LCL can help find variety of treatment options

Issue June 2004

Q:Since I entered law school, my various anxieties seem to have become more severe. For example, I now have a more pronounced fear of flying and even driving. Everything in life seems more fragile and impermanent to the point of constant worries and doubts. Although I have been doing well academically, I now fear that these concerns are taking up so much mental "space" that they may interfere. I would appreciate your thoughts on dealing with my problem.

A:Without a full evaluation, it is difficult to discern exactly what about law school may have triggered an exacerbation of your proneness to phobic anxiety and obsessive worries. It may even be coincidental with other events (for example, our current heightened concerns about terrorism could feed into such fears). With this type of problem, various forms of treatment might be useful, individually or together.

A number of therapeutic approaches can be effective in addressing the sorts of anxiety that you describe. Were you to come to LCL for an evaluation (involving much more information than can be conveyed in this Q&A format), we might draw upon any of the following approaches in putting together a "treatment plan." (The following brief sketches give a bit of the flavor of each approach but are quite incomplete.)

Insight-oriented (or psychodynamic) psychotherapy might help you recognize aspects of your anxieties that may not be completely conscious, such as conflicts with parents or within yourself about your current career direction.

Cognitive-behavioral therapy would overlap with the above in focusing on recognizing thought patterns (some of them "automatic") and beliefs, but the thrust of treatment would be less to value insight and expression of feelings per se, and more to change patterns of thinking and coping in such a way as to alleviate anxiety.

Behavior therapy (with less of a cognitive component) is an approach best known for successfully addressing phobias. The emphasis here is on gradual exposure to the feared situation, usually after applying a relaxation technique, until the anxious response is "extinguished" and replaced with a gut sense of relative safety. The exposure can be done through visualization alone (e.g., visualizing the airport and later the plane), though the process is often more powerful "in vivo" (spending time near the airport and eventually on an actual aircraft).

Medications can sometimes be helpful. Depending on the individual picture, the prescription might, for example, include tranquilizers (benzodiazepines, effective but also potentially addictive), antidepressants (which for many people will reduce obsessive worries and/or panic), or beta blockers (more typically used for high blood pressure but can reduce the intensity of social anxiety symptoms).

Sometimes optimal results are achieved by using more than one of these strategies. In any case, although we favor providing consumer information as we've done here, we do not recommend constructing your own treatment plan. We do suggest collaborating with LCL staff or another licensed, experienced clinician to develop an individually tailored course of action.


Questions quoted are either actual letters/emails or paraphrased and disguised concerns expressed by individuals seeking assistance from LCL.