welcomes as our guest, Reid Wilson, Ph.D., who is an international expert in the treatment of anxiety disorders, with books published in nine languages. He is the author of Don't Panic, co-author of Stop Obsessing!, and co-author of Anxious Kids, Anxious Parents. His most recent book is Stopping the Noise in Your Head: The New Way to Overcome Anxiety & Worry.

Dr. Wilson is Director of the Anxiety Disorders Treatment Center in Chapel Hill, NC and is Adjunct Associate Professor of Psychiatry at the University of North Carolina School of Medicine. He designed American Airlines' first national program for the fearful flier and served as Program Chair of the National Conferences on Anxiety Disorders for three years.

He currently serves as the expert for WebMD's Panic and Anxiety Community. He has appeared on The Oprah Winfrey Show, Good Morning America, CNN, The Katie Show, A&E's Hoarders, and MTV's True Life.

Norm: Good day, Dr. Wilson, and thanks for participating in our interview.

When and why did you become interested in the treatment of anxiety disorders?

Dr. Wilson: Way back in the 1970s, the media began to report on women with agoraphobia – the fear of panic attacks that kept them trapped in their homes. Soon, many of them started showing up at the doors of psychologists around the country. At that time, my specialty was the treatment of chronic pain patients. So I was versed in relaxation training, hypnosis and biofeedback techniques, and these were helpful for those suffering from panic attacks. Helpful, but insufficient.

As I looked around in the literature, very few articles and no books were written on the subject. So, basically, I had to train myself in trial-and-error ways. That set me on the course to write my first book, Don’t Panic. That’s how the treatment of anxiety disorders became my specialty over those next years.

Norm: Do you believe that a person is more likely to develop an anxiety disorder if they are biologically predisposed to anxiety, in conjunction with a psychological vulnerability?

Dr. Wilson: Most people’s psychological vulnerability to an anxiety disorder has a strong biological, or genetic, component. More importantly for the treatment is what maintains the disorder, not so much what started it. What maintains the disorder tends to be the way we resist and fight against our symptoms and avoid challenges.

Norm: What are the symptoms of anxiety disorders?

Dr. Wilson: In adults, the anxiety disorders are made up of five types: specific phobias, panic disorder and agoraphobia, social anxiety disorder, and generalized anxiety disorder. I add obsessive-compulsive disorder (OCD) into this grouping.

Their common denominator is the fear of real or perceived threat, as well as anxious anticipation of that threat.

If people decide to avoid the perceived threat, then they can end up having very few symptoms. This, of course, reinforces avoidance as a strategy, even though it is a failed one. But when they think of stepping toward the threat, that’s when they tend to be more symptomatic. And those symptoms can range from anxious, worried thoughts all the way to full-blown panic attacks.

Norm: What is the difference between Panic Disorder and Social Anxiety Disorder?

Dr. Wilson: Someone with panic disorder has experienced at least one panic attack and feels fear and dread about the possibility of another one. That’s certainly understandable, because a panic attack is a sudden onrush of intense physical sensations such as a racing heart, dizziness, difficulty breathing, chest pain, sweating and shaking, and it shows up out of the clear blue.

These are coupled with what we call thoughts of impending doom: the fear that I’m going to faint, have a heart attack, die, humiliate myself, or go crazy. And, of course, who in their right mind would want to experience that again. And so, as quickly as possible, people try to figure out how not to have that experience anymore.

 The most common way they control the panic attacks is by avoiding any circumstance that might provoke them again. Very often, these are any places where they feel trapped or out of control. That might include driving on highways or entering grocery stores, elevators, flying, standing in an open field, even getting their hair cut (since they are socially trapped).

Social anxiety is related to the fear of criticism by others in social situations. The most common social anxiety is the fear of giving a formal presentation. But they can also worry about any circumstance where they have to speak up and might stumble over their words or start blushing or have their hands shake. So they might worry about and even avoid signing their name in public, talking to someone that they don’t know very well, asking for a date, leaving a message on an answering machine, or speaking up in a meeting.

