I am currently reading a book by Caroline Knapp “Drinking: A Love Story,” in which she details her struggles with alcoholism and the story of her recovery. I highly recommend the book! So many people are living with chronic addictive illnesses either in the active stages or in recovery from it. As a therapist I find myself discussing addictions of different stripes with my clients almost daily. I have read more books about the topic than I can count and am always seeking out more information and training on the matter. A recurring theme related to addiction is the description of people using a substance (or sometimes a behavior such as gambling or binge eating) to cope with a feeling. Addictive illness is an intensely complicated topic, so the accounts of the feelings and situations that drive people to drink or use are individual and diverse. A simplified view would not do the issue justice. Something Knapp describes in her book, however, resonated with me beyond her individual story and it seemed she touched on a more universal experience. During the stages of her early sobriety she finds herself at a family gathering feeling highly uncomfortable due to the emotions the encounters create in her and she struggles with the intense desire to drink. She then comes to the realization that she is “phobic to feelings.”
Phobias in the clinical sense are always linked to anxiety and avoidance. People who suffer from phobias avoid anxiety provoking situations or things. While the situation, such as public speaking, or the thing, such as a snake, may carry some potential for anxiety for most people, folks with phobias experience anxiety at such a high level –often already when they just think about the matter—that they believe they cannot bear exposure to the situation. For people suffering from panic attacks with agoraphobia, the experience of anxiety itself becomes the object of the phobia. In this case people avoid leaving the house out of fear of having a panic attack when they do so. While this may be the most obvious phobia of a feeling, in my experience the avoidance of anxiety rather than the avoidance of the object of the phobia is truly the driving force of most phobias. When we work in therapy to support people in overcoming phobias, we generally address the anxiety as the problem and not the object of the phobia, also because the object, e.g. flying in an airplane or crossing a bridge, cannot always be avoided. We prepare a client to learn ways to manage intense feelings of anxiety and then work on exposures to the anxiety provoking object. During the exposures clients will still experience intense anxiety but ideally they can now evaluate and to a degree even control it, and, most of all, they will consciously feel the anxiety build and subside. They learn with their whole being that anxiety will not kill them and will eventually go away.
So when Knapp realizes that she used alcohol in order to cope with her own “phobia of feelings” there are two levels of feeling experiences she was trying to avoid. One is the emotion she is phobic to, perhaps sadness or anger, the other is the anxiety over potentially fully experiencing this feeling. Sounds complicated? Well, it is. We humans are complex creatures. Throw a substance such as alcohol with its physiological as well as psychological impact into the mix and it can be really difficult to figure out what our own experiences of self and others are comprised of. That is why I applaud Knapp (who sadly since has passed away from lung cancer) for undergoing the tedious and scary task of investigating and describing her own story of addiction.
Coming back to the “feeling phobia” and comparing it to other experiences characterized by anxiety and avoidance, it could then make sense to address some of the underlying psychological processes of addiction like those of an anxiety disorder. This would include relaxation and mindfulness training as well as exposure and response prevention. The exposure in this case would be to consciously identify and allow strong emotions and the accompanying anxiety. This would require we learn to distinguish these emotional levels from each other. Using Knapp’s family gathering as an example, she was quite outraged that nobody acknowledged that she had recently lost both parents. It would make sense that she was sad, disappointed and probably angry. Having been raised in an environment, however, where openly showing feelings was unacceptable, just sensing these emotions creeping up made her anxious. Before she entered recovery she would have used alcohol to “take the edge off the anxiety.” Anxiety with its strong physical component of unrest and existential fear and dread is extremely uncomfortable, as most of us know, but it is originally a survival mechanism. Sadness, in its extreme expression, is something that we might fear could kill our life spark. In an environment where we have been primed to see the expression of strong emotions as unacceptable it would be logical to fear intense sadness also for its social stigma. As living feeling beings, however, we cannot truly avoid sadness and trying to do so will bring on anxiety. And in comes the attraction of alcohol with its promise of reducing anxiety.
Exposure and response prevention for “feeling phobia” would therefore include allowing original feelings to come through, evaluating what the feelings actually are and what creates them while consciously observing the rise and fall of the accompanying anxiety in order to alleviate the need to drink or use as a response. Embracing our whole story, allowing it to be remembered, allowing ourselves to feel deeply and with our whole being and learning that our feelings will neither harm us nor be unbearable would be a beautiful outcome of such an enterprise.
Cognitive Behavioral Therapy for addictions works within these parameters and is an evidence based psychotherapy treatment for addictive illnesses. As Caroline Knapp describes so well in her book, recovery from addiction is a lifelong and courageous process and it requires looking at the whole person and the full story of her life to maintain and thrive through it.