An Interview with Psychologist Kevin Chapman
Dr. Kevin Chapman is the Founder and Director of the Kentucky Center for Anxiety and Related Disorders (KY-CARDS), and specializes in the treatment of anxiety, panic disorder and social phobia using CBT.
Jennifer Ghahari: Hey, thanks for joining us today for this installment of The Seattle Psychiatrist Interview Series. I'm Dr. Jennifer Ghahari, research director at Seattle Anxiety Specialists. I'd like to welcome with us licensed clinical psychologist Kevin Chapman, who is certified by the Academy of Cognitive and Behavioral Therapies. Dr. Chapman is the founder and director of the Kentucky Center for Anxiety and Related Disorders, KY-CARDS. He specializes in treating anxiety, panic disorder, and social phobia, and has written a multitude of books, book chapters, and peer reviewed journal articles, including “Minority Inclusion in Randomized Clinic Trials with Panic Disorder” and “Clinical Behavioral Treatment of Social Anxiety among Ethnic Minority Patients.” Before we get started, can you please let our listeners know a little bit more about yourself and what made you interested in cognitive behavioral therapy?
Kevin Chapman: Thank you. I appreciate that. Well again, I’m Kevin Chapman, licensed psychologist. I'm originally from Louisville, Kentucky, and again, run the Kentucky Center for Anxiety and Related Disorders. And I've always been fascinated, honestly, with anxiety-related disorders and CBT in particular, because I was also a college athlete, and when I took my first psychology course, it kind of spilled into the abnormal psychology. And once I took that, I learned something in the literature that was pretty perplexing to me; it was “Wait a minute, more people have anxiety than anything else.” It's widespread, yet it's treatable.
So immediately I was like, “Oh, sign me up!” That's something that's not only challenging, but something where we can plug some holes. So as I matriculated throughout that process, I learned about the different modalities and types of therapy, and cognitive behavioral therapy not only was rational and logical, it just made a great deal of sense. And I think that the practical application of CBT that we know today is really attractive to me because it gives you the ability to not only be flexible, but also creative. So it was just a really fun approach, but also something where you actually saw what I call the “before- and after-shot” when you're working with clients who struggle with anxiety. So it just made a lot of sense.
Jennifer Ghahari: Great. We've had several clients reach out to us for help specifically for panic attacks. And can you explain what a panic attack actually is and what someone with this disorder might experience when they're having one?
Kevin Chapman: Yeah, sure. So I mean, I guess we define panic as a discrete experience, like a concrete experience of the fear response, essentially, where you have intense fear and discomfort. Ultimately what we've learned about panic over the years is that panic is what we call a false alarm. It's essentially a fear response out of context. And I think for many people, when they realize that a panic attack and fear are actually the exact same process, it's just that I'm having the fear response out of context, that in and of itself can be really helpful in helping a lot of clients manage.
So in many ways, when we see the experience of panic, it's very discrete. So ultimately, we have the fight or flight response, right? Our body's flooded with adrenaline and noradrenaline. And ultimately, it's preparing us for perceived danger. So we have heart palpitations, shortness of breath, lightheadedness, smothering sensations, sweating, tingling sensations in our body, and essentially it's fight or flight. And the good thing, as you know, is that if I'm in actual danger, that's super adaptive and helpful. It's that when people have those recurrent panic attacks when there is no threat, that's a problem.
I always tell people that it's like saying, “I'm pulling a fire alarm in a movie theater when there's no fire.” And ultimately, that's very scary for people who experience it. And then they start pairing that with situations. And all of a sudden we develop agoraphobia, so I start fearing places and situations in which those panic attacks occur. And now I have two problems. I have that panic cycle, but then I have situations in which the cycle occurs, and therefore I'm really distressed when I go out and about.
Jennifer Ghahari: Wow. And what will be the best and most effective treatment for something like that?
Kevin Chapman: Yeah, that's a great question. And we often talk about the most effective treatments in that regard, and the first line treatment, of course, is medication, and medication certainly seems very helpful in that regard. And it certainly helps a client dampen some of the depression symptoms that come about, also the anxiety that's associated with it. So it decreases that negative affect, if you will.
But the gold standard treatment is cognitive behavioral therapy. And that's something that I certainly implement with my clients. So CBT, and of course CBT is the gold standard where we're teaching clients to not only recognize that, psycho-educate them about what's the difference between anxiety and fear and panic, but also teaching them the importance of the role that their cognitions or thoughts about having panic attacks and the sensations themselves, and in some people, the situations in which they occur, teaching them that their thoughts influence the physiological arousal, the feelings in their body, and that leads to subsequent action, which in many cases, of course, is avoidance of things that trigger panic. So teaching them how to engage in cognitive restructuring and engage in exposure-based therapy is really the best way to treat panic.
Jennifer Ghahari: And anxiety, particularly social anxiety, is another disorder that clients often reach out to us about. What is social anxiety, and can you describe what someone feels when they're experiencing that?
Kevin Chapman: Yeah, doc, I think that when we think about social anxiety, I think that the seductive part about social anxiety is that social anxiety is a normal part of life, right? And when we talk to clients about social anxiety, we normalize it, because it's saying, when we think about being in a situation that's unfamiliar to us or that's uncomfortable, that involves people, certainly anxiety to a degree is super helpful. So on the one hand, we all experience anxiety, but social anxiety when it becomes a disorder, is essentially me having this persistent fear, not just occasional, but a persistent fear of social or performance situations where negative evaluation may occur.
