Unresolved

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As I mentioned a few days ago, I have an irrational fear of dying. It’s not the being dead part that scares me; it’s the fear of the sickness and pain and suffering that’s associated with death that gets me. I talked about how the book I’m currently reading, The Anxiety and Phobia Workbook, Sixth Edition by Edmund J. Bourne PhD, has a section that covers the fear of death, and how I was looking forward to getting to that section to hopefully find some guidance in how to get over my fear.

Today is the day that I got to that section, and it is … lacking.

It explains that some of the most common types of thanatophobia (the official term for a fear of death) are a fear of nonexistence; a fear of the unknown; a fear of negative afterlife based on religious beliefs, such as hell or purgatory; my situation, the fear of the negative aspects of the process of dying; fear of the death of a loved one; fear of what will happen to loved ones after you die; and an outright fear of dead things.

The book goes into some detail about the fear of nonexistence. It talks briefly about the fears of death that center around religious beliefs. It has a couple of paragraphs on how some people respond favorably to literature on near-death experiences. It mentions a couple of therapeutic options for people whose fear of death began with a traumatic experience of watching a loved one die.

And this is what it says about dealing with the pain and suffering of the process of dying.

“The fear of pain and suffering associated with death may arise from a traumatic experience of witnessing a loved one go through a protracted process of dying. Often the death of a loved one may lead to an increased fear of one’s own death as well as a fear of sights and objects associated with death.”

That’s it. That’s all the book offers.

First off, I’ve had this fear for as long as I can remember. My mom’s dad passed before I was born. My dad’s dad passed very suddenly in a town three hours away. We lost dad’s mom after a protracted illness, but because of my age I wasn’t allowed in to see her throughout most of it, and Mom and Dad didn’t go into much detail about what she was going through. My first memory of a protracted illness in a loved one was my mom’s mom, who died when I was 25 after a years-long deterioration into dementia. A stroke finally took her in November 1994 after spending over a year living at a nursing facility that I never visited. My first hands-on experience with death was with my father, a year later. He suffered a heart attack and then a second one took him a week after that. I had that week with him in the hospital and woke up the morning of his death knowing that it would very well be his last day on earth. But my fear of death dates back long before my father and my grandmother. It wasn’t anything to do with a loved one dying.

Secondly, There’s absolutely no real help here at all. Just two sentences speculating about the origin of the fear, and another sentence later in the section that says that hypnotherapy or eye-movement desensitization and reprocessing could be helpful in instances where the fear of death originates with the death of a loved one.

I’ve been eagerly anticipating what turned out to be nothing useful.

I’m a little frustrated about this. I was really hoping to find something that would address the dreams that I have about dying, the ones where I wake up in a cold sweat. I was looking forward to getting some tips on how to combat the immediate sense of panic that I feel anytime the thought of my death crosses my mind. And instead I’ve got nothing concrete that I can use to alleviate that fear.

Well, no matter. It’s something that I can bring up with my therapist and we can work on it together.

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Getting Down to Brass Tacks

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As longtime readers of this blog may know, every day I try to read a section in a non-fiction, usually self-help book. Right now I’m reading The Anxiety and Phobia Workbook, Sixth Edition by Edmund J. Bourne, PhD. It’s a bit of a slog, and it’s an incomplete read, because there are several exercises that take weeks to complete, not to mention some chapters and sections that aren’t relevant to my particular situation. Nevertheless, I’m reading the whole thing cover to cover, and then going back and doing the exercises recommended for me.

I’m currently on Chapter 11, called Ten Common Specific Phobias. It’s pretty much as advertised, a listing of ten phobias and some potential methods of overcoming each one. Most of these don’t pertain to me. The most common phobia, performance anxiety (public speaking and the like), is something that I only marginally deal with, others listed don’t bother me at all. The tenth one, however, is my single greatest fear. I’ve awoken in a cold sweat dreaming about it, and I can feel the panic rising in me even now just thinking about it, because it’s something that I WILL eventually have to face.

I have a tremendous fear of dying.

I’m not scared of being dead. That part doesn’t bother me. I’m not worried about my soul in the afterlife, and an endless, dreamless sleep if there’s nothing is just that. What bothers me, however, is the process of dying, the panicked gasping for breath that doesn’t come, the potential for a long, drawn out illness, the chance that it’s going to hurt very badly. That’s the part that I’m terrified of.

Fortunately, there appear to be some concrete things that the book suggests to help ease that fear. I only today discovered the section existed, and skipped ahead briefly to scan it. There appears to be more reading that I’m going to have to do after I finish my work with this book, but I’m okay with that. I just hope that it helps. I really wish I didn’t fear this so much, but the older I’m getting and the poorer my health becomes, the more I’m forced to face the fact that I likely don’t have as many years ahead of me as I do behind me. (Hopefully I’m wrong about that, and if I’m not, I hope I miss it by just a few years.) It’s a crippling feeling to know that I’m helpless to prevent it from happening.

I’ll have more on this in a few days when I get to the actual section itself.

Exposure Therapy 2.0

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There is a treatment method in dealing with anxiety and phobias called exposure therapy. Let me give you a personal example of how it works. First, a little background.

