Anxiety Disorder Game III: Playing with Fire

Anxiety

Credit: Elizabeth Gadd

“We have met the enemy, and he is us.”
Pogo (Walt Kelly)

We have been learning from Dr. Reid Wilson, a leader in the field of anxiety treatment, that anxiety disorder is not just a matter of experiencing anxiety. It is when the anxiety takes on a life of its own and starts to play what Wilson calls the “anxiety disorder game.”

In it, anxiety goes out of control and gets disconnected from the situation that triggered it. The client builds a fortress of maladaptive behaviors designed to banish the anxiety at any cost. Clients believe they are avoiding a threat to their safety, which is what the disorder “wants” them to think. This disguises the real culprit and allows the anxiety to become a continual self-fulfilling prophecy. Anxiety wins, and gets to play the game again and again.

The Real Culprit

The real enemy, says Wilson, is doubt and distress. Clients

  1. doubt their ability to cope with the perceived threat, and
  2. believe themselves incapable of tolerating the distress that accompanies it.

“Anxiety wins when clients seek certainty and comfort. My goal is to persuade clients to go out into the world and purposely look for opportunities to get uncertain and anxious in their threatening arenas,” he explains.

Asking for Trouble

Asking anxiety patients to seek out threatening situations? This is where Wilson, based on 25 years of clinical experience, goes out on a limb a bit. He has found that if he just asks clients to relax and stand down when anxiety strikes, they will do so only in order to make the distress go away. Since fear is such an intense emotion, it naturally overcomes efforts to merely accept the situation. Instead, he proposes they take a provocative stance: “I help clients shift to an attitude of provocation that is equally as powerful as, and can compete with, fear.”

“This strategy is extreme and can be thought of as fighting fire with fire,” says Wilson, but it is the only way for the client to become habituated to the feeling of distress, and habituation requires frequency, intensity, and duration. A qualified therapist can guide the client through this process safely and methodically.

Source: “The Anxiety Disorder Game” by Reid Wilson (2006). Retrieved August 13, 2014 from http://www.psychotherapy.net/article/Anxiety-Disorder-Game

Doug Westberg is a freelance writer who writes about mental health issues. His books include The Depressed Guy’s Book of Wisdom.

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