Chapter 2. Priya’s Case: “Everyone has some anxiety, right?”

Client Name: Priya

Age: 33 years old

Gender: Female

Ethnicity: Southeast Asian (Indian)

Occupation: Flight attendant

Current living situation: I live alone

Why are you seeking services at our clinic? I am afraid my anxiety will start to get in the way of my job as a flight attendant.

Priya: I’ve thought about coming in before [hesitates]. I just wasn’t ever sure if it was a good idea. But now ... I feel like I’m fighting a losing battle and I’m … [sharp intake of breath] I’m going to get fired! I’m a flight attendant for a major airline. I actually really love my job! It gives me a chance to travel and see new places and meet new people. I like helping the passengers and hearing their stories. I don’t mind the multitasking. I feel like I’m really good at solving problems while I work with the passengers. I like the bustle of the airport. [with pride] I think I’m good at my job, too. I feel like I can manage any crisis that comes up. But over the past, I don’t know … [tries to remember] year or so… I’ve been missing work – a LOT of work … [sighs] because I feel anxious about flying. That’s not a good problem to have in my line of work, obviously. I sit and think over and over about all the possible things that could go wrong. I just feel really tense all over and super anxious – almost panicky – and then I can’t bring myself to go to work.

Priya: I am very anxious about staying in hotels in different cities. I’m starting to wonder if this is the right career for me. I used to be able to calm down once I got to work. But now I find myself worrying about terrorist attacks or a plane crash. But … all this anxiety makes sense, right? It is actually dangerous to fly – we could crash! And something could happen to me while I’m staying in a strange city. We always arrive so late at night, and some of those cities have very high crime rates. As a single woman, it’s just not safe to be out at that time of night … you know what I mean? … Even as I was sitting in your waiting room I was wondering whether I should even be here. After all, everyone has some anxiety, right? Then I was worried you might think I’m crazy for even coming … [pauses] … or the opposite, that I’m beyond help and there’s nothing you or I can do. I find myself thinking about everything that could go wrong … all these possibilities … just play over and over in my mind. I can’t stop worrying …Then, I’m exhausted and I can’t sleep, and that’s when I call in sick to work … I worry I won’t be able to do my job well because I’m sleep deprived. I’m worried that my co-workers will think I’m not pulling my weight or that I’ll snap at them because I’m so tired.

Priya: There have just been so many crashes and mishaps in recent years. Every time I hear about one, I keep thinking, “I could be on the next plane that goes down! This is just one more sign that the world is not safe at all.” You would think that we would not see air disasters like these … especially after 9-11 … and yet … After those crashes, I get sick with worry every time I fly. [pauses] … I worry that I will miss the bus to the airport and be late for work [feels the need to explain] – I take the bus because I don’t drive. I never wanted to drive – I find it incredibly scary. My father made me take Driver’s Ed when I was 16, but then I had two accidents in my first 6 months of driving … so I quit. Driving is too dangerous. I got into accidents even when I was being perfectly safe! I feel like I used up all my good luck with those accidents, so I’ve never driven again, but I still worry about my parents or siblings getting killed in a car crash. But my biggest worry is really flying … I worry I’ll panic on the airplane and then the pilots will have to make an emergency landing, which would upset the passengers. It would be completely embarrassing.

Priya: Yes, definitely! It’s so scary! I feel like I’m going to have a heart attack or die. [reflecting] … I guess I’ve had a few in my life. I have Xanax I can take if I have one, so I carry it with me everywhere I go. I haven’t had an attack in probably like 2 years, though.

Priya: Pretty normal, I guess. My parents were married and had four of us – I was the baby. We lived in a normal, average-sized town in Ohio. My dad was kind of distant, hard to impress. I would try to do well in school to impress him, but he never noticed. He worked long hours and when he was home, he had to take my mom out to do errands because she was afraid to go out alone. She was “sick” a lot, and she only ever left the house with dad. Now that I’m older, I wonder if she might have had some kind of phobia. She kept telling me that the world was a dangerous place and warned me about all the horrible things that could happen if you are not on your guard at all times. I wasn’t allowed to play outside unless my mom or dad was there watching me, which made it hard to make friends. [pauses] … I always felt like I didn’t really fit in with my siblings. My brothers are the two oldest, and we got along fine, but they felt like two more dads more than anything else. My sister is 3 years older, and we weren’t really very close … we are so different – different personalities, different ways of looking at the world. My sister never worries about anything and lives one day at a time. She always made me feel inadequate, because she did really well at everything she tried … spur of the moment … no planning … just like that! She never understood why I was always thinking about the future. [sadly] I felt like she looked down on me for it.

