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medical examiner: Health and medicine explained.

The Doctor Is in Your PCI was irritable, gloomy, and couldn't afford a therapist. So, I tried FearFighter™ instead.

By Daniel B. Smith
Posted Tuesday, April 29, 2008, at 12:33 PM ET

(Continued from page 1)

The first thing I noticed about the program—I suppose it's the first thing I would have noticed about a human therapist as well—was not the treatment's content but its style. FearFighter has the look and feel of one of the computer games my brothers and I used to play as children on our clunky, premodern Commodore 64: the flat interface; the sketchy, clip-art graphics, the if-this-then-that logic.

FearFighter is divided into nine steps, from "Welcome" to "Troubleshooting." My first task was to fill out a series of questionnaires in order to establish a diagnosis and to provide a base-line reading of my emotional state, with which the results of later questionnaires could be compared and progress measured. (Questionnaires are standard in CBT, which prides itself on its empirical cast.) As I've already suggested, my problem is what Freud called "free-floating" anxiety—its particular torture is that it has no object. The program, however, was unable to detect this. It asked specific questions, I gave specific answers, and it drew specific, and incorrect, conclusions. When asked how much I avoid "injections or minor surgery," I answered that I "definitely avoid it." When asked how much I avoided "being watched or stared at," I answered that I "markedly avoid it." The result of these and other exchanges was that I was diagnosed with agoraphobia, blood/medical phobia, and depression. But not generalized anxiety disorder, the best clinical description of my state of mind.

Once, I had a therapist who fell dead asleep in session. These misdiagnoses corrupted my confidence more than that considerable indignity. On the other hand, the kink was understandable. FearFighter applies a subset of CBT known as exposure therapy; it identifies specific "triggers" of anxiety and encourages patients to face those triggers squarely. For Bill, the presumably fictional elevator phobic used as an example in Step 2 ("How to beat fear"), this is sensible; if Bill rides the elevator a bit at a time, he'll probably recover. But how does one expose oneself to fears about the loss of one's youth, to intimations of imminent catastrophe, to abject terror that one's firstborn will suddenly stop breathing? Actually, there are ways, but they are linguistic and cognitive—in short, outside of the purview of a computer program, at least so far.

Yet, as I knew well, in recovery persistence itself can be salubrious, and I resolved to take from my computer treatment what I could. Over the next few weeks, I marched steadily through Step 3 ("Problem sorting"), in which I perused a list of potential triggers that ranged from "driving/traffic jams" to "vomiting" to "sex"; Step 4 ("How to get a helper"), which urged me to find a supportive partner who would not rush me, mock me, or encourage me to drink; and Step 5 ("Setting goals"), in which I was instructed to devise therapeutic actions that were neither too easy nor too hard, and in which I heard the poignant tale of my namesake, Daniel, who, when anxious for more than 90 minutes, evacuates his bladder. Step 6 ("Managing anxiety"), which suggested approaches for reducing anxiety in real time, was from my perspective measurably more useful. It offered some thin methods, such as reciting the ditty "I feel so embarrassed/ I'm dying of shame/ But it's only a feeling/ And those I can tame!" But it also suggested methods I knew from experience to be rather helpful. For instance, "diaphragmatic breathing," a system of respiration that reduces anxiety by restoring the balance of oxygen and carbon dioxide in the blood, and forcing oneself to imagine the worst possible thing that can occur until the fear grows small.

Following Step 6, I admit that my attention waned, though only for a lack of applicable treatment. Step 7 ("Rehearsing goals") was intended to help me practice coping skills by projecting photographs of things many anxious people fear and avoid but which I don't. (A picture of the exterior of a British council flat, which would send any housebound agoraphobic into a freefall, filled me with little but warmth: I adore London.) Step 8, aptly titled "Carrying on," was essentially the end of the line. I was urged by the program to visit regularly—to inspect graphs tracking the (hopefully southward) route of my pathology; to add, delete, or revise the focus of my treatment as the need arose; to consult the extensive list of troubleshooting topics in Step 9; and, above all, to continue practicing and practicing until equilibrium was established.

I didn't. It wasn't just that the program was not well-suited to my particular brand of insanity, but that eventually the circumstances that had gotten me into my quavering state dissipated. Slowly, my daughter began sleeping better, the freelance sluices opened back up, and a decent rhythm asserted itself into my young family's life. Before long the anxiety had, if not disappeared—it will probably never do that—tamped down to a level that seemed appropriate in light of the risks of existence. I felt better, and not long after I'd completed my treatment, I expunged the FearFighter Web site from my bookmarks menu and said a quiet prayer that England should feel as well as me.