Norm: From reading about you and watching your videos, I believe, and correct me if I am wrong, that the core of your approach to treating patients with anxiety is to change their response. Could you elaborate and explain how you go about changing the response?

Dr. Wilson: Yes, you are right, Norm. There are two primary issues here. First, people with anxiety want to get rid of their symptoms. While that is understandable, it works against them. There’s an expression that says, “Anything that is resisted will persist,” and that is true with anxious symptoms. It’s like pushing a child on a swing: the more you push, the more that swing comes back toward you with greater force.

When you try to push symptoms away, they come back at you with greater force. So all treatment of anxiety should be paradoxical – opposite of logic. If your response to anxiety is to push it away, which will cause it to get stronger, then what is the opposite of that? That’s the direction we should go toward. I want people to understand that when you learn to step toward your distress, to find ways to move toward what you fear, that will be your strongest asset. Fearful thoughts pop up spontaneously from the unconscious.

Anxiety pops up spontaneously from the unconscious. We need to accept those experiences, because we are not in conscious control of them showing up. (That’s why trying to control them will fail.) But we are in control of is what we do next, what we say next. And that’s where we have power.

Norm: You believe that worry can be healthy, depending on how we react to it. Would you care to explain this belief of yours?

Dr. Wilson: Worries come in two forms: signals or noise. Signals are worries about problems that are solvable, that are our responsibility to solve, and it’s time for us to think about solving them. We need worries! They help us prioritize our tasks; they motivate us to get to work. But worries also show up as repetitious unproductive noise that makes us anxious and distressed.

They are not a signal that we need to start problem-solving, so we don’t need to pay attention to them. But there lies the problem: all worries, whether signals or noise, show up in the mind as signals. We need to use our conscious attention to decide whether that worry is worth listening to. If we decide it’s a signal, our job is to start problem-solving. If we decide it is noise, then we can do anything we want with those worries other than pay attention to them.

There are skills involved with learning how to let go of those noisy worries. But the first step is to decide to treat them as noise.

Norm: What effect do you believe the media has on us such as the sensational news broadcasts we are subjected to on a daily basis and how do we tune them out?

Dr. Wilson: Today we live in a global village. We tend to hear about everything and everybody worldwide as though it’s right down the street. And 90% of what we hear is bad news. Lots of us can handle this information and are able to tune it out as needed. But some people are sensitive to such intrusions into their mind. If they hear about a plane crash on the other side of the world in which dozens of people are killed, then it doesn’t take much for them to start thinking, “Oh, no. That could happen to me!”

That leads them to be more upset and preoccupied by the news, of course. The next mental move they might make is to think, “I don’t want to have that happen to me.” Then they confuse the possibility of it happening with the probability of that happening: “It’s likely that my flight could crash.”

And just that quickly, those people can begin to back away from commercial flight and become fearful fliers. How to tune all that out? Easier said than done. Because if we decide to start avoiding such stimuli, we can generate another set of problems: we have to avoid looking at newspaper headlines, not watch TV, in case some news flash comes across the screen, and so forth.

Norm: How do we conquer interview anxiety?

Dr. Wilson: We don’t have to conquer interview anxiety; we have to tolerate it. There’s nothing wrong with being nervous about an interview. It’s a sign that that interview is important to you. But as soon as we start saying, “I can’t let myself become nervous in the interview,” then we signal the amygdala in our brain to secrete epinephrine, and we automatically become more anxious.

So now the solution we have chosen – “don’t be anxious” – perpetuates the problem. Don’t make a mistake; don’t let them see my hands shake – these kinds of messages are moving us in the wrong direction. Prepare for the interview in the best way you can. If you’re going to a job interview, study up about the company, see if you can get good advice on what clothes to wear in that interview setting, have a clean and neat resume, and, of course, use the bathroom before you walk in the room!

