Giorgio Nardone, the enchanter of phobias

“Lfear looked in the face becomes courage, fear avoided becomes fear, panic.” Whether it was the Sumerians, from the 4th to the 2nd millennium before Christ, who formulated this thought, or the Sufi mystics, the most spiritual current of Islam, condenses a truth that has always been known. And it has always been ignored. Today the mechanism, six thousand years after the Sumerians, still works perfectly. The latest data in this regard are “old” – a European research in which he also participated Italy dates back to 2005/06 and reports 5 – 7 percent of people living with a phobia – but it is enough to have gone through the Covid season to perceive its widespread diffusion. Giorgio Nardone, psychologist and psychotherapist recently in the bookstore with The book of phobias. And their care (Ponte alle Grazie) has treated quite a few of these patients, more or less 25 thousand.

Fears and phobias

Above all, in the thirty years of activity of his Strategic Therapy Center in Arezzo, founded with Paul Watzlawick, he has identified various protocols to free phobics from their traps. With an approach that is as scientifically rigorous and replicable as it is fascinating, which reminds us that care is first and foremost a relationship.

We all have fear. But what makes you phobic?
Fear is the most important emotion, in fact, it saves our lives, it encourages us to face what happens with greater awareness, therefore it is a fundamental adaptive endowment. The phobia is structured when the fear reaches such an intensity that in order not to be overwhelmed by it – what happens when you experience a panic attack – you try to control it with three specific methods: avoid situations or people that send you into crisis; ask for someone’s help to overcome the situations that paralyze us; try to bring the overwhelmed mind back under the dominion of reason. It is enough to implement these three scripts for a few months to become phobic.

Are there people or situations more “prone” to phobia?
Pathological fear is democratic, it unfolds equally between rich and poor, between Nobel prize winners and the ignorant. People who have been courageous suddenly become fearful. There are very shared phobias, such as that of flying or diseases, and others that are truly unique, such as that of corners or uncorked bottles. But being creative is not a “risk factor”.

Taking precautions fuels phobias

Has Covid affected the spread of the problem?
Covid has made a paradox possible: at the beginning the phobic obsession with sanitation became the rule shared by everyone, to the great relief of those who had suffered from that pathology for some time. Then, sanitization phobia became rampant, because taking precautions is the worst choice when faced with a fear, it incites it more and more. Above all, Covid has brought out new phobias, such as that of not being connected, which arises from having experienced only virtual communication for a certain time. The suspension of reality was the main detonator of the disorders born in lockdown, such as those relating to sociality and school, suffered by children. In fact, if you don’t face what you fear, fear can only increase.

Can you live with fears?
There are small phobias that you can come to terms with. For example, taking the elevator: I can do without it, within certain terms and certain contexts. If I lived in New York maybe it would become a disabling problem. Or another classic: airplane phobia. We are not meant to be in a little tin box that sails across the skies. I can decide to live without taking a plane. On the contrary, even a limited fear, let’s say that of spiders, when it transforms into a phobic delirium forces a completely altered reading of reality, which compromises existence. Speaking of the fear of spiders, in the book I report this case, which is among the most serious I have treated, a patient who was reduced to living in the shower at home. He only went out to eat quickly and always held the shower in his hand to spray water on any spider nearby. So even on the basis of an absurd phobia a total invalidation can be created.

Imagining the worst counteracts phobias

The most fascinating part of his book is that of the therapies devised to overcome phobias…
I have now been working on these problems for 40 years, our center in Arezzo has 20 branches around the world that replicate our protocols. Basically, one escapes from the phobic “psychotrap” by interrupting the neuronal response circuits that have been built by the three dysfunctional solutions to the problem – avoidance, request for help, rational control of fear. Over time we have developed three techniques, scientifically validated and replicable. The most used is that of the worst fantasy, with which the patient is taught to imagine the threatening situation in every possible catastrophic detail. Due to a paradoxical effect, this work causes fear to collapse on itself. We operate, of course, after having put the person in a safe situation, so to speak. Gradually the person trains to evoke this context on their own and to face what scares, until the phobia is disarmed. This is the most usual therapy for obsessive compulsive disorders. However, when faced with particular phobias, in addition to this technique and the maneuvers that serve to block avoidance and requests for help, specific, even very creative, stratagems are developed.

Let’s take the example of cardiophobia, a pathology linked to existence of instruments capable of measuring impulses and controlling the heart. A fear that arises from the illusion of thus avoiding a heart attack. The stratagem, which has become a validated treatment protocol, consists in having the patient perform a sort of empirical Holter: he is asked to take note of the pulse rate, the two weeks separating the next session. This generates a corrective emotional experience whereby the commitment to listening to the heart and measuring it functions as a regulator of the heartbeat. The commitment to recording the heartbeats continues at increasingly diluted intervals, until after two/three months of this work the phobic perception of the heart rhythm decays.

The tightrope walker therapist

His words depict a therapist who is also an artist
I have supported it for many years and I am not the only one to say it: psychotherapy is a synthesis between science and art. We need rigor in applying the techniques suitable for healing a certain disorder, techniques that have been approved after their validity has been ascertained, we must be artists when the situation requires us to invent something new. I believe this is the difference between an excellent psychotherapist and a psychotherapist who only treats standard cases: the former constantly “dance” between science and art. Communication style also counts in therapy: the psychotherapist must make the patient “feel” rather than understand the prescriptions, so as to set in motion certain reactions and behaviors in him.

It will take a lot of training…
The strategic therapy that I practice and teach is based on a logic of problem solving and does not look for hypothetical causes or explanations. It applies to disorders that have a disabling effect, what makes the difference is knowing how to adapt it to the context and to the person’s relational style. A lot of practice is therefore needed under the supervision of an expert person: those who follow this path, to obtain the diploma of strategic psychotherapist, attend four years of school, during which they work on around a hundred cases with colleagues, supervised by me. It is a short form of psychotherapy, but for this very reason it requires long training, because one must learn to handle suggestive hypnotic language, a form of influence that serves to make the therapy work. It must be done with rigor, and you must be very expert.

There is no room for drugs in his therapies
The phobia does not respond to drugs because these can inhibit anxiety but do not affect the perception of fear in the slightest. Once suspended, you’re back to square one.

Can relapses occur after freeing oneself from phobias?
If the intervention is radical, that is, if the mechanisms are dismantled as described and the patient gains confidence in his own resources, putting them to the test, the phobia does not return. It can happen, and not infrequently, however, that someone confuses the release from the phobia with total recovery. And at that point stop the therapy. But behind a phobia that has persisted for years there are brain neurosynaptic circuits that must be inhibited if one wants to overcome it. And this means that alternative ones take over, shaped by the experience of repeated successes in tackling their problem. A follow up process of a few months is needed.

So how important is the patient in the success of the therapy?
A phobia is a distorted individual perception of reality and therefore it is the person who suffers from it who must solve the problem. We can suggest the strategy, but it is the patient’s responsibility to put it into practice: and this accounts for 50 percent of the success of the therapy.

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