John J. Murphy, Ph.D.

Do you think you have too much anxiety? Are you at the point where you're thinking of treating that anxiety? Well, you found the right place. It's my specialty. Most other therapists focus on anxiety & depression. That makes sense because they're very similar, but I still prefer to focus just on those who have anxiety primarily, or at least more so than depression. Most of my clients have some level of anxiety. Many times it's not at a clinical level--just too much for comfort.

But before you book that appointment, you'll want to know a little bit more about anxiety and the strategies I use to help manage it. Here are five good starting questions about anxiety to guide you along this path:

1. Just what is anxiety?
2. Where does this anxiety come from?
3. What types of anxiety disorders are there? Do I have one?
4. So what are you going to do about my anxiety?
5. Are you going to lock me in an elevator?
6. Putting it all together

Every animal that moves (including us humans) has an alarm system and a relaxation system. This is known as the sympathetic process and the parasympathetic process, respectively. Most of the time we're in the parasympathetic process, essentially the relaxation mode. When there's a problem that requires quick action, we get into alarm mode. The alarm system works by preparing our body for action and sending us mental thoughts leading us to do something about a given threat.

There are two types of mental thoughts. The first type is an assessment that compares us with the environment. You see a mountain lion, you might think "Oh my God, that's a big cat with claws and I'm completely unarmed and vulnerable." The second type of thought is an assessment that thinks about consequences: "if it gets me, I'm dead."

Preparing the body means flooding the blood stream with hormones, which then activates the body to help escape or attack, hence "fight or flight." That means heart racing (to better run away), sweating profusely (to better slip away), and tunnel vision (to better focus on the threat or escape route). If the brain thinks injury is imminent it will also lower blood pressure so that less blood is spilled and perhaps to play dead.

The combined behavioral response (sense of body action) and cognitive response ("Danger!") generate the emotion, the emotion of anxiety.

Some people are born with a more sensitive alarm system than others. They more easily get that flood of hormones and are more prone to have those negative thoughts. Sometimes it's good to have this, especially if you're surrounded by lots of predators!

We inherit this alarm system from our parents. Just like some kids are naturally tall, or smart, or happy, some kids are essentially born with a sensitive alarm system.

But that's not all we get from our parents. We also tend to pick up though observation what's a good level of anxiety to have and what to be fearful off. This makes sense: you don't want to learn the hard way that bears are dangerous. If you see Mom freak out over a snake as a child, chances are good you might just learn that fear as well. Likewise, if you're exposed to a lot of anxiety as a kid, you might just learn that the world is a dangerous place, and be more prone to have anxious thoughts as an adult. You might be asking, "well, if we evolved this anxiety, how come it's so destructive? How come it's messing up my life?"

Consider that our body and mind are well suited for the Stone Age. That's where we spent most of our time developing as a species. Our alarm system is therefore designed to respond to threats from the Stone Age. All of a sudden we enter the modern world and what worked 100 thousand years ago no longer works very well. This explains why our propensity to store fat helped us a lot back when food was scarce but makes us all overweight in modern times when the longest you'll have to wait is the hour long line at Pinks. We react the same way towards modern threats (giving a speech/being trapped in an airplane/mingling at a party) the way we used to respond to a mountain lion attack (rapid heart beat, sweaty palms, tunnel vision). Here's a separate section I wrote for how this all relates to phobias and social anxiety.

Sometimes, anxiety will prop up when the sub-conscious senses a new series of threats. There's a concept in astrology called "Saturn's Return." Essentially, every time the planet Saturn returns to the same spot it was when you were born (every 29.5 years) it seems to coincide with a major life change. The first event (of which Gwen Stefani wrote about in her album "Return of Saturn") produces a lot of anxiety about transitioning from childhood to full on adulthood. There's a growing sense that time is running out, that things should have happened by now, and that they better happen soon. I know next to nothing about astrology, but I like the concept, so I'm borrowing it. Essentially, stressful periods of life (e.g. when you first get out of college into the "real world," Return of Saturn), are often the catalyst of anxiety issues.

Here's a good diagram, used (with permission) from healthknowledgecentral.org.

Some caveats:

• This isn't for self-diagnosis! This is a quick reference guide and is not a substituted for a trained, professional assessment.
  
