In A Brief History of Anxiety: Yours and Mine, Pearson describes the Flu Wiki:

“The conversations ranged widely, from scientific discourses on virus mutation to historical analysis of pandemics, to tips for home fuel storage—on the presumption that self-quarantine would be the only effective protection from contracting the virus.”

Though she realizes that her fears may be unwarranted and absurd, she can’t stop stockpiling her house with twelve containers of freeze-dried vegetables and powdered butter, which requires 27 cups of water. Still, she isn’t hypervigilant about everything: She doesn’t fear house fires, terrorism, crime or harm striking her two small children.

But she fears other things, including the dark, the state of her finances and on one occasion, her car exploding. Her phobias are chameleons:

“My anxiety is a shape-shifter. It visits me in unfamiliar guises. Phobias, in particular, tend to take me by surprise, as they rear up and then fade away depending upon the stresses in my life. One minute, I’ll be going about my business, being the sort of person who likes to fly on airplanes and to marvel at the deceptive fluffiness of clouds, and the next thing I know I’m in a state of white-knuckled panic as the jet I’ve just boarded powers itself off the tarmac. After a few years, that phobia resolves and something else—some other act or object—unexpectedly becomes the embodiment of all that is terrifying.”

As she delves into her own anxiety — triggered by a devastating relationship — Pearson tries to understand our anxiety, too, wondering why America tops the list of countries with anxiety disorders. While 28.8 percent of us suffer from anxiety disorders, only 6.6 percent of Mexicans do. We’re also nine times more likely to be anxious than citizens in Shanghai.

For insight, Pearson looks to a variety of experts, including psychologists, psychoanalysts, psychiatrists, philosophers and writers. In turn, she creates a book that’s rich with research without being overwhelming or reading like a textbook. She weaves her own experiences with the work of today’s thinkers and luminaries from long ago. Her writing is witty, humorous and powerful. There’s no highfalutin’ language. No psychobabble. Individuals with anxiety may very well see themselves and find that Pearson captures perfectly the gnawing angst of anxiety:

“There are several ways to cope with dread, but I specialize in what psychologist Maria Miceli calls ‘hypothetical analytical planning.’ This is where you lie in bed at night and run through as many perspective scenarios as you can imagine and then rehearse them in French, or from the vantage point of a cat.”

“The signature vexation of anxiety is that it is objectless. It washes over one in formless waves, pulls one under until the pressure and constriction are tangible and panic rears: I’m in deep, I’m going to drown.”

Part of our problem, Pearson concludes, is that we turn to pills at a time when our anxiety might be telling us that we’re “caught and flailing in arrested development.” She draws on this conclusion after quoting Danish philosopher Søren Kierkegaard:

“Anxiety is an alien power which lays hold of an individual, and yet one cannot tear oneself away, nor has a will to do so; for one fears, but what one fears, one desires.”

Kierkegaard viewed his own time as “the cowardly age,” when a person “does everything possible by way of diversions and the Janizary music of loud-voiced enterprises to keep lonely thoughts away.” Pearson sees the same thing with today’s society, except that we push existential philosophy aside. We’ve also sidelined meaning, a result of rationalism, which was supposed to reduce our fears. Instead it’s only “invalidated meaning, which merely served to heighten our dread.” The idea that we can control our lives hasn’t helped us either.

Pearson also talks about the culture of the workplace, where employee loyalty has been replaced with fake “team building” and traits viewed as positive and polite in countries like Japan — “being deferential, soft-spoken, courteous and self-effacing” — are considered disordered here in the U.S. (i.e., “social phobia,” “avoidant personality disorder,” “workplace depression”).

