overcome this?
ANDERSON: Depending on the time that you could devote to it. Most research studies usually do eight sessions. But certainly there have been intensive treatments for specific phobias that might last only a day.
GUPTA: That's really fascinating. I want to talk more about that as well. But first, Regina from Ohio asking, "I am phobic about snakes. I logically know that snakes are not in my yard urban Ohio," where she lives, I guess. "Academically, I know the fear is irrational. Is there some part of the brain that processes phobias differently than other fears?"
That's a good question. We talked about the amygdala a little bit in the piece about being the fear center. Is that where it all comes from?
ANDERSON: Yes. The amygdala is the hot spot for fear and anxiety. And most people who have phobias will say that intellectually, they know there is nothing to be afraid of. But it's a matter of making it feel real.
GUPTA: I mean scientifically, does -- is -- people who have phobias is that amygdala sort of hyperactive in their brains?
ANDERSON: Yes, and they become more attentive to potential danger in the environment.
ANDERSON: Scanning for danger, whether it be dogs, airplanes or spiders.
GUPTA: We're going to learn a lot about phobias and fears this half hour.
When HOUSE CALL continues, from bugs to bridge, we'll talk more about fighting phobias.
UNIDENTIFIED FEMALE (voice-over): Does driving over bridges terrify you? What about being around spiders? Stay tuned for tips to help you conquer specific phobias.
And later, if crowds are your nightmare, you may have social phobia. We'll tell you all about it.
But first, today's "Daily Dose" quiz. What is the most common phobia? The answer when we come back.
(COMMERCIAL BREAK) UNIDENTIFIED FEMALE (voice-over): Checking the "Daily Dose" quiz. We asked, what is the most common phobia? The answer is arachnophobia, the fear of spiders.
GUPTA: I don't like spiders either. Hmm.
Phobias are the most common psychiatric illness in women and second most common in men over the age of 25. Besides fear, phobias sometimes bring on physical symptoms like sweating, or rapid heartbeat, you may also have difficulty breathing and trembling. Nausea can be another side effect that accompanies panicky feelings and intense anxiety.
Page Anderson, she's a clinical psychologist here in Atlanta, is here to help us work through all of these phobias.
And as you've just heard, spiders are No. 1 on the list in terms of overall phobias. We've got a lot of questions coming in on this and one specifically about this.
Melissa from New York writing, "I have never liked spiders," not many of us have. "But my fear of them has gotten worse over the years. It has gotten so bad that I dream of spiders crawling on me. I even check the ceiling and the walls near my bed before going to bed. What can I do to get rid of this fear?"
What point -- and this -- you -- you and I were talking saying when it interferes with your life, it's a problem. Melissa clearly has a problem, right?
GUPTA: What do you tell her?
ANDERSON: Again, exposure therapy is what's known to be...
GUPTA: Exposure to spiders?
ANDERSON: Exposure to spiders. There are different types of exposure therapy. Imaginal exposure has one imagining spiders. Which probably makes more people comfortable when they think about facing their feared object. In vivo exposure means exposure in real life. There's a third type of exposure, virtual reality exposure, which helps a person face their fears in a virtual world.
GUPTA: Should people be seeing someone like you, when they are doing this sort of exposure therapy? Or should they sort of listen to what you are saying and do it on their own?
ANDERSON: It depends. Most people who have a diagnosable phobia have tried to help themselves, and if they've not met with much success, then I would encourage them to contact a mental health professional.
GUPTA: You know, here's a question I have. She's scared of spiders. A lot of people are scared of spiders. But more of it is it's affecting her sleep and affecting daily life. Is there something she can do specifically about that and still be scared of spiders? I mean she may always be scared of spiders, right?
ANDERSON: She probably will be always scared of spiders. It's a matter of managing a fear so that it's not overtaking your life.
GUPTA: I'm going to talk about some strategies on this.
Vicki in New York also asking, "I am deathly afraid of flying. I miss out on every vacation that is not within driving distance." I know that feeling as well. "When I am up in the sky, I tremble, cry and can't sit still. I've taken pills but they haven't work. Please help. I'm getting married and would love to have -- to soon be on my dream honeymoon."
All right, page. We talk about virtual reality therapy. I think you actually brought a prop over here to give us a sense of this. What is something you recommend for Vicki?
ANDERSON: Well, if she were going to do virtual reality exposure therapy, a person doing that kind of therapy, it's simply a way of facing one's fear. So too do that, one works with a therapist. It's not something that you do on your own.
A person would put on this. It's called a head-mounted display and a computer program feeds them what look like a virtual airplane. They'll see the virtual airplane; they'll hear the noises that the virtual airplane makes. and they can feel the rumble of the virtual airplane. And the therapist assists them in facing their fear in a gradual way.
GUPTA: So you...
ANDERSON: Say for example, if Vicki is afraid of takeoff, one can practice takeoffs over and over again.
