50 Attend Reid Wilson’s Master Workshop on

Worry and the Anxiety Disorders

R. Reid Wilson, Ph.D. described his approach to treating worry and the anxiety disorders at NJ-ACT’s seventh Master Clinician’s Workshop.  Here are a few highlights from Dr. Wilson’s March 17^th presentation to 50 ACT members and guests: 

Exposure is the most important technique in cognitive-behavioral treatment for all the anxiety disorders.  From the outset of treatment, try to convince patients to seek out rather than avoid anxiety provoking situations.  When patients don’t complete homework, make sure patients understand and accept the CBT model.

Worry occurs in all the anxiety disorders.  Patients believe that worry is adaptive.  (“If I think about this enough, I’ll figure out a way to be safe.”)  Dr. Wilson views worry as an avoidance strategy that blocks patients’ experience of distressing emotions, such as sadness, anger, or intense anxiety.  When patients worry, they cannot access complex strategies for coping with a feared situation.  They cannot emotionally process an event.

Treatment of worry begins by teaching patients to categorize a troublesome thought as either a signal -- a warning of an impending problem -- or noise -- a meaningless symptom of their particular anxiety disorder.  If patients are uncertain whether a worry is a signal or noise, they should assume the worry is noise.

If the worry signals a real problem, patients should problem-solve and work on strengthening their coping skills.  If  the worry is noise, patients should choose a strategy for reducing the worry such as: cognitive restructuring, flooding, writing down or singing the worry, postponing the worry, setting aside a specific time for worry, or using meditation or relaxation to facilitate detachment from the worry.  All of these strategies facilitate exposure to the avoided emotion or experience. 

In treating any anxiety disorder, always encourage patients to experience the thing they fear, even if they must experience it in a very attenuated form.  Regarding specific disorders, Dr. Wilson gave the following advice: 

For OCD, ignore the content of patients’ obsessions.  Encourage patients to seek out situations that evoke feelings of uncertainty and distress.  When they encounter these situations, patients should behave as though their obsessions were irrelevant.  Don’t reassure patients and don’t discuss the content of their obsessive fears.  Encourage patients to postpone compulsive behavior and disrupt rituals by changing them in one or more ways. 

For panic disorder patients, provoke panic symptoms and help patients develop new ways to respond to their arousal.  Initially, allow patients to use crutches such as cell phones, mantras, prayers, or Xanax in their pockets, to  mitigate their anxiety and help them feel safe.  Once patients learn that the consequences they fear (heart attacks, fainting) don’t occur, they are more willing to give up their crutches. 

With social phobia, focus on exposure as well as cognitive-restructuring.  Social phobics must learn to function in spite of anxiety.  Since successful in vivo exposure can’t always be scheduled or structured for these patients, behavior rehearsal and imaginal exposure in the office are especially helpful.   

Anyone who wants to learn more about Reid Wilson’s approach should read his books Don’t Panic and Stop Obsessing (with Edna Foa).  Or, consult Dr. Wilson’s website, www.anxieties.com.

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