If you live in the San Francisco Bay Area, it's reasonable to fear earthquakes. However, it's far less reasonable to fixate on the possibility that, in a major temblor the snakes in a nearby pet shop will escape and slither into your office, looking for you.
That kind of phobia is right up Dr. Howard Liebgold's alley. You may not have heard of Liebgold by his real name. He's much better known as "Dr. Fear," and for a couple of decades, he's treated thousands of people with crippling fears of everything from doctor visits to public speaking.
Dr. Fear runs workshops that teach people not only how to confront their fears, but how to get rid of them as well. He's dealt with the fear of elevators, freeways, heights, crowded places, insects, and yes, snakes. In fact, a fear of serpents tops the list of irrational frights among Americans, and Liebgold has treated his share of snake phobics. For the woman who worried about an earthquake-induced snake attack, he started with a simple suggestion: "Her initial homework was to research the 1906 earthquake in San Francisco to find out how many people died of snakebites," he says.
Phobias and anxiety disorders
Phobias -- including snake phobia -- are fears based on irrational beliefs. They're among a constellation of illnesses called anxiety disorders, which are marked by anxiety and avoidance of the source of perceived danger. Other anxiety disorders include panic attacks, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, and generalized anxiety disorder (GAD), which is marked by chronic, exaggerated worry and tension.
The National Institute of Mental Health (NIMH) divides phobias into two main categories: specific and social. Specific phobias are marked by "extreme, disabling and irrational fear of some situation or object that poses little or no actual danger," according to the NIMH. Such phobias include a fear of spiders, snakes, or flying in airplanes. Someone with a social phobia, on the other hand, fears that every social situation he encounters will result in being scrutinized, embarrassed, or humiliated.
It's common for phobics to be afflicted with multiple phobias and types of anxiety disorder. As with other forms of mental illness, anxiety disorders are thought to result from the influences of both family and society, as well as the peculiarities of an individual's genetic wiring. An estimated 40 million Americans suffer from anxiety disorders each year, and less than one-third are diagnosed correctly or receive proper treatment, according to NIMH.
According to Liebgold, a typical patient of his has gone 10 years without a proper diagnosis, seen from six to 10 doctors, and spent approximately $10,000 on medical care to try to pinpoint the cause of the digestive disorders, insomnia, and other physical ailments that result from anxiety disorders.
Liebgold's way of combating such disorders is to gradually desensitize people over time, teaching them to face their fear in small doses. In his years running the workshops, he has never encountered a symptom of phobia that he hasn't experienced himself. "Dr. Fear" was once so phobic he could be comfortable only at work, at home, or driving between the two locations. He could rarely go anywhere else without panicking. In 1991, he received the California Physician of the Year Award, which he half-jokingly attributes to being unable to venture to many places besides his workplace.
His first phobia -- claustrophobia, or a fear of being in enclosed spaces -- came out of nowhere one day during his junior year of college. "I walked into my Shakespeare class and had a panic attack. My heart was racing, my face was numb, I was sweating, and I thought I was going to die," recalls Liebgold. "I walked into that class a normal human being, and came out of it a severe claustrophobic." After that, he recalls, he began to experience panic attacks more and more frequently.
Despite his crippling fears, Liebgold became a physiatrist, a medical doctor who specializes in treating patients with musculoskeletal problems and chronic pain. To avoid the many situations that caused him to panic, Liebgold continually narrowed the perimeters of his world, so that in 31 years he had barely seen the inside of a restaurant, concert hall, or movie theater. Also during that time, his son Mark developed agoraphobia (fear of open spaces) and social phobia (fear of scrutiny, embarrassment, and humiliation in social situations), and eventually committed suicide at the age of 21. Distraught over his son's death, Liebgold vowed to find a way to get help for himself and to understand why his son, who had seen several psychotherapists, had found no relief from his paralyzing fears.