She dedicates a chapter to “a drug’s odyssey,” in which she describes her own experience with medication. In the first few weeks taking Effexor, Pearson feels like it’s “heaven-sent.” But then she begins to feel “apathetic insincerity.” She likens her “secure and yet largely disengaged” state of being to her first job out of college ghost-writing letters at Ontario’s Ministry of Labour:

“I did not enjoy this ghostwriting job, mostly because I spent the day responding to genuine human calamity by (a) pretending that I was someone else, and (b) lying. Yet, it was effortless. Paperwork and coffee breaks and lunch, all at a placid pace. I watched the clock a lot, waiting for it to hit five. ‘Dear Widow Whose Husband Drowned in a Vat of Toner at the Wallpaper Factory, thank you for—‘Oh, five o’clock, gotta go.”

Pearson was addicted to Effexor for five years. Of her horrifying, heroin-like withdrawal, she writes:

“My withdrawal featured night sweats, muscle aches, and shortness of breath. There were the electric pulses but I was used to those from the times I missed a dose. (Seth Silverman in Slate best described them as feeling like someone had removed your skull cap and dragged a staticky blanket across your naked brain.)…On most days, I felt a sort of hypercaffeinated wiring and buzzing sensation, a feeling of continuous adrenal rush. It was like being mildly electrified. And then on certain days, it was as if someone had pulled the plug from the socket and the energy simply winked out. I experienced nothing but darkness, an unbearable density and weight that almost brought me to my knees.”

She faults her psychiatrist for failing to inform her of Effexor’s side effects, and criticizes psychiatry as a whole for steering away from talk therapy and withholding important information:

“How can so many thousands of people, very possibly millions, have been abandoned by so many of the practitioners of medical science and been made to fall back upon rumors and whispers about how to manage their meds? At first, I could only think that these particular doctors needed to be in control, to fix what they’re interested in fixing; they suspect that they’ll lose control if they allow their patients to make an informed choice. ‘I can repair your illness, but you need to know that you’ll become emotionally bland, sexually absent, likely fat, probably at risk of getting diabetes, and every time you miss a dose, you’ll feel like you’ve been shocked with a cattle prod. It’s up to you.’ They don’t want it to be up to you. They don’t trust your judgment. They think you’re nuts.”

It’s understandable why Pearson holds such a negative view of medication. Had she been provided with all the facts—which would’ve taken mere minutes to discuss—she could have avoided years of agony. However, as she scours history for insights on anxiety, she does little to explore all facets of pharmacology. Medication does help many people. It can be used to facilitate psychotherapy, jump-start recovery or help diminish debilitating, severe anxiety. But Pearson gives little in a well-rounded discussion. Her “cautionary tale,” as she describes it, certainly can help others to seek better treatment. If you’re considering medication, see a psychiatrist who specializes in anxiety disorders and who can answer all of your questions (and be sure to ask many). Don’t hesitate to do your own research and remember that you and your doctor are a team. You should never feel like a powerless bystander when it comes to your treatment.

Cognitive-behavioral therapy (CBT) is the first line of treatment for anxiety disorders — and a highly successful one at that. In fact, the success rates make other researchers envious, as one expert put it. So it’s disappointing that Pearson devotes just several pages to her experiences with the treatment. This does a disservice for readers who are learning about anxiety disorders for the first time. They may easily feel like there’s nothing out there that can help them. Pearson could’ve noted CBT’s efficacy and demystified the treatment for her readers.

What’s Pearson’s prescription for anxiety? For one, she calls for American society to grow up. She writes:

“What we need is to bend to the tempest like pine and palm trees—flexible, adaptive, attuned, yet fully rooted in our principles. What we need, in essence, is to grow up.”

We also should look inward and seek meaning. Pearson introduces her last chapter with a quote from the philosopher Rumi:

“Don’t look for the remedy for your troubles outside yourself. You are the medicine. You are the cure for your own sorrow.”

While this quote is empowering, it also implies that it’s best to treat an anxiety disorder on your own. And if you can’t reduce your anxiety, there’s something inherently awry. Again, anxiety disorders are treatable, and oftentimes, avoiding treatment only amplifies the anxiety. Seeking treatment means that you’re taking care of yourself; you’re seeking the resources that will help you get better. There’s no reason to suffer with anxiety. But Pearson’s point is important: Meaning is missing from our lives. In our “I want,” ever-entitled culture, it can be tough to find. But it’s key to us thriving.

