Innovative cognitive-behavor therapy and research group

Flight Phobia

Flight Phobia is a specific phobia, and is defined as a state in which you experience fear whenever you consider the prospect of flying. This fear results in avoidance of flights, postponed vacations, perhaps even lost business deals. Flying, or preparing for a trip may generate a panic attack. You may suffer extreme discomfort whenever you consider flying, in addition to the negative repercussions that occur as a result of avoiding flying. Flight anxiety may result from fear of enclosed places, fear of heights, fear of suffocation, fear of a panic attack, or fear of vomiting or fainting.

Cognitive and Behavior Therapy (CBT) has been found to be the treatment of choice for flight anxiety. CBT is superior to all other psychotherapeutic approaches in the percentages of people who improve following therapy, degree of improvement in therapy, as well as long term effects in follow-up studies.

The Behavioral component is comprised of controlled exposure in Virtual Reality. Since the exposure is controlled, you are never overwhelmed by anxiety. Therefore, you will experience a reduction in anxiety as the catastrophic events you anticipated do not occur, and you will be able to practice both behavioral and cognitive coping skills that you will develop in therapy.

The Cognitive component challenges your irrational thoughts and perceptions about flying and the thought that you cannot adequately cope with the situation, thus resulting in a reduction in vigilance to bodily sensations and environmental factors and to a reduction of fear of bodily sensations.

Social Phobia

Social phobia is characterized by continuous fear of situations that involve unknown others, or being ridiculed by others, or from fear of behaving in an embarrassing or shameful manner. This phobia may appear as fear of public speaking, fear of eating or drinking in public, fear of speaking on the phone, fear of opening a conversation or approaching the other sex. Social phobia can be specific or generalized. Generalized social phobia leads to greater interference with daily living. The fear leads to avoidance of social activities. When avoidance is not possible, behavior is impaired (for example whispering, becoming unassertive, etc.). Physiological responses include increased pulse rate, sweating, shivering, blushing, or increase in urination. Social phobia is the most prevalent phobia and has an incidence rate of 13%. It begins in adolescence, and results in lower academic attainment, difficulties at the work place, problems finding a spouse, and social difficulties in general.

The causes of social phobia are: genetic disposition, childhood experiences (strict social rules, negative messages regarding ability) and childhood environment (overprotection, lack of social interactions) which lead to feelings of lack of social ability, social inhibition and lack of social skills, or from traumatic social experiences.

Group Cognitive Behavior Therapy (GCBT) has been found to be the treatment of choice for social phobia. This combination is superior to all other psychotherapeutic approaches, in the percentages of people improving, degree of improvement as well as long term effects in follow-up studies. The group component is extremely important in social phobia since it enables clients to practice dealing with their difficulties in a safe and controlled environment. In addition they receive feedback about their performance, thus enabling them to improve performance, and then to receive feedback about these improvements, thus reducing anxiety and improving their social skills. The cognitive component challenges the perception that the situation is dangerous, that the client cannot adequately cope with the situation, reducing vigilance to bodily sensations and environmental factors as well as fear of bodily sensations. This occurs through disputations of erroneous and irrational assumptions.

Phobias (other than flight and social phobia)

Phobias may be specific or generalized. Specific phobias include social phobia, flight phobia, fear of heights, roaches, etc. A specific phobia is defined as a state in which a person is filled with fear whenever s/he considers approaching the feared object. This fear causes avoidance. Staying in contact with the feared object can generate a panic attack. Avoidance reduces experienced fear, but results in inability to perform necessary tasks and a disruption in every day living.

Cognitive Behavior Therapy (CBT) has been found to be the treatment of choice for all phobias. This combination is superior to all other psychotherapeutic approaches, in the percentages of people improving, degree of improvement as well as long term effects in follow-up studies.

The behavioral component includes exposure to the feared stimulus. The client experiences a reduction in anxiety during exposure, as well as the absence of the catastrophic event he/she anticipated, and practices coping skills learned in therapy. Exposure may be employed in a natural setting (“in-vivo”), through imagination ("in-vitro") or in Virtual Reality (VR).

The cognitive component challenges the perception that the situation is dangerous, that the client cannot adequately cope with the situation, thus resulting in a reduction in vigilance to bodily sensations and environmental factors and to a reduction of fear of bodily sensations. This occurs through disputations of erroneous and irrational assumptions.

Panic attacks

Panic attacks are extreme, anxiety provoking physiological and cognitive reactions to a feared object. The physiological reactions may include: a racing heart, muscle tension, increased sweating, etc. The cognitive reactions usually include the fear of losing control, of going crazy, of fainting or dying. Panic attacks cause major disruptions in one's life. People are incapacitated when these attacks occur, and as a result, many individuals avoid any stimuli that may trigger them.

Cognitive Behavior Therapy (CBT) has been found to be the treatment of choice for panic attacks. This combination is superior to all other psychotherapeutic approaches, in the percentages of people improving, degree of improvement as well as long term effects in follow-up studies.

