Overcoming Public Speaking Anxiety: Q&A with Dr. Robert Reiner

A phobia is an irrational fear of an object or experience which triggers an anxiety strong enough to interfere with quality of life and daily activities. In this interview, Dr. Robert Reiner, Executive Director and founder of Behavioral Associates, shares how he treats public speaking phobias with Virtual Reality Therapy (VRT) and biofeedback.

How common is public speaking phobia?

Of all phobias, public speaking is considered the most common, accounting for about 20% of existing phobias. People suffering from public speaking anxiety are often too embarrassed to admit they have a problem and may never seek help. It’s not uncommon for them to have spent their life hiding their fear from family, friends and co-workers which can be extremely isolating.

What makes a person finally confront their fear after years of avoidance?

Often, the person reaches a point in which concealing their phobia becomes a bigger problem than the underlying issue. They may have recently embarked on a new career, furthered their education or reached a point in which the stress of avoidance was unbearable. I had a patient come to me when she found herself in a situation in which refusing to confront her fear was going to result in letting down a family member. The event was her daughter’s wedding, and the bride felt the celebration wouldn’t be complete without a toast from her mother. After about 16 treatment sessions and a lot of practice, she got up in front of 120 guests. To her daughter’s delight and her own relief, the toast was a big hit.

Can you explain how this therapy works?

Cognitive Behavioral Therapy (CBT) has always been combined with a form of exposure therapy in treating phobias. In the past, exposure was accomplished by either putting the person in the actual situation or through imagery. While putting the patient in the situation was impractical, it was even more unreasonable to expect a patient to conjure realistic imagery of something they had spent their entire life trying to avoid. Virtual reality is a perfect way to expose the patient to the feared object or situation within the safety of the doctor’s office. Combining VRT with biofeedback makes it possible for the patient to learn to control the physiological responses that result in anxiety.

In addition to practicing speeches in front of a virtual audience, how does biofeedback help with public speaking phobia?

Heart rate variability biofeedback teaches the patient breathing patterns that dramatically reduce anxiety. Breathing air into the lungs produces an increase in heart rate, while breathing air out of the lungs results in a decrease in heart rate. Diaphragmatic breathing at a rate of approximately 5-7 breaths per minute causes the largest variability in heart rate in approximately 95% of people.

The breathing rate that produces the biggest drop in heart rate is known as the person’s “sweet spot” and results in a state of total relaxation, incompatible with feelings of anxiety. Once the patient’s “sweet spot” is established, the patient practices the optimal breathing rate for a suggested 20 minutes per day. Although a timer can be used, I have found making patients a recording using the sound of a harmonica for timing breaths in and breaths out to be very helpful.

How often does the patient need to practice breathing along with the Virtual Reality Program?

Generally, sessions will be weekly for 45 minutes to an hour with treatment lasting 12-16 weeks. More recently, and specifically for cases in which time is of consequence, we have been suggesting 6-8 double sessions over about 2 months which has proven to be extremely effective. VRT combined with biofeedback has a success rate exceeding 90%.

Are the results lasting or will the phobia return without continuous treatment?

From the day treatment ends, it’s crucial to get up and practice speaking publicly. The patient needs to confront their fear on a regular basis to avoid falling back into a pattern of protective behavior. This can be accomplished through exercises like making toasts among groups of friends or asking questions at meetings. Once the phobia is resolved through VRT and biofeedback training, practice will yield the greatest long term results.

Is this treatment effective in treating other phobias?

We have had success in treating all sorts of phobias with VRT and biofeedback. For example, Fear of flying is another extremely common phobia that was difficult to treat in the past. Virtual reality now makes it possible for a patient to experience a flight without ever leaving the ground.

If you are looking to overcome a phobia, Dr. Reiner and his staff at Behavioral Associates have been successfully treating phobic patients with VRT and biofeedback for more than 15 years. If you currently struggle with a fear of public speaking, you’re not alone. Contact us or call our office at (212) 860 8500 to schedule your initial consultation with Dr. Robert Reiner.

Jennifer Pollack, Senior Editor has been writing for Behavioral Associates for more than 10 years.

December 14, 2016

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