Joanna (not her real name) is a 22-year-old brunette with an intense look in her eyes. She suffers from a fear so pervasive that, in her words, she "wants to die."
Joanna's fear is called emetophobia, the fear of vomit. Few of us enjoy the concept of throwing up. But she is paralyzed by it, forcing her to avoid potential encounters that include holding babies, getting on boats or taking amusement park rides.
Joanna, who asked that her real name not be used to avoid ridicule, had searched for help, but was either laughed off by friends and family or told to "get over it." Finally, she found a possible answer: exposure therapy. In the course of three days, Joanna would go through the process with Mark Pfeffer, the director of the Panic and Anxiety Center in Chicago. The concept is literally to face your worst fears, whether it be spiders, elevators or cocktail parties, guided by a trained therapist.
Pfeffer sees it this way: "Exposure therapy is more of an art form than a science. It's a technique for people to learn to be unafraid, but it's not as simple as throwing someone into a snake pit. "
Edna B. Foa, professor of clinical psychology at the University of Pennsylvania in Philadelphia and one of Time magazine's 100 most influential thinkers in 2010, is a leading figure in the use of exposure therapy. "For the exposure to work," she cautions, "it needs to be done systematically and repeatedly until the anxiety reduces. Exposure therapy is not for every anxiety. It is for people who are anxious about a particular issue."
Although the use of it is expanding, Pfeffer says, "It is the best-kept secret in the psychological world."
In the weeks before the exposures began last year, Pfeffer worked with Joanna to help her understand her triggers. "We teach clients the physiology and the mechanics of their natural fear response," Pfeffer says. "Severe anxiety or panic is a very primitive response to a perceived threat. That's healthy if the threat is real, but it's incapacitating in those with severe anxiety disorders."
Joann, who has since moved from Chicago to Indiana, did her written homework, but soon enough she would have to face situations designed to bring up the sheer panic she went to great lengths to avoid every day of her life.
"It's the anticipatory anxiety that gets in people's way," Pfeffer says. "We teach people how to identify irrational thoughts like, 'If that elevator is stuck not only will I have the biggest panic attack ever, but no one will find me and somehow I'll die in that elevator. ' Anxiety sufferers go to catastrophic thinking very quickly."
Worry is a self-defeating mechanism that tricks people into feeling better, for the moment. "We try to head off the terrible consequence of what we fear by thinking about that very thing," Pfeffer says. "And we do get that momentary sense of being in control. I have a client who's going to have to take the bar exam in nine months and he said to me, 'I'm going to have to start worrying about that right now.'"
When fear or worry is excessive, it infects a person's entire life. Joanna rarely left her apartment and was afraid to move forward in a serious relationship because she feared becoming pregnant. Public transportation was out of the question so the only jobs she could take were those to which she could walk. Socializing was impossible.
"To do exposure therapy the right way requires surrendering", Pfeffer says. "It's letting the symptoms come. It's saying, 'OK, I don't have to do this, but I'm going to choose to face my fear on my terms."
Pfeffer and Joanna had worked out a hierarchy of triggers for her emetophobia, from lowest to highest. He would be asking her to face them one by one on a graduated scale.