I opened the doors of Agoraphobia Resource Center in 1977, and ever since then, have specialized in treating Panic Disorder, Social Phobia, Fear of Flying, Post-Traumatic Stress Disorder (PTSD,) Obsessive-Compulsive Disorder (OCD,) as well as more obscure anxiety disorders such as tricholtillomania and hoarding. I have recently acquired the technology to use Virtual Reality Exposure Therapy (VRET) for fear of flying. The patient wears special goggles while being guided through the entire experience, from the gate to the plane, getting seated, taking off, flying and landing. Fears such as height, turbulence, storms, loud noises, etc., can be simulated to the point that the patient feels "as close to the real thing" as possible.
Patients with anxiety disorders are highly motivated to recover, yet scared to death to change. The anticipatory fears of experiencing yet another panic attack, or losing control in public, or feeling embarrassed and humiliated, are enough to keep them frozen in fear, unwilling to chart unfamiliar waters. My job is to invite them back into the water, a little bit at a time, shallow end first. They return to a safe shore, and then they venture out again, until they realize that the safety they are seeking resides within themselves.
The techniques I use in the treatment of anxiety disorders are the tried and true, as well as the experimental. The tried and true consist of Deep Muscle Relaxation (DMR), Cognitive-Behavioral Therapy (CBT), particularly the ongoing challenge to irrational, phobic-style thinking, Systematic Desensitization, IN VIVO (“real-life”) Desensitization, sometimes therapist-assisted, and Exposure and Response Prevention (ERP) for OCD. The experimental, or more creative techniques consist of Eye Movement Desensitization and Reprocessing (EMDR), Hypnosis, Somatic Experiencing (SE), Interactive Guided Imagery (IGI), and ACT: Acceptance and Commitment Therapy (see "About My Practice").
I have created my own patient workbooks, filled with hand-outs and homework assignments, and I often recommend additional reading material, movies or free webinars. IN VIVO assignments, in small steps, are absolutely essential to recovery, for example, trying to “drive to the nearest mall, eat in a fast-food restaurant, stay home alone for one hour, prepare a one-minute speech, go to the movies and sit on the aisle, take a very short flight to Tampa or Key West,” and so forth. There is no substitute for actually attempting the feared and avoided situations, WHILE IN TREATMENT, reporting back to me, processing the experience, and planning the next step(s).
Patients with anxiety disorders DO recover; treatment does not have to take a long time, depending on the patient’s motivation level, compliance with homework assignments, willingness to take risks, and support system at home and in the workplace. Medication can be a great adjunct to recovery, particularly in order to manage high levels of free-floating anxiety, frequent and treatment-interfering panic attacks, and uncontrollable intrusive thinking. With 2 wonderful psychiatrists employed at Miami Counseling and Resource Center (MCRC), my primary practice location, I like to refer in-house so we can continue to collaborate and follow every patient’s progress.
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