My Interview with Dr Zacchia

image_zacchiaDr Zacchia is a clinical psychologist specializing in the treatment of anxiety disorders, depression and interpersonal problems. I saw a few of his lectures on TV and his humor and the simplicity of his approach captivated me. Most of my clients, if not all, deal with fear in one form or another. In fact, I think we all do to various degrees. Anxiety disorders are the most common mental illness in the United States, affecting 18% of the population, according to the Anxiety and Depression Association of America. In my opinion, courage can only truly exist when fear is present. Overcoming a fear gives a great sense of accomplishment, because it IS one! So I went to DrZ, a specialist on the topic, for some tips on the subject.

Caroline C Stolzy -Dr Zacchia, what would you say is the best way to face our fears? 

Dr Camillo Zacchia -The key is to do something that results in an experience of success. The best way to do this is to face fears gradually. Whatever the challenge, the person can always find something that is a manageable step toward their goal (I suggest something that is challenging but doable). Ideally the person should repeat things a few times. The important principle is to stay in the situation long enough for the anxiety to begin to dissipate before leaving. If the person leaves while anxiety is rising, or at its peak, he or she will tend to be even more afraid the next time. 

CCS -What is behind fear?

DrZ -It is a natural survival instinct (fight or flight) that all animals have. This instinct is stronger in some people (our temperaments are not all equal from person to person). Then, we are raised in an environment where we learn what is dangerous and what is not (social learning and learning from family and culture). Finally, we experience situations and events. How we interpret and manage these events will influence how we will handle them in the future. Life stress is a factor that worsens anxiety. It can even trigger a first panic attack, but it is not normally the real cause. The true cause can be found in how the body responds to a stressor (the anxiety) and how that response is interpreted. These reactions and interpretations do not have a single source. Human beings are far more complex. We are the result of our biological make-up and of everything we experience in our lives. Certain fears are innate and made sense at some time in our development.  Many fears ensured our survival and became instincts. Our temperament plays a big role. The common personality trait in individuals who are prone to anxiety disorders is the way they think in absolute terms. They don’t easily let go.

CCS -I heard a lecture of yours in which you observe that depression has to imply a pessimistic outlook, or result in it. Would you then say that optimism, even as a kind of exercise, is a legitimate «self-treatment» for depression? Is there some possible therapy in this direction, through changing our thoughts, beliefs and perceptions? 

DrZ -When we are sad, we will have a negative view of ourselves, the world around us, and the future (Beck calls this the Cognitive Triad of depression). As a result, cognitive therapy tends to be very effective for depression because it addresses the distorted perceptions that come with it. If we learn to think critically, we won’t necessarily be optimistic, but when we see things from a more rational (realistic) perspective, we feel better. Life may not be perfect but it ain’t so bad either. The best path to more positive thinking is through a critical examination of our thoughts. Critical thought helps us see things from a broader perspective. For negative thinkers, this results in more positive thought. Critical thinking involves the ability to examine facts from an unbiased perspective. This means having to question your perceptions of events and to recognize your biases in order to be able to see things as they truly are, rather than as you may currently perceive them. This type of change will be believed at a much more profound and longer-lasting level than any unconvincing attempt at positive thinking. Depressed people, or those who tend to think poorly of themselves, are always finding proof for their beliefs. The goal is to try to identify these schemas (a strongly held belief, or what is often called a “core” belief)  and to help the person see how they lead to a distortion of facts and events. It is these distortions that feed the negative thinking patterns.

CCS -How can we discern between legitimate fears that exist for our survival and the ones based in imagination that lead to anxiety?

shaun_walton_photography_male_lion_stareDrZ -If I am in a forest with a group of people and we run into a lion, chances are, we will all run away. (We should listen to fear when it is natural). But if I am afraid of an elevator and I am standing in front of one with a group of people, chances are they will all get in when it arrives even though I want to take the stairs. In other words, when a fear is real, we all sense it and act accordingly. When a fear is mostly in our own minds, the fact that other people are not running away or avoiding them is an indication that perhaps there isn’t any real danger. The only way to rebalance our fear mechanism is to distinguish between things we know are truly dangerous – which we should avoid – and things that are merely uncomfortable – which we need to face. Avoiding a real danger – like a lion – protects you. Avoiding an imagined danger – like an elevator – costs you. The more we avoid a danger, real or not, the bigger and bigger it will feel. This is why phobias tend to get worse over time. The only way to reverse the trend is to treat imagined dangers differently from real ones. We should never face death needlessly. Discomfort, on the other hand, is not death and we do need to face it.

CCS -One of the tools to handle stress, as you mention in a recent post, is self-confidence. Talk about this more. How does one build self-confidence? 

DrZ -People with low self-esteem do not believe they are worth very much. In their minds, their beliefs reflect the reality. This has the effect of influencing how they see things. Weaknesses get magnified, strengths become minimized, and events get distorted in such a way as to confirm their beliefs. The same principles work in the opposite direction for people who are overly confident in themselves. In therapy, The goal is not to deny weaknesses nor to fool them with exaggerated flattery, but rather to help them see the reality of who they are as others see them. This will hopefully result in a more accurate and fairer self-perception, one which acknowledges and normalizes imperfection, and which sees strengths for what they are. When we believe something, it becomes our truth. When it comes to judging ourselves, we think our level of confidence in an area is directly related to our actual level of competence. But do confidence and competence really go together? In truth, they are unrelated. It’s not that we are never accurate in our own self-assessments. It’s just that they are influenced by personal biases. Confident people will, by virtue of that confidence, believe they are good. They may sometimes be right, but they may also just be full of themselves.

The same goes for people who lack confidence. While at times they may feel this way because they don’t have the same level of abilities as others, there are many times when it is just a reflection of poor self-esteem rather than poor skills.


 zacchiac-mainFor more information about DrZacchia, visit his website.

You can read his blog here.

Watch one of his lectures (in English).


*Photo Credit (lion): Shaun Walton


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