Overall, Pearson’s book is a powerful read, which provides a refreshing perspective on anxiety in our age. It offers profound words of wisdom, coming from both Pearson and a slew of gifted, inspiring thinkers. And it can help jump-start your exploration into your own anxiety. At the same time, however, there’s no need to suffer. If you’re experiencing anxiety, make an appointment with a therapist who specializes in anxiety disorders.

A Brief History of Anxiety: Yours and Mine
By Patricia Pearson
Bloomsbury USA; Reprint edition (paperback) March 3, 2009
$13
208 pages

You can also learn more about these techniques on your own, and through self-help books. Keep in mind that not every technique is appropriate for every kind of concern or every person — some may work better than others for you. If you fail at one, don’t despair; it means you should either try again until you succeed with that technique, or try another one from the list.

1. The Experimental Method

Do an experiment to test your belief that you’re “cracking up,” having a heart attack, or losing control.

2. Paradoxical Techniques

Exaggerate your fears instead of running away from them. If you have the fear of cracking up or having a stroke, you try your hardest to crack up or have a stroke.

3. Shame-Attacking Exercises

Purposely do something silly in public, in order to overcome your fear of appearing foolish.

4. Confront Your Fears

Expose yourself to a frightening or high-anxiety situation instead of avoiding it and allowing your fear to control you. There are three common methods:

• Sudden Exposure or “Flooding.” You allow yourself to experience all your symptoms, no matter how bad they get. You endure your fears until they run their course and wear out.

• Gradual Exposure. You gradually expose yourself to whatever you’re afraid of (such as being away from home alone, going into grocery stores, or riding a bus or elevator). Thereafter, you withdraw when your anxiety becomes excessive.
• The Partnership Method. If you are afraid of walking alone, you can ask a trusted person to walk a certain distance ahead of you, and wait. After walking to meet her or him at the location, the individual will walk further ahead before you meet her or him again. This gradual method of managing fear-related anxiety will increase the distance to a point that you are able to walk reasonable distances alone.

5. Daily Mood Log

Write down the negative thoughts that make you feel anxious or frightened. Identify the cognitive distortions associated with those thoughts, and replace them with realistic and positive thoughts. Instead of worrying and constantly predicting failure and catastrophes, tell yourself that things will turn out reasonably well.

6. The Cost-Benefit Analysis

Make a list of the advantages and disadvantages of worrying and avoiding whatever you fear. Weigh the advantages against the disadvantages (refer to the Cost-Benefit Analysis worksheet). Make a second list of the advantages and disadvantages of confronting your fears. Contrast the advantages with the disadvantages.

7. Positive Imaging

Substitute reassuring and peaceful images for the frightening daydreams and fantasies that make you feel excessively anxious.

8. Distraction

Distract yourself with intense mental activity (e.g., crossword puzzle), strenuous exercise, or by getting involved with your work or a hobby.

9. The Acceptance Paradox

When you feel anxious or panicky, you may make matters worse by insisting that you should not feel that way. This type of verbal or sub-verbal negativity only increases your anxiety. One way to develop greater self-acceptance is to write out a dialogue with an imaginary hostile stranger who puts you down for feeling excessively anxious. The hostile stranger is simply a projection of your own self-criticism. When you talk back to that symbolic person, you will develop greater self-acceptance, and you are better able to manage your anxiety or fear.

10. Getting in Touch

When you feel anxious or panicky, you could be ignoring a problem that is best addressed instead of being ignored. Review your life, and identify situations that are making you feel uncertain and fearful. When you find the courage to address a problem such as the fear of rejection in a direct and open manner, a sense of calm will replace uncertainty or fear.

Reference:

Burns, D.D. (1989). The feeling good handbook. New York: William Morrow.

