Barlow’s method for treating anxiety disorders is surprisingly simple, although its philosophical and clinical implications are anything but. He aims to reduce anxiety not by teaching customary relaxation techniques involving calming mantras or soothing imagery, but by doing just the opposite: forcing the patient to repeatedly face his most dreaded situation, so that, eventually, he becomes accustomed to the sensation of terror. Barlow claims he can rid some people of their symptoms in as little as five to eight days. His treatment promises to be psychotherapy’s ultimate fast track, but while many clinicians praise its well-documented results, others take a dimmer view of what one clinician calls ”torture, plain and simple.”
The economic rationale for this, is, of course, straightforward. Make some form of thought, feeling or behavior more costly, and people will do less of it.
And does it work?
…his success in ameliorating anxiety is by his reckoning as high as 85 percent. David Tolin, the director of the Anxiety Disorders Center at the Institute of Living in Hartford, says: ”Barlow’s program is an ideal toward which other clinicians should strive. It is the most rigorously tested and documented treatment for anxiety. Most practitioners don’t teach his approach because the field of psychology is relatively slow to adapt to evidence-based treatment.” Reid Wilson, a professor of psychiatry at the University of North Carolina School of Medicine and an ardent Barlow supporter, adds that Barlow’s work hasn’t completely caught on because, as he puts it: ”We’re still on the uphill climb. We haven’t had the manpower to train enough people. Only a very small number of clinicians know about this. They don’t understand that relaxation training could actually slow treatment instead of speed it up.”
I don’t have the clinical or medical expertise to evaluate this, but surely it deserves a closer look. The economist, however, should not spring to any quick conclusions. Yes, the “substitution effect” favors a cure, but in the meantime the “income” or “portfolio” effect may drive the individual to very low and possibly counterproductive levels of despair.
By the way, our colleague Bryan Caplan offers this extreme, economistic perspective on mental illness. I think Bryan’s view is crazy; he probably thinks you would be crazy not to read such a short, entertaining polemic.