"Anyone can reach that breaking point of fear"

A patient with an anxiety disorder that has particularly stuck with him? Damiaan Denys, a psychiatrist specializing in anxiety and compulsive disorders, doesn’t have to think twice about that. He is head of the psychiatry department at Amsterdam UMC. In people with a severe anxiety disorder, he makes a home visit before determining the treatment. “I came to a woman with a fear of contamination, she was cleaning all day long. Together with her husband she had a beautiful villa built in which everything was spotless. It turned out that she lived with her husband and children in the garage. fear that the villa would get dirty had completely taken over her life and that of her family.”

We all know fear. What makes one person able to handle it well, while the other hides in the garage? “It has to do with genetic vulnerability, in other words with predisposition, but it is often difficult to find out exactly what that means. For example, we know that women more often have an anxiety disorder than men. Testosterone may protect men against too much anxiety because this hormone also plays a role in overconfidence and impulsivity. But the figures may also be skewed because women may seek help more often. It also has to do with upbringing and what you experience in life. your life. If enough happens, you can reach a breaking point. But some are more susceptible and reach that breaking point sooner than the other.”

What exactly is fear?

“An intense feeling of loss of control. A strong emotion that we all experience from time to time. In some people, fear is so deep that it affects their lives profoundly. But we know the need for control, to control what is going on in our lives. all. More than ever. In fact, a hundred years ago people were able to bear the lack of control more easily than now. The world has not become more dangerous since then, quite the contrary. But our intense desire for control and certainty makes us more anxious. I recommend that everyone examine their fears carefully. Just sit on the couch for an hour without being distracted by your smartphone or Netflix. What are you afraid of? How does that hinder you?”

Why would you want to face your fear?

“If you think carefully about what you are afraid of and analyze that fear, you will find that it reveals your own shortcomings. Suppose you are afraid to speak in front of a large group. You really do not dare, the fear sweats break out on you. Then you may think: I have a social phobia. But if you ask yourself what your real fear is, it will turn out that you are afraid of your own failure, a loss of control, that you may not do well. also ask yourself what you do to avoid situations that make you anxious. Why don’t you go on holiday to that distant country? Why don’t you dare to speak to a certain person? Why don’t you take that step in your career? Analyzing your fears doesn’t just show you what you’re avoiding, it brings you in touch with yourself on a deeper level. You can learn a lot from that.”

The right help

Anxiety disorders are the most common psychological complaints: one in five or six people has an anxiety disorder. It often takes a long time before people seek help. Psychiatrist Denys: “Sometimes they don’t even know they have an anxiety disorder, and often they are very ashamed. They feel guilty or think they have failed. That shame makes it even more complicated to get the right help. Sometimes the fear is there.” also hidden behind physical complaints such as hyperventilation, palpitations.”

What is the effect of the years of delay before aid arrives?

“People avoid situations that frighten them for a long time. This way you can live without the need for assistance. The story of the family who lived in the garage of their beautiful villa is not unique. I once asked the children of a woman with a fear of contamination whether they suffered from her anxiety disorder. “No, that’s not all that bad,” they said. After further questioning, I discovered that this family largely lived in the attic so that the children would not dirty the rooms. For years. it took a long time before good help was called in.”

What treatments are there and are they effective?

“There is a wide range of treatments. Body work, for example, where you learn to recognize fear and receive breathing exercises that help you not to panic. You can also go to a psychologist for cognitive behavioral therapy with an anxiety disorder. You then learn to recognize your fear Sometimes treatment with antidepressants is the way to go, they often bring relief. A combination of drugs and therapy can also work well. In cognitive behavioral therapy, practitioners often use exposure. Then you are exposed to what is causing your anxiety Patients are also treated in this way at the Amsterdam University Medical Center, in groups.”

How am I supposed to see that? Is there a bin with spiders ready in the hospital?

“Not immediately, it happens gradually. People with a spider phobia first look at an image of a spider, then at a movie and then at a real spider, at a distance. Eventually the spider then walks over someone’s hand. gradually increase the fear stimulus. First touch a surface with a stain, and build it up until someone dares to put a hand in the toilet bowl. It is also possible with the method where it happens in one fell swoop. Someone with a fear of heights then immediately to a high floor. The mechanism behind exposure is that the patient notices that in reality nothing threatening is happening. That breaks the link between the fear stimulus and the panic response.”

Can you fully recover from an anxiety disorder with these treatments?

“That is possible, although the fear will never completely disappear. With the treatments you learn to do the daily things. When the obstacle has been reduced, you can say that someone is more or less healed. But completely freeing yourself from the fear you are dealing with is struggling is exceptional.”

About 30 percent of people with an anxiety disorder have not recovered three years after diagnosis. Is there still hope for them?

“We offer deep brain stimulation to people who have been treated at the Amsterdam UMC. This option is available if medicines and behavioral therapy do not work and you are seriously ill for a long time. We place an electrode in two brain regions. The electrodes emit electric pulses that change the stimulus transfer. “That can dampen or completely eliminate the symptoms. We don’t treat many people yet. We would like to help sixteen a year, but we are now at eight or nine. It is an invasive treatment, brain surgery actually. Sometimes patients are hesitant themselves, care providers do not refer quickly either. A pity, because the results are regularly spectacular. I would grant many more patients this treatment.”

Spectacular, what should I think about?

“In 50 to 60 percent of the patients there is a significant decrease in the complaints, while other treatments have not helped. In 15 percent the complaints disappear completely, I find that impressive. Imagine a man who has had a has obsessive-compulsive disorder and spends hours a day on it. For example, washing his hands over and over until the sheets hang. For twenty years he has tried everything: medicines, behavioral therapy … Nothing has helped and he is at his wits’ end. After this treatment he can lead a normal life again. It is a miracle for these patients after all these years when they can function again. They feel like reborn.”

Damiaan Denys is a psychiatrist at Amsterdam UMC, specializing in anxiety and compulsive disorders and deep brain stimulation. He is a professor of psychiatry at the University of Amsterdam and a philosopher and wrote the book The shortage of excess – the paradox of mental care. Damiaan Denys also gives lectures and theater performances about fear.

This article originally appeared in +Gezond april 2022. Want to subscribe to the magazine? You can do that in an instant!