GUPTA: So you're talking about exposure therapy, you don't have -- you can't obviously get them up in a plane. So this is sort of a substitute.
We have some video, which we can look at as well, to try to give us a sense of what somebody would see here. Take a look now. What are we seeing here? What is going on?
ANDERSON: Well, this person is in a virtual heights environment. Again, she is looking at the headset; and as she moves, her world moves with her. So as she's looking down, she's looking down the elevator shaft. The therapist is talking to her through the headphones. Encouraging her, helping her talk about and challenge the negative thoughts that she's having here.
GUPTA: Is this effective? I mean because I see this and the images are actually pretty startling. But it's not the same as being in an elevator, right? How effective is it?
ANDERSON: It's not. And for people who aren't phobic, they would get into the virtual reality and think that it's cool, but not really real. But for people who are phobic, they can actually activate that fear network such that they feel as if they are really real. What they bring with them to the virtual experience is as important as what they meet there. Your mind fills in the blanks, so to speak.
GUPTA: Interesting. And that's the helmet there.
ANDERSON: It is.
GUPTA: So we'll take a look at that.
Also, let's try and get to another question. Sharon in Florida wanting to know, "Is there any treatment available that helps one overcome the fear of driving over bridge?
How do you know what type of therapy someone needs, like Sharon? And I should point out I was talking to one of our producers, Karen Denise; she says she has the same problem driving over bridges. It started in adulthood. What do you tell someone like Sharon or Karen?
ANDERSON: Get a lot of calls from people from California and Florida...
GUPTA: Lots of bridges there.
ANDERSON: ... and some in Atlanta about bridges. The fear of bridges, the fear can come from different places. Sometimes people are a fear of getting stuck over a bridge, they're afraid of being trapped, they're afraid of how they are going to feel when they're driving over a bridge. And so, I would suggest a therapist to help them pinpoint those fears, so they can more affectively face them.
GUPTA: The exposure therapy...
GUPTA: ... you drive over the bridge again?
ANDERSON: Oh, absolutely.
GUPTA: This is tough stuff.
ANDERSON: Oh, yes. I've gone driving around Atlanta with people before for people who are afraid of driving.
GUPTA: All right. I hope that helps Sharon and Karen.
GUPTA: Stay tuned for more HOUSE CALL. We're moving on to the social phobias. Stay with us.
UNIDENTIFIED FEMALE (voice-over): You are avoiding going out, don't want to be around people, and fear being judged. Is it shyness or social phobia? Plus, if a child suffers from a phobia, will it go away as they age? The answer when we come back.
But first, here's a tip from our health conscious "Bod Squad."
(BEGIN VIDEO CLIP)
HOLLY FIRFER, CNN CORRESPONDENT (voice-over): We've all tried to hula-hoop at some time or another. But did you ever think of using this childhood favorite as a fitness tool? Wendy Iverson did. Looking to take her hoola workout to a new level, Iverson created a weighted version, twirling the popular toy into a strength and aerobic trainer.
WENDY IVERSON, CREATOR, HEAVY HOOP: The stomach muscles are actually contracting, so you are working the stomach, you're working your frontal abs, you're working your obliques, your side stomach muscles. And you're getting the back, so you're getting that circular pattern. But of course, we're working the hips. We're working the glutes because of the position we're in. And then the upper body, you can't put the arms down. So what we do is we start adding in punches and stretches. And you're twisting against the weight of that hoop.
One, two, three, four...
FIRFER: The result is a dual packed cardio and strength workout. And best of all, it's an enjoyable way to sweat your way to success.
And if that isn't enough to inspire you a study by the Cooper Institute showed one minute of vigorous heavy hopping burns as many calories as running an eight-minute mile, or a high-impact aerobic class.
Holly Firfer, CNN, Atlanta.
(END VIDEO CLIP)
GUPTA: Welcome back. We've been talking about specific phobias, such as the fear of flying, heights or animals. But not all phobias are the same. While specific or simple phobias are the most common, there are two other types, social phobia and agoraphobia.
Social phobia affects more than 5 million people and can be debilitating. This disorder tends to strike during mid to late adolescents with shyness-like symptoms, including fear of humiliation and embarrassment. Also, small mistakes tend to be exaggerated. People with this disorder also tend to suffer from low self-esteem.
We're talking with Page Anderson; she's a clinical psychologist and an assistant professor at Georgia State University.
Seems to me, Page, everyone has a social phobia from time to time. ANDERSON: Fear of public speaking is the No. 1 fear among American adults. We've probably all felt our heart race, as we get ready to give a presentation in front of a large group.
GUPTA: Sometimes people take medications even to try and diminish those fears.
ANDERSON: Absolutely. Or start to use alcohol in the face of social situation.
GUPTA: A little "liquid courage," they call that.
ANDERSON: Yes. But it can be a problem.