But once you’re in the room, support your efforts. Don’t start second-guessing yourself while you’re talking. Don’t look for signs that you are doing a poor job while you’re in the middle of trying to do a good job! You can analyze later. Stay in the present, listen to the questions, and answer as best you can.

Norm: Could you tell us a little about your most recent book, Stopping the Noise in Your Head: The New Way to Overcome Anxiety & Worry?

Dr. Wilson: I now have over 35 years working with some of the most difficult cases of anxiety you will ever see. So I have figured out a few things. Two of the biggest things I’ve learned are, first, that people with any of the anxiety disorders make the same, understandable mistakes, so the same skills can apply to any of the disorders, and, second, we can get better by doing the exact opposite of what our intuition seems to be telling us to do.

We can perceive the anxiety disorders as our challenger in a mental game, and we can be just as clever and as cunning as our challenger is. We study it, learn its moves, and then counter those moves. Along the way, we have to be willing to take a few punches to the gut. It comes with the territory. There are no tricks here to prevent us from getting anxious. But there are absolutely some maneuvers that will catch our challenger off-guard.

Norm: What were your goals and intentions in this book, and how well do you feel you achieved them?

Dr. Wilson: Anxiety is looking to generate within us fearful thoughts and symptoms that we think we can’t tolerate and that we try to get rid of. It doesn’t just give us fearful thoughts and symptoms. It only wins if we play our role, which is to fight against them. You can’t win this competition by fighting against your symptoms.

My intention was to change people’s mindsets about this relationship with worry. So I knew I needed to write a book that was first and foremost entertaining. Because if I don’t keep readers’ attention, I cannot teach them anything. There are many, many stories in the book of individuals who serve as role models for how we overcome adversity. In the field of sports alone you will read about one of the world’s greatest rock climbers, the cleverness of Mohammed Ali in the Rumble in the Jungle, how Michael Phelps became one of the greatest swimmers of all time, and how Kerri Strug helped the USA women’s gymnastics team win the Olympic gold.

You’ll read about how we teach kids to dive and how your personal trainer purposely makes you feel awkward when you lift weights. But we’ll also talk about Sir Isaac Newton, and how clumsy I’ve been in my life, and how the first female to win a World Series of Poker bracket actually pulled off that championship. (She was also the youngest player to ever win.) I want time to fly by as you read this book. And when you’re done, I want you to go into action against your challenger.

Norm: What is the biggest thing that people THINK they know about your subject, that isn't so and what is the most important thing that people DON'T know about your subject, that they need to know?

Dr. Wilson: What’s not true? That the only way to quiet anxious worries is to take medications. That it takes months or years in therapy to “get better,” and that’s way too hard and expensive, so why bother. What is true? You can do this; you can get stronger. And if you read this book, you will actually know more about how to handle anxiety and worry that most therapists. In the most important thing you need to know: this knowledge means nothing unless you act on it. So go stick your neck out.

Norm: What are your plans for future projects?

Dr. Wilson: Actually, I’ve just completed my next project: to create a free, six-episode brief video series that teaches the basic principles from the book. I’m now working on an app that will help people set up practices to learn the skills from the book and to reinforce their efforts.

Norm: Where can our readers find out more about you and your work?

Dr. Wilson: If they go to  NOISE IN YOUR HEAD   they can download all of the tables and charts and figures from the book without even purchasing the book. That’s a great way to find out whether the book might interest you. On that same website they will find the free video series. When the app is finished (and hopefully it will be free), they’ll learn about downloading it there, as well.

Norm: As this interview draws to a close what one question would you have liked me to ask you? Please share your answer.

Dr. Wilson: I am a charter member of CHAOS Rowing Club. You didn’t ask me how good a rower I am. My answer: I’m the oldest and probably least skilled member of the entire team. And I am always intimidated when I get in that boat. But, boy, do I have fun!

Norm: Thanks once again and good luck with your future endeavors.