Thousands of dollars, one psychoanalyst, and two psychotherapists later, the elder Liebgold was no better off. Counseling and anti-anxiety medications like Valium were no help. Release, when it came, was unexpected: he saw a 10 o'clock news segment about a phobia workshop.
"I went to that group, and for the first time in 31 years, somebody said that what I had was curable," he says. In the four-month phobia workshop, he learned he could find freedom from his panic attacks and phobias by exposing himself gradually to the source of the fear. To help him overcome his severe claustrophobia in theaters, for example, the doctor was instructed to sit in an aisle seat and breathe deeply until he felt comfortable, then move another seat down the row. "After four weeks, I was sitting in a movie theater with tears running down my face," Liebgold recalls. "It wasn't because of the film. It was because I was sitting in a theater without having to be in an aisle seat and I wasn't anxious. It was as if someone had given me my life back."
The experience eventually led him, in 1994, to trade his title of Dr. Howard Liebgold, Kaiser Permanente Medical Center Chief of Rehabilitation, Chief of the Pain Clinic and Chief of the Acupuncture Clinic, for just plain Dr. Fear. Liebgold has no degree in psychiatry, just a passionate desire to help others with similar afflictions find their own road to recovery. Convinced that recovery from phobias could save lives, he initiated a series of phobia and anxiety recovery workshops, which he now conducts across the country. ("Dr. Fear," by the way, stands for "Dispute and Reframe False Exaggerations Appearing Real.") Liebgold says that all phobias are simply false exaggerations of normal concerns and fears, and that his job is to help people with phobias challenge and reframe their fears.
"My son's suicide gave me my mission in life: to give people hope that what they have is curable," says Liebgold. "Not a month goes by that I don't get a call from a parent with a kid going through the same thing."
From cloth snake to live python
Liebgold's phobia workshops -- like those of many other practitioners -- rely on "experiential desensitization," a term used in cognitive behavioral therapy. Phobic participants write out a list of tasks to undertake, starting from one that produces the least anxiety to one that produces the most. They don't move on to the next task until they're comfortable with the one before it. For example, someone with a freeway phobia may start by driving on a freeway and turning off on the first available exit; when ready, she'll drive as far as the second exit, and so on.
What's important is to experience the discomfort and see that you can survive it without using typical avoidance techniques. "If you're afraid of flying and you have two martinis and three Valiums and they load you on a plane in a wheelbarrow, you don't get credit for the flight -- because you were in a coma," Liebgold jests.
As part of his recovery, Liebgold created a list of situations that made him panic -- like going to the movies -- and examined them in detail to face down his fear. "To master the fear, you have to experience it, to get used to it," he says. Aided by his "obsessive-compulsive behavior," he adds wryly, he began extensive research, reading everything he could that dealt with the subjects of anxiety disorders and their treatment. He also made a study of how workshops -- like the one that had turned his world around -- were run.
During the course of his research, Liebgold came up with a helpful construct he called the "Boo Voice," which he uses to describe the undermining internal voice that keeps a phobic person in the grip of fear and avoidance. In order to undo the voice's hold, participants are taught to recognize it, give it a name or persona, and "banish it from the controls," according to Liebgold. Even the goofy-sounding name, "Boo Voice," serves to diminish the phobia.
"I called mine 'La Vampira' ('the vampire')," recalls Ashley Lamar*, a freelance artist and teacher in the San Francisco Bay Area, referring to her own inhibitory inner voice. She first took one of Liebgold's workshops to try to overcome her fear of driving on bridges and freeways, which cost her hours of valuable time by forcing her to take roundabout routes to her destinations. Eventually she learned to confront La Vampira by talking back to her. "You say things like 'I'm sick of you! Get away from me!'" Lamar says raising her voice in an impromptu enactment. "After that," she says, "we'd do positive self-talk. For example, I would say to myself, 'I'm a good driver. I'm good at driving.'"