In PTSD, exposure therapy is intended to help the patient face and gain control of the fear and distress that was overwhelming in the trauma, and must be done very carefully in order not to re-traumatize the patient. In some cases, trauma memories or reminders can be confronted all at once (”flooding”), while for other individuals or traumas it is preferable to work gradually up to the most severe trauma by using relaxation techniques and either starting with less upsetting life stressors or by taking the trauma one piece at a time (”desensitization”). A therapist works with the client to determine which method is best suited for the particular client and their trauma.

In phobias, exposure therapy is used in conjunction with relaxation exercises and/or imagery. In conjunction with learning how to bring about a relaxed state at-will, the therapy technique gradually exposes patients to what frightens them and helps them cope with their fears.

Exposing someone to their fears or prior traumas without the client first learning the accompanying coping techniques — such as relaxation or imagery exercises — can result in a person simply being re-traumatized by the event or fear. Therefore exposure therapy is typically conducted within a psychotherapeutic relationship with a therapist trained and experienced with the technique and the related coping exercises.

The “worried well,” it would appear, are everywhere: An estimated one in four physician appointments is taken by a healthy person.

But while the popular view of the hypochondriac is the patient who instantly declares a cold to be flu, those who suffer from health anxiety, as it is now more sympathetically named, rarely concern themselves with such mundane conditions. For those with health anxiety every twinge can be the latest symptom of a terminal disease. Anxiety exacerbates any ache they have so that their pain becomes real and potentially debilitating.

Physicians’ reassurance can have little effect, as the individual often doubts the doctors’ conclusion that they are perfectly healthy. The disorder can become disabling, especially when it coexists with obsessive-compulsive disorder (OCD).

Thousands of people suffer from such acute health anxiety that they are unable to work. “They may be at the extreme end of the spectrum, but this is a problem for many people and it has to be seen as condition in itself,” says Prof. Paul Salkovskis, the director of the Maudsley Hospital Centre for Anxiety Disorders and Trauma, London, UK. “Their suffering is genuine, and their pain often greater than if something really was wrong with them.”

But hypochondria — a Greek word meaning “beneath the breastbone cartilage” — is not a modern phenomenon. Famous hypochondriacs include Tennessee Williams, whose health fears led to alcohol and drug dependence; Lord Byron, who wrote and worried about being thirsty; and Howard Hughes, who became a recluse over fear of germs.
But while health anxiety sufferers formerly had limited sources to feed their paranoia, the Internet makes it more possible than ever, while media advertise for wellness checks and body scans.

This is fueling anxiety, according to general practitioner Dr. Mike Fitzpatrick. “But you can’t just blame the media and the Internet,” he says. “People are becoming ever more introverted and self-preoccupied, and consequently they do worry much more about their bodies. The advice on health awareness sometimes seems to make that worse.”

Currently there are no guidelines to deal with the condition. Patients either are repeatedly turned away by their doctor or sent for “reassurance” scans to prove to them that nothing is wrong. But such tests, it is argued, rarely provide the patient with the reassurance he or she needs, leading to further demands for more tests and examinations, or merely tiding them over until the next worry emerges.

Cognitive behavioral therapy (CBT), a form of psychotherapy which tries to understand and modify behavior, is one option. It has been found effective along with selective serotonin reuptake inhibitors (SSRIs) in recent clinical trials. Talking through the issue can help while antidepressants help reduce obsessional worry through altering neurotransmitter levels.

A team led by clinical psychologist Anja Greeven of Leiden University in the Netherlands found that CBT and the antidepressant paroxetine (sold as Paxil or Seroxat) are both “effective short-term treatment options for subjects with hypochondria.” Their study assigned 112 patients to CBT, paroxetine, or a placebo. Both therapies were “significantly superior to placebo, but did not differ significantly from each other.” After 16 weeks, CBT showed a 45 percent response rate, Paxil a 30 percent response, and 14 percent for placebo.

