Like most of you, I enjoy the comforts of living in the modern age. Cutting edge technology has provided me with Global Positioning Satellite (GPS) navigation in my car, a BlackBerry in my pocket to communicate with others around the globe, and medical advances that saved my left hand when I fell off a trampoline many moons ago as a teenager. However, it is also abundantly apparent that there are a number of drawbacks to life in this era. One, which I help others to deal with every day, is anxiety.
According to the National Institute of Mental Health, almost a full fifth of Americans (over 60 million people!) experience a full-blown anxiety disorder in every given year. Over the lifespan, the numbers jump to nearly 50%. If you do the math, the economic costs of anxiety so high that they likely constitute the single greatest tax facing the West today. Including the direct cost of treatment, time off from work, increased use of medical care, and the contribution of anxiety to medical conditions (e.g., heart disease, hypertension, asthma), anxiety disorders come with a $100 Billion/year price tag in the U.S. alone. And that doesn’t include anxiety-driven selling of stocks during an economic downturn.
Before you have a panic attack, there is good news:There is a simple, effective, non-pharmaceutical, evidence-based treatment that can have a rapid impact on anxiety symptoms. In fact, there’s even better news: This treatment is informed by the Torah. As our sages taught us, God always brings the cure before the malady.
What is this treatment, you ask? It’s called Cognitive Behavioral Therapy, or “CBT” for short. Here’s the Cliff Notes version of how it works.
CBT is based on the fundamental premise that human beings can change their emotions by changing their thoughts and behaviors. By recognizing how thinking contributes to feelings, patients learn that anxiety doesn’t “just happen”. Anxiety, like any other emotion, is the product of thought patterns that we can choose to change if we wish – we just need to take the time and make the efforts to do so. Similarly, by learning the role that behavior plays in maintaining and exacerbating anxiety, one can embark on a tangible road to a calmer and more peaceful existence.
This simple framework bears a striking resemblance to a Torah approach to education, articulated most explicitly in Rabbi ShlomoWolbe’s preeminent text on Jewish pedagogy: “Planting & Building in Education”. As Rabbi Wolbe describes, ALL education involves only two processes: (1) cognitive change involving learning new perspectives and values and adopting new outlooks, and (2) behavioral change involving learning new ways to act day-to-day. Truth, be told, Rabbi Wolbe adds one other critical component that is currently absent from CBT: Prayer. Evidently education is a spiritual process that requires Divine assistance. Nevertheless, the straightforward framework of CBT bears enough similarity to a Torah-informed approach to education that it’s worth a closer look. And there’s nothing stopping individual practitioners from including prayer in the context of CBT, when desired by patients.
The scientific research on CBT is truly impressive. At this point the field has moved well beyond case reports (stories about individual cases) and open clinical trials with no control group. Several multi-site, randomized controlled trials have found that CBT is as effective if not better than Selective Serotonin Reuptake Inhibitors (SSRIs) or other medications in the treatment of anxiety and related conditions. Further, some recent evidence using structural and functional magnetic resonance imaging (fMRI) has found tangible changes in brain functioning following CBT with no medication. The message: Human beings have the capacity to change our emotions if we’re willing to invest the time and energy to change how we think and how we behave.
So why aren’t these treatments more widely practiced? I think there are a few contributing. We can thank Sigmund Freud and his colleagues for widely inculcating the perspective that emotions are primarily a function of parental upbringing. We can also thank the pharmaceutical industry for advertising en masse that emotionsare ‘caused’ by neurobiology. Perhaps the greatest reticence to use CBT however comes from a failure to have faith in God. If we truly believed that God is running the show, it would not be so foreign a concept that we can change our emotions through simple means. Further, if we were to recognize the incredible potential that is inherent within a human being – if we truly believed that we have a Soul, which emanates directly from God – perhaps we would be more open to the notion that we have the capacity to rise up from our destitute state by making a few small but bold changes.
Fortunately, CBT is becoming more widely available in healthcare settings and myriads have already benefited from this Torah-informed evidence-based approach. However, the situation is becoming so dire that this radical shift in our approach to mental health needs dissemination and promulgation en masse. It is my hope and prayer to see this trend continue, and that it will help to alleviate much unnecessary suffering in our modern world.
David H. Rosmarin, Ph.D., is an Instructor in the Department of Psychiatry at Harvard Medical School. He is also Director of the Center for Anxiety in NYC, a clinical-research facility dedicated to furthering evidence-based treatments for anxiety symptoms with a focus in the Jewish community. He can be reached at [email protected].