Although it is good to think about what you say or have said, if everyday things cause excessive worry, you may have an anxiety disorder. Behavioural scientist Julie Krans is working on new treatments, especially when the usual methods no longer work. So, what do you do as a practitioner? This is the focus of her most recent scientific publication, which the Society for Schema Therapy co-funded.
Exposure therapy
An effective treatment for anxiety and compulsive disorders is exposure therapy: in a controlled environment, a psychologist will practice with the patient the situations they are afraid of. Think of grasping a door handle in case of a fear of contamination. This works well because the patient notices that the expected disaster does not happen. It allows the patient to do things again that were avoided and resume daily life.
When exposure therapy doesn't work
'But sometimes exposure therapy doesn't work,' says Krans. Some people have deep-rooted negative thought patterns that make it challenging to learn new things. For example, because they were constantly told as children that the world was a dangerous place.' We see those patients turn off their feelings in fearful situations later in life or become overwhelmed by emotions. Krans points out that this can trap individuals and hinder their ability to benefit from exposure therapy. It's basically like holding your hands in front of your eyes for a while until the scary part of the film is over. That works well for that moment, but you don't learn from it in the long run.
Schema-therapy exposure
Krans' research shows that for this patient group, a combination of exposure with schema-therapy, a treatment for people with personality disorders such as borderline or excessive dependency, can work well. Not directly because these patients have a personality disorder but because they often deal with the same persistent negative thinking patterns. 'In our new treatment, schema therapy exposure, we also start with exposure therapy, but to see what patterns surface that get in the way of recovery and learning'. These might include self-criticism, detachment or excessive powerlessness.' We teach patients to recognise and cope with these moments, for example, by applying breathing exercises if you are overwhelmed or looking at a picture of yourself as a child if you are detached. So, we do exposure therapy from schema-therapy and consider the patient's learning history. In this way, patients learn to do the exposure exercises healthily, making the most of them and eventually reducing their anxiety and compulsion symptoms.
A meaningful step forward
Krans currently implements this treatment at Pro Persona Overwaal, where she is also a senior researcher. 'Patients report that they finally understand why exposure therapy didn't work and are given new tools to still benefit from exposure,' says Krans, 'It also provides understanding, self-compassion and acceptance,' she concludes. And that is a meaningful step forward.