• "Secondary to" is a fancy way of saying "because of."
  
• Often times, anxiety is secondary to a medical condition or drug use. Certain medical conditions such as hyperthyroidism and certain drug use (caffeine, amphetamines, cocaine) will cause anxiety. Also, drug withdrawal will often cause anxiety. In this case, treatment revolves around resolving the contributing factor.
  
• GAD stands for generalized anxiety disorder.
  
• Usually, a diagnosis of GAD requires a few physiological symptoms (e.g. stomach pains, muscle tension) over a certain period of time.
  
• OCD is different from tic disorders because in OCD, the behavior is for a purpose or is functional (i.e. to resolve the anxiety). Tic disorders often have a neurological component.
  

I work with a combination of cognitive-behavioral therapy and hypnotherapy. There's a lot of information here. But here's a brief summary:

Self-awareness
A good first step is to become aware of automatic thoughts that present the world as a scary place and you as a vulnerable person. Most people don't notice these thoughts. Once you become aware of them, you can see how they create anxiety.

Disputing thoughts; using cue word
The next step is to dispute those thoughts using evidence. Once you have a good response to those negative automatic thoughts, they start to lose their strength and impact. We also use a "cue word" from hypnotherapy to create a sense of detachment from those automatic thoughts.

Focusing on core beliefs
Negative, automatic thoughts are often developed in the past and remain with us in the present. As we explore your automatic thoughts we'll often find themes and generalizations, which reflect some core beliefs. As we focus on these core beliefs and use evidence to dispute them, they can lose their impact on your life.

Hypnotherapy
Hypnosis can be used to both counter the negative thoughts and create a sense of relaxation in the body. The more this is practiced, the less sensitive the body becomes, resulting in less "false alarms."

The main use of the hypnosis is as a relaxant. I've found that with hypnosis a person can relax quite quickly and easily. There's a lot of variation in hypnosis, from a deep trance to the type where a person simply hears a passage with their eyes open. There are also other techniques that don't involve hypnosis, for those who might feel uncomfortable with it. Generally speaking, I use hypnosis techniques that involve biofeedback or conditions where the person's eyes are open. People are generally the most comfortable starting off with these techniques.

Abdominal breathing training
This trains the body to be able to better relax. Yes, just like learning how to ride a bike, you can learn how to relax. Abdominal breathing is about breathing in a deeper, more natural fashion.

Progressive relaxation
Progressive relaxation is similar to abdominal breathing in that they both result in relaxation. By tensing than relaxing various muscle groups, an overall sense of relaxation ensues.

Before we explore systematic desensitization, exposure with response prevention, and virtual therapy, let's look at the last question.

No! Many people who have anxiety, especially those with phobias or OCD get worried that therapy means facing your fears all at once. In reality a good analogy is that of a couch potato who wants to lose weight. Yes, he'll have to start exercising but that doesn't mean going outside and running for ten miles. Any fitness trainer worth his salt will introduce a gradual process.

Likewise, I'll be pushing you to face your fears. But 50% of the art of therapy here involves breaking the process into manageable steps. It's not going to be a cakewalk but it won't be anything you can't handle. In fact, I've found that with hypnosis the anxiety during the whole process becomes much more manageable.

So, how will I get you to face your fears?

Systematic desensitization
Way back in 1796 a man named Edward Jenner discovered that if you expose a weakened variation of smallpox -- known as cowpox-- into a person, that person developed immunity to both cowpox and smallpox. This was significant because the cowpox was significantly less harmful than smallpox and would protect the person from future outbreaks of smallpox.

About 150 years later, a man named Joseph Wolpe found that when you mix relaxation with a stimulus that normally elicits fear in an animal or person, the old relationship between stimulus and fear breaks down. In other words, if a snake makes Mary panic but you're able to relax her every time she sees a snake, Mary will soon no longer have the panic reflex.

Putting these two concepts together, we have systematic desensitization. We can break up the unwanted association between snakes and panic by first using a weakened variation. We first find that Mary has *some* anxiety when seeing a picture of a snake. There is some anxiety but not nearly the same level of actually seeing a live snake. By paring relaxation to seeing a picture of a snake, the panic is broken down a little. It is then much easier for Mary to see a video of a snake. Again, there is some anxiety, but it's anxiety in a weakened form.