If the feared stimulus is known, then the behavioral component includes exposure to it. In situations where the stimulus is unclear, the behavioral component includes reduction of avoidance of general situations. As a result of exposure, the client experiences a reduction in anxiety, and practices the coping skills learned in therapy. Exposure may be employed in a natural setting (“in-vivo”), through imagination ("in-vitro") or in Virtual Reality (VR).

The cognitive component challenges the perception that the situation is dangerous, that the client cannot adequately cope with the situation, which results in a reduction in vigilance to bodily sensations and environmental factors and to a reduction of fear of bodily sensations. This occurs through disputations of erroneous and irrational assumptions.

OCD

Obsessive-Compulsive disorder (OCD) refers to both obsessions and compulsions. However, some people suffer from one without the other. Not every recurring thought or repetitive and rigid behavior constitutes OCD. For example, many religious ceremonies require these types of thoughts and behavior, but they are not problematic as they are a part of the person's lifestyle. However, when these thoughts or behaviors persist, lack logic, and create a disturbance or have a negative impact on one's daily performance, treatment becomes necessary.

Obsessions are thoughts, pictures or urges that are repetitive, and uncontrollable. They are unwanted, and intrusive. Research has revealed that the vast majority (approx. 90%) of people experience such thoughts at times. However, in OCD these thoughts become "stuck" and are repetitive. Obsessions result in negative feelings such as fear, disgust or doubt, or feeling that things must be performed in a rigid manner.

Compulsions are created as a means of reducing anxiety resulting from your obsessions, to neutralize your obsessions or to prevent the feared consequences. You become aware that these compulsions reduce anxiety. This is your only way to control anxiety, so you adopt them, and experience strong urges to perform them. You do not enjoy your compulsions; however they produce a brief reduction in anxiety.

Slowly a cycle develops which you are unable to control. Obsessive thoughts cause anxiety, and the only way to reduce it is by performing the compulsion. Unfortunately, anxiety reduction is temporary, and obsessions quickly recur and anxiety reoccurs. You begin to fear your obsessions, knowing they will trigger the cycle, so you try to avoid them by increasing your compulsive behavior, and slowly you become enmeshed in this cycle which takes up more and more of your time and attention.

Research has revealed that there is a genetic component to OCD, resulting in disruptive brain waves as well as chemical imbalances. Most individuals have occasional "bad thoughts"; however they do not cause distress. In contrast, you fear that these thoughts may actually result in these problematic behaviors and the result is anxiety. Cognitive Behavior Therapy (CBT) and medication has been found to be the treatment of choice for OCD. This combination is superior to all other psychotherapeutic approaches, in the percentages of people improving, degree of improvement as well as long term effects in follow-up studies.

The behavioral component includes exposure and response prevention. Exposure helps reduce the high levels of anxiety. In addition, response prevention breaks the link between obsessions and compulsions. For example, if you have unreasonable fear of germs, you will be asked not only to come in contact with "contaminated" objects, but to also refrain from washing your hands. You will learn that thinking about something doesn't make it happen. With repeated exposures, your body becomes accustomed to the feared stimulus, no longer produces adrenaline, and thus you are able to relax. Our aim is to help you stop fearing the fear, to stop avoiding it with compulsions and to learn to wait for the anxiety to subside.

Often the behavioral component is sufficient, and there is no need for a cognitive component. The cognitive component is added when one experiences difficulty performing the exposure assignments, or if there are obsessions without compulsions, or if the compulsions are thoughts rather than actual acts. The cognitive component helps reduce catastrophic thinking and increased sense of responsibility. Cognitive therapy helps challenge the illogical assumptions that support the obsessions.

Depression

Depression is characterized by feelings of unhappiness and lack of self worth, beliefs that nothing can change the difficult situation and that it will remain negative forever. Depression contains elements of hopelessness and helplessness. Depressed people are overly self-critical, and usually avoid enjoyable things. Depressed individuals impose very high demands on themselves, perceive obstacles they face as impossible to overcome, and translate everything that happens to them as failure. Therefore, they expect the future to be negative, and that these difficulties and bad mood will remain forever. They also tend to believe that others do not want to be in contact with them. As a result of these thoughts they avoid most activities they performed prior to their depression, and lack the will to do things. Many of these individuals develop over-dependence on others as a result of their feelings of inadequacy and the tendency to exaggerate difficulties in overcoming the perceived obstacles. Often, when they perceive the situation as unbearable, they have suicidal thoughts.

Depression may result from a traumatic experience which triggered underlying negative self-schemas. These schemas persist due to thinking errors, such as disqualifying the positive – reducing the value of positive experiences.

Cognitive and Behavior Therapy (CBT) has been found to be the treatment of choice for depression. CBT is superior to all other psychotherapeutic approaches, in the percentages of people improving, degree of improvement as well as long term effects in follow-up studies.

The behavioral component includes assigning tasks to be performed as homework, with the client rating the level of pleasure and the level of mastery he experiences. Thus avoidant behavior and pessimism is reduced, and the client may begin to experience pleasure.

The cognitive component challenges the perception that the situation is hopeless and the person cannot adequately cope with it. It also challenges feelings of guilt that are usually part of depression.

|Innovative Cognitive Behavor Therapy and Research Group, Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905 | Tel. : 972-4-6647901