When I was 13 and at Scout camp I was playing with my campmates near one of those tin-roofed open-walled shelters with several picnic tables underneath it. Electricity ran to the shelter to power the lights underneath, and it entered the shelter through a junction box high in one of the corners of the shelter. It began to rain fairly hard though the sun was still shining, so we had the weird experience of running underneath the shelter to avoid rain in bright sunshine. The clouds eventually crossed over the sun, and within seconds of that there was a tremendous clap of thunder and a flash of light underneath the shelter. The thunder was so loud it was disorienting, and when I came back to reality I saw one of my counselors fall straight backward from the edge of the cement slab underneath the shelter into the mud just outside of it. There was pandemonium everywhere else, and it took me a couple of seconds to realize that lightning had just struck the junction box underneath the shelter, directly in front of me not ten feet from where I was standing. It went out in several streams, and it hit four people total, the counselor I’ve already mentioned and three campers. One of them got a perforated eardrum from the experience and was deaf in one ear for weeks afterward. Another got hit with enough juice to fuse the zipper in his pants together (I’ll give you a minute to recover from that one). All four went to the hospital overnight for observation; the counselor that was hit only experienced lack of muscle control and a brief spell of unconsciousness and was back at the camp the next morning and the three boys were pretty much done with camp. All four survived the day, fortunately, but my previous love of thunderstorms was a casualty. From that moment forward I became terrified of thunder and lightning, and understandably so. I was closer to the junction box than the three boys that were hit. That could just as easily have been me that was hit that day.

Fast forward many years to a time in my life when I was dealing with anxiety far worse than I am today. I entered an outpatient program at the local psychiatric hospital geared to deal with anxiety and phobias, and it’s there that I learned about exposure therapy. With regard to my fear of lightning, we started with a written exercise: what’s the worst thing that could happen? I wrote the very grim paper and then was asked to rate my anxiety from 0-100, with 0 being no anxiety at all and 100 being the worst anxiety imaginable. Then I was asked to perform deep breathing exercises until my anxiety was half of what it was when writing the paper. After that, I was asked to write a paper detailing what it would be like for me to be out in a thunderstorm – no worst case scenario this time, but just express everything I was experiencing, using all five senses if possible, followed by the same 0-100 measurement and deep breathing exercise until my anxiety was half of what it was. The next step was watching a video of a thunderstorm, with a writing exercise explaining what I experienced watching the video and the same measurement and deep breathing exercise. The final step was a little creative, since it was a time of year when thunderstorms were pretty rare (this was in Illinois, not in Texas, which is known for some spectacular thunderstorms), and it was my own suggestion. I proposed that I take a day off from the program at the hospital and go face as close to my fear as I could. The Museum of Science and Industry has a gigantic Tesla coil that fires overhead at regular intervals. It’s loud, it’s pure raw electricity, and it’s only maybe 20 feet above the seats that are beneath it. My goal was to go sit under the Tesla coil and measure my anxiety both when I sat down and when the coil fired, and to do deep breathing exercises until my anxiety was half of what it was at its worst. I went downtown with a friend who was able to accompany me and we sat underneath the coil for nearly an hour, and by the end of my stay there I was so desensitized to the lightning going off overhead that I was experiencing no anxiety at all. (I took the photo at the top of the article myself, while sitting directly underneath the Tesla coil.)

The process of exposure therapy is to have you experience your fear in a safe setting and to gradually experience it with more and more actual sensory input until your fear has subsided to the point that you’re not experiencing as much anxiety in situations that would previously have you frozen with fear.

Nowadays I can even go stand outside in a thunderstorm, though if it’s particularly close and violent I tend to want to head back inside, but that’s just as much my desire to avoid being soaked to the skin as it is to get out of the way of a potential lightning strike. I enjoy them, in fact. The exposure therapy worked exceptionally well and has stuck for almost six years now with no relapses at all.

So I told you all that to tell you that today I learned about a new tool being used in exposure therapy, in a similar method as the video that I watched, a technology that existed in 2011 when I went through the program but was prohibitively expensive for the hospital to own.

Virtual reality exposure therapy.

In a sense, everything I did was a form of virtual reality, even the culmination of my therapy underneath the Tesla coil. None of them were the actual experience of being caught outside in a thunderstorm, and so the experience had to be simulated to the best of the hospital’s ability using the tools that they had. (Fortunately my phobia about lightning was common enough that they had a tape – still using VCRs at this point, kids – featuring a thunderstorm. If it were a different phobia, and I presented with several, they used different methods to expose me to the thing I feared. The therapies for the rest of my phobias all culminated in that one day trip to downtown Chicago and I’m better off with all of them today, thank goodness.) With the technology of virtual reality becoming more common and accessible, there are programs that can simulate situations of fear far better than watching a video, for instance. You’re immersed in the experience much more so than I was, and you have a controller to help get you out of the situation if need be.

Virtual reality is not a replacement for the process that I went through. It’s far more immersive than writing a paper about “what’s the worst that could happen?” and needs to be built up to, just like I was built up to the videotape. Odds are good that VR would be a further step from simply watching a video of what scares you since it is so immersive. In addition, exposure therapy – whether virtual reality or not – should only be done under the watchful eye of an individual trained in administering exposure therapy, so if you have fears of your own that you wish to conquer, I would recommend searching out an outpatient anxiety program near you. It helped me immensely with several phobias and I feel it could likely help you with yours.

The good thing is that exposure therapy can be used for other anxieties besides phobias, something that I tend to forget is a large portion of what we’re trying to establish in my own therapy right now. A lot of my anxieties can be ported over easily. My fear of crowds, my fear of driving, my fear of everyday socialization – all of them are being treated with a form of exposure therapy to try and convince my brain that these situations are not something to be feared, but rather a part of everyday living that I’ll need to embrace before I can get back out in the job market.

I don’t know if I’ll ever get to – or need to – experience therapeutic virtual reality. But it’s nice to know that the option is there should the need arise.