Priya: Come to think about it, as far back as I can remember I’ve always been a worrier. My brothers and sister used to call me a “worry wart” growing up. When I was little, I used to go around the house unplugging all the appliances before bed because I was afraid of a fire starting overnight. … I remember hearing about how smoking causes lung cancer, and then I was afraid my mom would die because she was a smoker and that all the rest of us would die from secondhand smoke. Even after my mom quit, I still worried about getting cancer.

Priya: Come to think of it … I guess I do have some problems with trust. I just don’t know when it is safe to trust someone. About 4 years ago, I started dating someone I really felt close to. He was a pilot, so he “got” me – he understood my anxiety about flying and being in new cities. We had been going out for two years when the airline transferred me to Seattle. That made me very anxious because I’d never lived anywhere but Ohio before that. But my boyfriend said he would move with me, so I felt better about the transfer … excited even … We picked out an apartment together, and I flew out there and was setting it up when he called and told me he wasn’t coming. [sadly] He said he “wanted some time apart.” I had a severe panic attack – this is actually the last one I had, two years ago – and I spent my first night in Seattle in the E.R. What a way to start off in a new city, huh? I haven’t dated anyone seriously since. I now live in that apartment we picked out together, and I’m terrified of it being broken into. I have the same worries at home now that I have when I’m travelling. I even keep a pair of men’s sneakers and a large dog bowl outside my front door, even though I’m single and don’t have any pets.

Priya: Like I said at the beginning of the session … I’m not sure I made the right decision. One of the reasons I’ve never tried therapy before is that although it’s really obvious that all this anxiety is interfering with my life, I [slightly embarrassed] … this is going to sound really weird … I kind of don’t want to give it up! I’m worried about not worrying, as silly as that sounds. Worrying about my safety and staying on my guard has kept me safe! People, in general, aren’t concerned enough about their personal safety and that is why they end up in dangerous situations. I also feel like if I worry, it prevents something bad from happening. You might dismiss this as superstition. But it really works! For example, I got my mom to quit smoking – she quit because she saw how worried and stressed I was about it. Because I kept worrying, she never started up again and she never got lung cancer. [sighs] But it’s exhausting. I can’t relax on my days off because I spend the entire time worrying about my next flight. I worry all the time about everything. I worry about things most other people see as silly – like whether I’ll be caught in the rain without an umbrella, if I can pay my bills on time, if the bus will break down on the way to work. I’ve been able to keep my anxiety under control for a long time, but now I just can’t anymore. So I’m hoping therapy can help me, but I’m worried that it won’t.

[MUSIC PLAYING]

WOMAN: I would worry about things. I'd be concerned about things. And I was just stuck. My tires were spinning and I wasn't getting anywhere. Those worries really kind of took on a life of their own. Things that would be a minor stressor for someone would really, really affect me and I couldn't get over it.

It was more like just a prisoner to these worries and these thoughts. And I didn't necessarily know to give it a name, that it was an anxiety disorder. That I was struggling with anxiety. That there was something that could be done about it.

I thought that was just life and how life was, and I just wasn't as good at coping with it as other people. You get stuck. The worry takes over. You're a prisoner to the worry.

It's hard to even have a conversation with someone about anything other than what you're worried about. It really just comes in like a poison and just takes over everything.

DR. TRACY DENNIS: We did a dosage study. So we had people come into the lab for a single session. And they played either a long dosage, so to speak, of the app, or a short dosage. The short dosage was about 25 minutes, and the long dosage was 40 or 45 minutes.

There we go.

So with this game we've developed, it's a very simple technique where we've taken a lab-based approach and embedded it in the structure of the game. And you basically create competition for attention. And what competes for attention is something negative and something positive.

In our game, we have an anger sprite and a happy sprite. And in the game, what we do is we train people to pay attention to the happy sprite-- to follow the joy, to focus on the positive-- by always following the trail in the grass that the happy sprite makes after the happy sprite burrows down. And what we found is that even with the short dosage, you actually saw reductions in subjective feelings of anxiety after playing the app compared to a placebo control. So it was the exact same game, except you randomly followed the happy or the angry sprite.

DR. SCOTT BEA: I think we need a little bit more evidence. I think we have to actually test this with clinical populations a little bit more characteristically. But I can absolutely see how this could work with a wide range of conditions that we're treating every day.

DR. TRACY DENNIS: We developed this game because there's really a crisis in mental health now, where we have some excellent, scientifically supported treatment for things like stress and anxiety disorders. But they're burdensome. They're expensive.

They're time-consuming. They're stigmatizing. And they're not accessible for many people. So we as psychologists need to do a better job of developing treatments that people can access, that are effective, and really give people a sense of empowerment to promote their own mental wellness.