Clinical psychologist Smith cites the fact that there are brain functions that issue “danger” warnings to the rest of the brain. Another problem with our brain’s primal self-protective instinct is that these neurological danger signs can confuse us by reacting to “emotional pain” warnings as if they are “physical pain” threats. Kids are now learning that they can “regulate” those “instinctive impulses” by recognizing them with their higher thinking brain function(neocortex). We explain this coping skill as part of our Brain Works Project wherein 9-12 yr. olds are able to differentiate between primitive brain “survival fear” instincts, and our ability to re-interpret such neurological impulses. See “The Brain Team” and “The Coping Brain” sections of our educational website for more on this process.

Just some thoughts.

But what if someone grew up, or lived in the jungle? They would probably be way less startled by growling large animals, and snakes appearing, etc, because they are used to it?

Now I do not have OCD but sometimes I am afraid of the unknown. An example. I used to be afraid of dying because I was pretty much convinced that after I die I can still feel things, and that just nobody on the outside would know because I had would lose the ability to communicate. The very last thing I wanted to go through, therefore, was cremation.

Then one day, I lost consciousness and when my boys and their father returned from a camping trip, they found me naked on the bathroom floor behind locked doors and the door had to be broken down, and 911 called.

My older son was allowed to make himself useful, i.e.. the paramedics asked him to find all my medications, etc. but my younger son was ordered to go to his room upstairs, and it was horrible for him as he was sure I was dead.
He actually suffered from PTSD symptoms for quite a few years afterwards. (Also, this happened again about two weeks later when I passed out in a pile of Monopoly money)

Unlike for him, what happened left me entirely unharmed and untouched. i missed everything. Since I was unconscious, I was not even able to feel embarrassed about being naked on the floor. I had no opportunity to feel fear, anxiety, or pain, either. Instead, the good thing that came from this was that I now was no longer afraid of dying as I knew what it felt like to feel nothing. So, the fear of the unknown became more known to me.

I also feel that over the years, I have died so many times in little and not so little ways, that because of this I am also no longer much afraid of that last moment. i don’t even think any longer, or rather know better, that dying is not necessarily something that happens to you from one minute to the next, at least usually, but is a process.

I am no longer much anxious about feeling pain either, because now I know I can survive it.

But what about load noises? Now, load noises really hurt me, and in a way that most people cannot relate to.

When I am prepared, and the noise makes sense, or is purposeful, I can be OK. But i do feel that it helps me to be prepared, as the less prepared I am for a noise attack, the worse it hurts. On second thought, perhaps the help is more related to a sense of control as I am never fully prepared for such occasions, and they never get better.

I would never voluntarily chose to suffer, but in retrospect I am very glad I did and have had those experiences, because with the horrible there also comes the exquisite. Agony and ecstasy go together.

Sorry, i sort of free associated here.

Cognitive behavioral therapy is not the only type of therapy that can help people with anxiety.

There are other therapies that have promise, but CBT has the most extensive history of research studies to back it up. Thanks for your comment!

Ok but let’s not pretend that other types of therapies don’t exist!

CBT can leave the source of the anxiety inside a person for x number of years-why not provide all the information and let people decide for themselves? Patients are not research subjects, and I know Im not a statistic.

I do appreciate your articles. Thanks to you too, Dr. Smith!

CBT is the most empirically supported therapy for anxiety disorders that we have. There are loads of studies that suggest that CBT works better than other types of therapies. Some even show that it works better than medication alone in the long term (because it helps one long coping mechanisms). Yes, patients aren’t research subjects but they should be informed of the research. However, every patient is different and won’t respond in the same way. So, there are still plenty of therapists who do not practice CBT or who use CBT as well as other methods.

I personally think the ideal therapy for both anxiety and depression would be to use medication to stabilize the patient if necessary, then use CBT to help the patient learn appropriate coping strategies for their anxiety and/or negative “self-talk,” then use some sort of interpersonal therapy to fix or at least improve the patient’s environment if possible, and then use a more traditional “talk therapy” to help the patient dig deeper into the origins of their anxiety and other feelings. However, if you only enough coverage or money for 10 sessions or so, I would just do the CBT (and meds if needed).

@Childhood OCD Survivor: You make some good points. The only aspect I would disagree on is that I generally recommend first trying CBT and then adding medications if and as needed. There are some cases (even severe) that discover they do not even need medications after a good course of CBT based psychotherapy. I also agree that dealing with interpersonal issues (whether through IPT or within a CBT framework) is often highly useful too.

By stabilizing the patient I mean when the patient is psychotic or manic or the patient is extremely anxious or depressed (ie suicidal) and not responding well to therapy or can’t reliably attend and participate. In the latter cases, later on, the patient may opt to discontinue the meds, but medications can help to get the patient into the therapist’s office and be able to learn techniques. However, clearly in the vast majority of cases, the patient will not need medication in order to do CBT and often (not always however) CBT is so effective the patient doesn’t need medication at all.

Basically, if and when the patient should start medication is highly individual depending on their condition, their preferences and insurance coverage (unfortunately).