An Interview with Richard Heimberg, Ph.D. on Generalized Anxiety Disorder and Social Anxiety Disorder Research and Treatment
Anxiety is a common and normal feeling of distress that all people feel when they become concerned about a possible future danger. It is closely related to fear, the difference being that fear is a direct response to actual danger, while anxiety involves the anticipation of possible future danger.
For the most part, anxiety is an adaptive response that helps people get motivated to take on challenges they face in life. However, a significant miniority of people find that their anxiety becomes so overwhelming that it negatively effects their social relationships, and ability to perform well at their job or in school.
Anxiety and fear are closely associated with activation of an area of the brain called the amygdala. However, anxiety is as strongly influenced by psychological factors such as thoughts and perceptions as it is by underlying brain circuits. Both levels of analysis are important and help shed light on this complex area of emotion studies.
Most recently, Dr. Heimberg has been conducting research on how to best treat people who have Generalized Anxiety Disorder (GAD), a condition characterized by chronic disabling worry over seemingly unimportant life issues. At this time, his research suggests that people with GAD tend to fall into the habit of worrying over little and unimportant life events as a way of distracting themselves from more pressing and serious concerns, much in the way that a student might avoid studying by cleaning her apartment GAD sufferers get stuck in the cycle of distracting worry and do not easily move on to problem solving.
This idea that GAD involves self-distraction with small worries so as to avoid a bigger worry is similar to the Freudian notion of symptoms that mask deeper concerns. However, Dr. Freud's notion was that the deeper concern was somehow unconscious, while Dr. Heimberg's notion is that there is no reason why the more pressing and serious concern cannot be thought about except for the fact that it is scary and threatening and therefore something that GAD people are motivated to avoid.
People with GAD appear to have four basic characteristics in common.
- They have difficulty identifying and describing what they are actually anxious about
- They find any strong emotion (positive or negative) to be threatening, preferring an even neutral keel
- They don't have well developed coping skills to enable them to cope with anxiety when it occurs
- They don't know how to bring their own anxiety under control very well, and therefore it continues for longer periods of time than is the case for non-GAD people.
Dr. Heimberg used to study Social Anxiety Disorder, which used to be called Social Phobia. The name was changed so that the word phobia could be reserved for more specific sorts of fears (such as fears of spiders). Social Anxiety Disorder, which is the second most common mental disorder after major depression, involves a more generalized fear of negative evaluation by other people and fear of the resulting feeling of humiliation and embarrassment that would follow being negatively evaluated. Social Anxiety Disorder can get so bad that some people never go on dates despite wanting to, or do not go to school or take jobs that involve social interaction for fear of being rejected. More mild cases of social anxiety disorder also occur when people are afraid of public speaking, but otherwise can function.
Effective treatment of Social Anxiety Disorder can happen with medication therapy or cognitive behavioral psychotherapy tailored to the disorder. Early research showed that both treatments were about as effective as each other in the short term, that medication treatment tended to work faster than therapy treatment, and that, upon follow-up after therapy was over, medication treated patients tended to relapse far more often than therapy treated patients.
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About Richard Heimberg, Ph.D.
Richard G. Heimberg, Ph.D. is Professor of Psychology at Temple University. He also serves as Director of the Adult Anxiety Clinic there. Dr. Heimberg is well known for his efforts to develop cognitive-behavioral treatments for social anxiety and examine their efficacy in comparison to (or in combination with) medication treatments. More recently, he and his colleagues have initiated a program for the study and treatment of generalized anxiety disorder. His research has been supported by a number of grants from the National Institute of Mental Health.
Dr. Heimberg has published more than 275 articles and chapters on social anxiety, generalized anxiety disorder, and related topics. He is co-editor or co-author of six books, including the 2006 book, Managing social anxiety: A cognitive-behavioral therapy approach. Dr. Heimberg is Past President of the Association for Behavioral and Cognitive Therapies. He currently serves as Editor of Behavior Therapy, the flagship journal of that association and he is on 9 additional editorial boards. Dr. Heimberg was named one of the four most influential psychological researchers in anxiety.