“Hypochondria is an underestimated problem,” Dr. Greeven said. “Patients have to cross an enormous barrier before seeking psychological help for their symptoms.” She believes it is not a straightforward task for a physician to give the right sort of care to hypochondria patients. “If you tell patients they are imagining their problem, they will immediately get up and leave,” she says. “It is important to take their complaints seriously and to help them to look at their physical symptoms differently. The danger of hypochondria is that the doctor gets tired of the patient and no longer examines him or her, even when there may be real medical reasons for doing so. Consequently, there is a risk that a real physical symptom may go unnoticed.”

References

Greeven A. et al. Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. The American Journal of Psychiatry, Vol. 164, January 2007, pp. 91-99.

University of Leiden study

Amy avoids going to the dentist. She becomes apprehensive, fears the pain and is embarrassed by her nervousness. She feels that she must do whatever the dentist says, whether she understands it or not.

John fears public speaking. He worries for weeks before a talk, can’t sleep the night before and rehearsing doesn’t help his confidence. He tries to get out of giving talks if at all possible.

These people suffer from phobias, irrational fears and avoidance of certain objects or situations. Phobias may be of places and things (such as heights), of people (such as social gatherings), or even of oneself (agoraphobia is a fear of one’s own feelings of anxiety).

Learning to Be Afraid

Phobias are irrational, which means people may be afraid even though the fear doesn’t make sense to them. For example, someone may fear a dog even though the dog acts tame and friendly.

Phobias frequently begin with a frightening experience. A child bitten by a dog, for instance, may fear dogs afterwards—at least temporarily. We also can learn to fear by watching bad things happen to others, and by being around people who are themselves fearful.

In general, avoidance and worry will increase the fear, while reassuring experiences will help a person become less fearful.

Unlearning Fears

Phobias are among the easiest to treat of psychological problems. Even if the fear is severe, the treatment can be fairly brief. In fact, we often can reduce or eliminate a phobia ourselves if we go about it properly.

The two main principles of phobia treatment come from common sense notions. If you fall off a horse:

1. Get back on right away so you don’t develop a fear of horses; or
2. Practice approaching the horse and riding a little at a time to get used to it.

If you suffer from social phobia, you tend to think that other people are very competent in public and that you are not. Small mistakes you make may seem to you much more exaggerated than they really are.

Blushing itself may seem painfully embarrassing, and you feel as though all eyes are focused on you. You may be afraid of being with people other than those closest to you.

Or your fear may be more specific, such as feeling anxious about giving a speech, talking to a boss or other authority figure, or dating. The most common social phobia is a fear of public speaking.

Sometimes social phobia involves a general fear of social situations such as parties. More rarely it may involve a fear of using a public restroom, eating out, talking on the phone, or writing in the presence of other people, such as when signing a check.

Although this disorder is often thought of as shyness, the two are not the same. Shy people can be very uneasy around others, but they don’t experience the extreme anxiety in anticipating a social situation, and they don’t necessarily avoid circumstances that make them feel self-conscious.

In contrast, people with social phobia aren’t necessarily shy at all. They can be completely at ease with people most of the time, but particular situations, such as walking down an aisle in public or making a speech, can give them intense anxiety.

Social phobia disrupts normal life, interfering with career or social relationships. For example, a worker can turn down a job promotion because he can’t give public presentations. The dread of a social event can begin weeks in advance, and symptoms can be quite debilitating.

People with social phobia are aware that their feelings are irrational. Still, they experience a great deal of dread before facing the feared situation, and they may go out of their way to avoid it.

Even if they manage to confront what they fear, they usually feel very anxious beforehand and are intensely uncomfortable throughout. Afterwards, the unpleasant feelings may linger, as they worry about how they may have been judged or what others may have thought or observed about them.

About 80 percent of people who suffer from social phobia find relief from their symptoms when treated with cognitive-behavioral therapy or medications or a combination of the two. Therapy may involve learning to view social events differently; being exposed to a seemingly threatening social situation in such a way that it becomes easier to face; and learning anxiety-reducing techniques, social skills and relaxation techniques.