GUPTA: It can be a problem.
Let's get to some e-mail questions here. Alex in Massachusetts asking, "I have a phobia of being around people and speaking to crowds. I hate it. I don't like to socialize with many people. How can I fix this problem?"
You know, it seems to me that the first step is recognizing, which Alex has done here. What do you tell him?
ANDERSON: That's correct. Recognizing that it's a problem is the first step. But that's not going to get you the whole nine yards. Again, cognitive behavioral therapy, exposure therapy is the treatment of choice in treating social phobia. And some have developed a group treatment for people with social phobia. The idea being that if you are afraid to be around other people, a group treatment makes it a convenient place to interact with others.
GUPTA: You talk about exposure therapy. Do you treat social phobias the same way you treat the other phobias, like a fear of heights, for example?
ANDERSON: In some ways, yes, you do. Because you want to expose the person to the thing they are afraid of. But that's going to be different for a person with social phobia than for a person who's afraid of heights. And getting to know the specific nuances of the fear can often be difficult.
GUPTA: Fear of speaking in front of large crowds. Spear of feaking -- fear of speaking in front of cameras sometimes difficult, as well.
GUPTA: Yes, as we're seeing here sometimes.
Cindy from New Jersey writing, "My 15-year-old son suffers from a fear of crowds. He does not like being in a large classroom setting, or being out in a public place with a lot of people, like restaurants, for example. He feels very insecure, like things are closing in on him. How can I help him feel more comfortable when he is in a situation like this?" Page, being a teenager can be hard enough. But it sounds like he has some real physical sort of symptoms associated with this phobia.
ANDERSON: And this is where I'd recommend the mom taking the child to a mental health professional. Because getting to know the nitty-gritty details of the fear is going to help the therapist and the mom know what steps need to be taken for the child to become more comfortable. And in working with kids and phobias, it's different because they don't have all the resources that we have as adults to face fears.
GUPTA: If someone develops a phobia as a child, how likely are they to sort of grow out of it as they grow older?
ANDERSON: Most kids will grow out of phobias.
GUPTA: How do you know when to take them to the doctor? You mentioned in this case, maybe he should go to a mental health professional. Is there something that triggers that in your mind? You say you know what? He really needs to see somebody, as opposed to dealing with it himself?
ANDERSON: If it's keeping a child from doing what they need to do, if it's keeping a child from developing friendships or doing well in school, or having difficulty going to school, it's time to seek professional help.
GUPTA: All right. We're talking to Page Anderson, lots of good advice here.
When we come back, we're going to take on the biggest myth of all about phobias. Stay tuned.
UNIDENTIFIED FEMALE (voice-over): If you need help staying awake, drinking that tall latte may not be the way to go. A new study just ahead.
Plus, not sure where to go to get help for your fears? We'll give you some web sites to check out. That's just a click away.
GUPTA: Welcome back to HOUSE CALL.
Let's take a look at some of this week's medical headlines in this week's edition of "The Pulse."
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE (voice-over): Your morning java may not be keeping you as awake as you think. Researchers found people who drink small amounts of caffeine throughout the day are able to stay awake and perform better than those who drink a large amount early in the morning.
Also, the majority of items in most school vending machines are sugary drinks, or snacks high in fat and calories, according to a new study by the Center for Science in the Public Interest. With nearly 16 percent of American kids overweight, many schools say they are now switching to healthier selections, like water, milk and nuts.
(END VIDEO CLIP)
GUPTA: OK. If you want more information about phobias, check out www.nmha.org. That's the National Mental Health Association website, where you're going to find some helpful fact sheets.
Also, try clicking on www.adaa.org. You can take a phobia quiz to see if you're experiencing fear or a phobia. The site is also a great resource for finding treatment or self-help groups in your area.
We've been talking to Page Anderson.
Really interesting stuff today. Page, thank you. Do you have a final thought that you'd like to share with our viewers today?
ANDERSON: Sure. People with anxiety disorders are not weak. They don't have a character defect. Most of the patients I see are very ashamed about their anxiety. People are smart and intelligence. They just suffer with an anxiety disorder.
GUPTA: And the myth of phobias as well.
ANDERSON: That phobias are intractable and difficult to treat. In fact, anxiety disorders, there are relatively good treatments out there. And I would encourage people to seek help. They're not going be in therapy for years; it's going to be a matter of week or month.
GUPTA: You don't have to live with them.
ANDERSON: You don't.
GUPTA: Really good stuff.
We are out of time for today. Page Anderson, thank you so much, really good advice today. Appreciate you coming by.
Also thanks to you all at home, as well, for all of your e-mails.
Make sure to watch next weekend when we do an overnighter at an American Cancer Society relay event. Meet inspirational people and find out where we are in the fight against cancer. That's next weekend on HOUSE CALL, 8:30 Eastern.
Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now to more news on CNN.
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