Great Minds: Oxford University anxiety disorder treatment using exposure to help brain

Herald columnist and Radio Hauraki breakfast host Matt Heath is taking on a new role as Happiness Editor for our Great Minds mental health project. He will share his own insights in his search for wellbeing as well as interviews with international experts in the field.

If you suffer terribly from claustrophobia, there is a one-off experimental treatment that might help. You can get yourself locked in a cupboard at Oxford University. It's an exposure therapy that's getting great results.

The more I read about anxiety, the more obvious it seems that facing your fears is essential. If you hide from what makes you anxious, its power over you grows.

Last week I got hold of the person conducting these cupboard experiments, Senior Research Fellow, Department of Psychiatry at the University of Oxford, Dr Andrea Reinecke, to ask if her successful ultra-brief treatments for anxiety disorders might help people fight lesser everyday anxiety.

Q: Dr Reinecke, tell us about your treatment for people with panic disorders.

A: Our approach is nothing unusual, apart from the time scale. In standard cognitive behavioural therapy for anxiety, you would see a therapist eight to 12 times, and you would gradually approach the situations you are afraid of. You and your therapist would develop a list of situations you fear, and you would start approaching the mildest one, working your way up your list.

In our single-session approach, we encourage the patient to go for one, if not the highest, fear on their list.

The standard approach might signal to the patient that a careful approach is needed. In our approach, we send the message that we are absolutely convinced that nothing terrible will happen, no matter how hard they push – so we drop all safety strategies in one go as far as that is possible, in a slightly bizarre "let's get on that bus and drop dead" fashion.

Our work shows that even such brief treatment reduces the amygdala hypersensitivity seen in anxiety disorders to a healthy level – within 24 hours of treatment.

Q: Are there lessons to be learned from this treatment for everyday life? Can we apply smaller versions to our everyday fears and anxieties?

A: Absolutely – I think the lesson here is to challenge your anxious thoughts and push yourself out of your comfort zone if the anxiety is starting to get in the way of achieving what you want in life.

Q: If we know a fear is forming, should we face it before it gets too powerful? If you are a little bit scared of clowns, is that a good time to spend more time with clowns? Should people who feel anxious about leaving the house make themselves?

A: That is a yes with a huge footnote. The key to lowering anxiety is to face what you are afraid of. The spider phobic might want to start by looking at images of spiders, the socially anxious might want to socialise every night, until they realise that practice makes things easier.

But then, as an example, the spider phobic might have a couple of drinks before looking at those spider images – this reinforces the idea that they would be unable to do this sober, so no win.

The important thing here is to really drop all safety behaviours – all shortcuts and props, so to speak. These exercises are all about testing whether what your brain tells you is threatening really is threatening.

Dr Andrea Reinecke. Photo / Supplied

Q: In terms of parenting, how should we apply this? Should we set up situations so our kids don't develop fears? For example, I make my kids go to the counter and pay at restaurants so they are not cripplingly scared of adults like I was at their age. It seems to have worked.

A: Yes, I think this is a great approach, although we should always keep the child's age in mind.

Children and adolescents are more anxious – this has a lot to do with how the brain develops – and the focus of their fears changes with development.

For instance, every toddler will be afraid of the dark at some point, so this might be something to sit out and wait for to pass – having them sit in a dark room will not make this better, as their brains are not ready to process the "intervention" like an adult brain.

In adult CBT, the key to change is that patients have completely understood the rationale for facing their fears. A child might not comprehend that and use all kinds of cognitive self-protection strategies in the situation that will prevent the fear from going down.

But yes, providing a healthy mix of mild to moderate, manageable everyday challenges that help them learn to interact with people, or how to deal with dogs etc, can help prevent an anxiety disorder in that area.

Q: In terms of how the brain works, is it true that anxiety or fear grows stronger if we don't face the things we are anxious about or fear?

A: The amygdala is a cluster of cells near the brain's base. The amygdalae help define and regulate emotions. If you are spider phobic, your amygdala might be "saying" spiders are terrible and might even tell you to avoid them, or it will give you a panic attack so bad you will die, so you avoid spiders. No-brainer.

Whenever you come across a spider and get away from it – by changing your hotel room or asking someone else to remove it – your amygdala will strengthen that spider-death association because you have not died – this is surely only because you avoided the situation.

So the key here is to deal with that spider yourself and teach your brain that it won't kill you.

It's 3am now, and with Dr Andrea Reinecke gone, I find myself speculating, unscientifically, about what all this means for the lives of several struggling young adults I know. For the first time, every day, New Zealanders can hide away from the difficult things in life.

Everything's at your fingertips if you want it, social media, video games, adult entertainment and food. You don't need to leave your room to face people.

Of course, this isn't healthy communication, socialisation, adventure, romance or sustenance. You can hide from life's challenges, but the power of the things that make you anxious grow stronger through avoidance. Over time it's harder and harder to get people out of their rooms.

One day you may wake up and realise someone you care about isn't functioning. They're unhappy, unhealthy and unfulfilled, and now they're trapped by their minds.

Anyone who has spent time trying to help someone who has slid down this reclusive path of least resistance knows how resistant people in this position are to help.

The longer they have been in there, the harder it is to get them out. If only they had forced themselves when the world was only a little bit scary. If only we had forced them.

My simplistic takeaway from Dr Reinecke's brilliant neuroscientific research is that we need to face our fears sooner rather than later. Maybe we all need a daily dose of that sweet exposure therapy.