The medications that have proven effective include selective serotonin reuptake inhibitors, MAO inhibitors and high-potency benzodiazepines. People with a specific form of social phobia called performance phobia have been helped by drugs called beta-blockers. For example, musicians or others with this anxiety may be prescribed a beta-blocker for use on the day of a performance.

Phobias aren’t just extreme fear; they are irrational fear. You may be able to ski the world’s tallest mountains with ease but panic going above the 10th floor of an office building. Adults with phobias realize their fears are irrational, but often facing, or even thinking about facing, the feared object or situation brings on a panic attack or severe anxiety.

Specific phobias strike more than 1 in 10 people. No one knows just what causes them, though they seem to run in families and are a little more prevalent in women. Phobias usually first appear in adolescence or adulthood. They start suddenly and tend to be more persistent than childhood phobias; only about 20 percent of adult phobias vanish on their own.

When children have specific phobias — for example, a fear of animals — those fears usually disappear over time, though they may continue into adulthood. No one knows why they hang on in some people and disappear in others.

If the object of the fear is easy to avoid, people with phobias may not feel the need to seek treatment. Sometimes, though, they may make important career or personal decisions to avoid a phobic situation.

When phobias interfere with a person’s life, treatment can help. Successful treatment usually involves a kind of cognitive-behavioral therapy called desensitization or exposure therapy, in which patients are gradually exposed to what frightens them until the fear begins to fade. Three-fourths of patients benefit significantly from this type of treatment. Relaxation and breathing exercises also help reduce anxiety symptoms.

There is currently no proven drug treatment for specific phobias, but sometimes certain medications may be prescribed to help reduce anxiety symptoms before someone faces a phobic situation.

People who have phobias often are so overwhelmed by their anxiety that they avoid the feared objects or situations. Specific phobias involve a fear of an object or situation, such as small animals, snakes, closed-in spaces or flying in an airplane.

Social phobia is the fear of being humiliated in a social setting, such as when meeting new people, giving a speech, or talking to the boss. Most people experience these fears with mild to moderate intensity, and the fear passes. For people with social phobia, however, the fear is extremely intrusive and can disrupt normal life, interfering with work or social relationships in varying degrees of severity.

Fortunately, through research supported by the National Institute of Mental Health (NIMH), effective treatments have been developed to help people with phobias.

How Common Are Phobias?

Approximately 4 to 5 percent of the U.S. population has one or more clinically significant phobias in a given year.

Specific phobias occur in people of all ages. The average age of onset for social phobia is between 15 and 20 years of age, although it can often begin in childhood.

What Causes Phobias?

Traumatic events often trigger the development of specific phobias, which are slightly more prevalent in women than men. Research shows that social phobia may have a hereditary component and occurs in women and men in equal proportions. However, men may seek treatment for social phobia more frequently than women.

What Treatments Are Available for Phobias?

Social phobia can be effectively treated with medications including, MAOIs, SSRIs and high- potency benzodiazepines. People with a specific form of social phobia called performance phobia have been helped by drugs called beta blockers.

There is no proven drug treatment for specific phobias, but certain medications may help reduce symptoms of anxiety before one faces a phobic situation. A type of cognitive-behavioral therapy known as “exposure therapy” is also a very useful treatment for phobias. It involves helping patients become gradually more comfortable with situations that frighten them. Relaxation and breathing techniques are also helpful.

Can People With Phobias Also Have Other Physical and Emotional Illnesses?

People with phobias, particularly social phobia, may also have problems with substance abuse. Many people with social or a specific phobia become so anxious that they experience panic attacks, which are intense and unexpected bursts of terror accompanied by physical symptoms.

As more situational panic attacks occur, people with phobias may take extreme measures to avoid situations where they fear another attack might happen or where help would not be immediately available. This avoidance, similar to that in many panic disorder patients, may eventually develop into agoraphobia, an inability to go beyond known and safe surroundings because of intense fear and anxiety. Appropriate diagnosis and treatment of other disorders are important to successful treatment of phobias.