By creating a hierarchy of fears relating to the phobia and working to associate relaxation with each level of fear, we can actually quite rapidly approach the point where Mary is able to handle the snake without any panic or anxiety. At this point, nearly everyone with a snake phobia would gasp at the prospect of actually handling a snake. Keep in mind that most processes in the human body are based upon gradual steps. And what works for snake phobics works for flight phobics.

Again, using the physical fitness model, when I first started running, I could barely run more than 2 minutes at a time. My goal was to run for thirty minutes straight. If I had simply woken up every morning and forced myself to run for thirty minutes, chances are I would become frustrated, overwhelmed, and I would quit. By starting small (at 2 minutes) and adding a minute or two of running in between walking, I was able to run for thirty minutes in just about a month. Each time I would see the next level of running (i.e. five minute run, followed by 2 minutes of walking) I would think "how on earth will I ever be able to run this amount." But then I'd be able to do it, because it was a small, gradual change.

As I've worked with phobia treatments, I've found that the process of alleviating a phobia can be even quicker than acclimating to an exercise routine. By having the right hierarchy, right exposure techniques, and right relaxation methods, a person can go from a fear of flying to being able to fly sooner than you might think.

Exposure with response prevention (ERP)
A key difference between systematic desensitization and exposure with response prevention (ERP) is that, with ERP, the progression is massed, or given all at once. The emphasis is on preventing the older habit (i.e. running away) from occurring, thereby retraining the body.

The best analogy is with a crying toddler. If you give in to the tantrum, it only reinforces that behavior in the future. Likewise, every time you panic and run away from something, you reinforce in your body that 1) that something is dangerous and 2) if you produce enough anxiety, I'll do your bidding.

On the other hand if you prevent yourself from running away when you see your phobic target (be it a snake or a plane), you teach yourself that you can handle the anxiety, you're not in any danger, and that the anxiety will go down. My job is to break down the phobias so each step is manageable, make you feel more relaxed, quicker, and show you that even if you feel anxious, it's not all that bad.

I use both systematic desensitization and ERB. I don't think it's that much better to mass the sessions all at once and most people would be too intimidated by that prospect (e.g. resolving your fear of flying in one afternoon). It can be done, but I find it's better to take smaller steps. I do use the concept of ERP with teaching yourself to tolerate anxiety as it comes up.

Virtual Reality
The virtual reality program is essentially a mini simulator where you feel like you're in a particular environment. For the software I use, these environments include being on stage, on a bridge, on an airplane, in a thunderstorm, in Vietnam, and in a crack house. Although no one would ever actually believe they are literally in a given environment, a person often feels the same way in the virtual environment as they would in a real environment. Why? To use an analogy, if someone is hiking and is worried about snakes, every rustling of a nearby bush will cause the person to *feel* that worry, even if rationally the snake really isn't there. The way the virtual reality program works is that the level of realism, and thus the level of worry, can be controlled so that the level of anxiety is reduced and manageable.

During our first session, please tell me if you have any vestibule abnormalities, seizure disorders, or migraines. Those with a heart condition must obtain medical permission from a qualified physician for use of virtual reality therapy.

The techniques I use are generally a mix of hypnotherapy, cognitive/behavioral therapy, and virtual reality therapy. I was a hypnotherapist several years before becoming a psychologist, so I tend to use a mix of both hypnosis and virtual reality for the program based upon what you're comfortable with and how you're progressing. The benefits of this hybrid are:
1. No dependence on hypnosis or virtual reality therapy, in case "cybersickness" is an issue or if you're reluctant about hypnosis.
2. Typically, you'll feel an improvement after the first session.
3. There's a high success rate in a relatively short amount of time.

Specifically for the fear of flying:
The fear of flying program consists of about 6 hours, usually spaced out either one hour a week or two hours a week, depending upon when the flight is. It's best if the time is somewhat spread out--one hour per week. If you know you have a flight coming up soon, contact me as soon as possible to ensure you pack as much in before the flight.

I hope this text here shows you a little bit more about my specialty and the battle plan I use. As you can see, I really focus on anxiety. If you have any questions, comments, or want to go ahead and book an appointment, contact me!