Of course, a deep-seated phobia isn't usually cured overnight. At one workshop, a participant claimed that the exercise "didn't cure me of my fear of getting stuck in the elevator." She had had to take an elevator to get to the phobia workshop, and complained loudly to workshop leader Stephanie Chambers that "it was just as bad as I thought it would be."
Chambers, who heads Liebgold's San Francisco phobia workshop, based in a whitewashed church schoolroom, grabbed a monstrous rubber frog head and held it up in front of the woman. "You know who's sitting on your shoulder right now," she said, letting the frog stand in for the fearful, undermining inner voice. "I want you to focus on how you handled it."
During the break, amidst friendly encouragement from the other participants, the curly haired woman announced her intentions to try the elevator again. "Don't worry -- this time we'll all go in there with you," offered a gray-haired man with a thick New York accent. "No," answered the woman good-naturedly, her palms forward for emphasis. "I also fear crowds."
On average, sufferers display a combination of as many as 12 to 15 different phobias. "But they don't mention all of their fears, because they're afraid people will think they're crazy if they do," Liebgold says. Noting that anxiety disorders are unusually prevalent among teachers, entertainers, and those in the helping professions, he adds, "We're highly intelligent and creative people. We tend to be smart and empathetic, and because of the way we're wired, we have a way of investigating things so thoroughly that we overanalyze and find an aspect of danger."
In one successful case of experiential desensitization, the woman who experienced extreme snake and earthquake phobia began to overcome her fear by writing a large letter 'S' for 15 minutes every night, an exercise that produced anxiety because of that suspect letter's disturbing resemblance to a snake. Once she was comfortable with the daily 'S' exercise, she progressed to viewing pictures of snakes, then to holding a rubber worm in her hand, and finally to handling a lifelike cloth snake. Before moving on to the final test, she watched someone grasp and hold a live snake. "At the end, she was actually able to touch a live pink python with the tip of her finger," says Liebgold.
After a few sessions of the workshop, freeway-phobe Ashley Lamar started testing herself by driving on and off freeway entrance and exit ramps. She then began taking her car out onto the freeway for longer stretches of time, and even drove across the Golden Gate Bridge. Per Dr. Fear's instructions, she rated every experience by the amount of fear the action inspired. If a participant found that the action rated a 5 (on a scale of 1 to 10), then she would be allowed to retreat from the action.
In Lamar's case, a variety of calming techniques learned in the workshop helped lower her fear barometer as she moved further into the territory of her irrational anxiety. "If my heart started beating fast while driving, or my palms started sweating, or I felt like I was going to have a panic attack, I'd start counting or rub my leg because that reassured me. I'd also look around, which refocused me on something else."
There are still times, Lamar admits, when her fears creep up on her, but they're no longer so overwhelming. "You're goal isn't to be comfortable but to manage things. I haven't totally overcome my problem, but I feel much better."
Since putting his own particular set of demons to rest, Liebgold has gone on 35 cruises -- a significant achievement for a man whose claustrophobia once kept him from traveling very far from work or home. The battle, he claims, is waged by wading into the pool of your own individual fear and realizing that ultimately it's not going to kill you. "Anxiety," he says, "doesn't lead to death, insanity or heart attacks. If you practice managing situations that make you nervous, the anxiety eventually goes away. It's that simple."
*Not her real name
National Institute for Mental Health Hotline for Acute Phobia Attacks
Anxiety Disorders Association of America http://www.adaa.org
Dr. Howard Liebgold aka Dr. Fear : http://www.angelnet.com/fear.html
Dr. Fear can be reached at: firstname.lastname@example.org
Interviews with Dr. Howard Liebgold and workshop participant Ashley Lamar (not her real name).
National Institute of Mental Health. Anxiety Disorders. Feb. 8, 2011.
National Institute of Mental Health. Anxiety Disorders. http://www.nimh.nih.gov/anxiety/anxiety.cfm