Generalized Anxiety Disorder: GAD is characterized by persistent anxiety unrelated to a specific event. People suffering from GAD cannot help worrying about anything and everything, even in calm situations. They have difficulty relaxing, falling asleep, or concentrating, and tend to be impatient and irritable. Physical symptoms accompanying GAD include sweating; an upset stomach; diarrhea; frequent urination; cold, clammy hands; a lump in the throat; a dry mouth; shortness of breath; headaches; and dizziness. Managing the normal demands of a job, relationships, and everyday life can become more and more difficult for people with this disorder. GAD appears in four percent of the general population.

Case Study: Amy, age 38, is a worrier. She is restless, irritable and has difficulty concentrating. She worries that she worries so much and isn’t always sure what it is that she is worried about. She can’t let her husband or children leave the house without making them call her regularly to reassure her that they are okay. Her husband is growing weary of her fretting. Her children can’t understand what all the fuss is about. Their impatience with her only makes her worry more. Amy has generalized anxiety disorder.

Panic Disorder: Panic attacks are just that—sudden, inexplicable waves of panic that seem to come out of the blue. The body responds with the “fight-or-flight” response, anticipating clear and immediate danger. Often, these attacks subside as mysteriously as they occur. A person who has experienced one or more panic attacks often develops a fear of having one again. Some professionals call this a “fear of fear.” The individual may even try to stay away from anything that reminds him or her of the last attack to avoid having another one. People can have panic attacks with or without agoraphobia (see “Phobias” below).

These attacks include symptoms such as heart palpitations, shortness of breath, chest pain, feelings of choking or smothering, nausea, dizziness, sweating, and trembling. An afflicted person might also be overwhelmed by a fear of dying, going crazy, or losing control.

Case Study: Annie is a 20-year-old student at a local community college. On several occasions recently, she has experienced sudden, absolute panic. During these episodes, her heart pounds; she trembles; her mouth gets dry and it feels as if the walls are caving in. The feelings only last a few minutes but, when they occur, the only thing that seems to relieve her fear is walking around her apartment and reminding herself that she is in control. She won’t ride in cars any more unless she is driving so she is sure that she can stop if necessary. She will only go to class if she can find an aisle seat in the back row so that she can leave quietly should she have another attack. She avoids any situation in which she might feel out of control or embarrassed by her own terror. Annie is suffering from panic attacks.

Deal With the Fear

Children and teens who fear school can be helped. But it usually requires either a collaborative effort between a mental health counselor and an educator or an educator who has been trained to manage anxiety disorders.

For a child to learn to master his fear about school, that fear must be addressed directly. It needs to be the focus of the lesson, not seen as a bothersome obstacle to the “real” stuff of school. As long as the child is phobic, lessons on dealing with the phobia are the real stuff. If the child can master the phobia, chances are he’ll be able to learn the curriculum as well as any other child.

Steps for Managing a Phobia

There are well-developed programs for helping people desensitize themselves to objects or situations they fear. Whether the phobia is a fear of flying, a fear of heights, a fear of dogs, or a fear of school, the steps are pretty much the same. Essentially, a counselor develops a highly individualized series of steps to help the person get closer and closer to the thing he fears and to tolerate it for longer and longer periods of time. Methods for managing anxiety are taught and reinforced. As the person gets practice in managing his fear, he learns that being in the feared situation is indeed manageable and that he won’t die. He learns ways to feel in control. And he learns that he is a person who can face a fear and get over it. These are life lessons that can lead to feelings of confidence and competence. And a confident, competent person can do just about anything—even school.

The Story of Jake

Jake had difficulty with fine motor skills in preschool that continued throughout most of his time in elementary school. Work with an occupational therapist helped him learn how to hold his pencil and how to write. Still, holding the pencil and making it go the way he wanted it to go was awkward at best and his handwriting was next to illegible.