You'll appreciate this, but I'll often tell the clients, so think about that. Any social situation you find yourself in, like for example, Chick-fil-A, the nicest people on earth, you technically could be made fun of in the drive-through. Now granted, that's unlikely, but ultimately, any situation that involves a person has the potential of negative evaluation. So therefore, I have this persistent fear of making a fool of myself, being negatively evaluated, humiliating myself.
And that tends to include things like initiating or maintaining conversations, group discussions, the number one fear in the United States: public speaking, meeting new people, speaking to a figure of authority. And that creates significant distress, I'm bothered by it, and also impairment in my day-to-day functioning. So that's what we talk about when we say the disorder or the diagnosis of social anxiety.
Jennifer Ghahari: Wow. You had an article on the KY-CARDS site, on your site, which discusses how wearing a face mask ironically may impact someone's social anxiety. And can you explain the correlation that some people are experiencing with that?
Kevin Chapman: Yeah. You know, it's interesting, because if we had our druthers as fellow scientists, of course, we would want to study that and see how that comes out empirically. But anecdotally what we find, I think, that one of two things can happen because of the pandemic with the COVID, of course, pandemic. And I think that what we find is number one, for people who have social anxiety, I've found quite a few clients, when they wear a mask, it's somewhat of a buffer to their social anxiety. In other words, they feel less anxious, because you can't really see my facial expressions, and therefore I have an illusion of control. So on the one hand, you can see it as a good protector.
However, from a cognitive-behavioral standpoint, we could call that a safety signal, too. And that could be problematic, because once you're able to resume normal, as we know normal life at this point, and interact with people socially, that kind of essentially prevents you from navigating those situations the way that we would want you to in treatment. In other words, that buffer is temporary. Just like having a bottle of Xanax in my pocket or having some essential oils or my safe person, or whatever it might be to make me feel better temporarily. So on the one hand, it can be a buffer. On the other hand, it can backfire and perpetuate vicious cycles of social anxiety, because after all, we communicate often non-verbally with our facial expressions, and that's what many people are very sensitive to, is “how I appear to other people.”
Jennifer Ghahari: Wow. Okay. It's a lot going on. Yeah, it's interesting that it's almost like a Band-Aid, but like you said, once that Band-Aid gets removed, the wound is essentially still there. Wow.
Speaking of COVID, the pandemic has led to an increase in anxiety for so many reasons, like health, financial, isolation, fear of the unknown, et cetera, et cetera. And you've come up with an acronym on your website to help people find ease during the crisis. Can you explain to our listeners what that is?
Kevin Chapman: Yeah. And I think, you know, doc, that I love CBT. So any time I do any sort of media, my whole purpose behind that is to disseminate the science and psychology to help people on a day-to-day basis. That's why I like media platforms. It's for dissemination. So with that being said, the acronym that I came up with is steeped in CBT, and people have really resonated with it, because it's very practical and easy to understand, and we call it FIGHT. And in this case, we talk about “Fight COVID.”
So FIGHT is an acronym. The F is focus on what I can control. So ultimately, I can't control what will happen in three hours or what happened two hours ago. But what I can control is what's happening in this present moment. So kind of borrowing from mindfulness-based literature, I can focus on this moment in time. I can regulate my emotions. I can regulate my breathing. I can see how this couch feels on my body, things like that. And focusing on what I can actually accomplish in the moment is critical to regulating emotions as it relates to things like COVID and such.
The I is identify negative thoughts, and identifying of thoughts ultimately is super important for regulation because thoughts, particularly catastrophic thoughts or negative prediction type thoughts, tend to fuel the fire, of course, to strong symptoms of anxiety. And that's something that when we identify the thoughts that are leading to the emotional experience itself, that gives us a knowledge base to be able to alter that to some degree.
G is my favorite, it really is. And that's generating alternative thoughts. That's the heart and soul of cognitive therapy, is coming up with not necessarily positive thoughts, because there's a lot of things happening right now in our society that's just simply not good. However, we can be flexible in how we think about situations. And that's what's key to emotional regulation, is that if I'm flexible in how I think about things, coming up with different alternatives, that can lead to different emotional experiences, which is so important.
Which leads to the H, which is highlighting adaptive behaviors. What can I do behaviorally to alter my emotional experience? What can I do to help my neighbor? What can I do that's something that's an action step that will alter my entire emotional experience? You know, as well as I do, like with depression, if I can engage in behavioral activation, just walk down the road, that in essence creates endorphins. And then even if I didn't feel like doing it, it makes many people feel better. So engaging in adaptive behaviors.
And then finally it's something that we really nerd-out about, and that's T, and that's teaching somebody else the same principle. So CBT is not a selfish treatment modality. It's something where it's like, if I learn how to do it, then I'm becoming my own therapist, and therefore, I can teach somebody else the same exact thing. So that's the FIGHT acronym, and it seems to be pretty practical.
Jennifer Ghahari: Awesome. Thank you. And so as a psychologist and a therapist specializing in CBT, do you have any other advice or recommendations for our listeners if they're suffering from panic attacks and/or social anxiety?
Kevin Chapman: Yeah. Well, number one, I would say for sure, “You're not alone.” And I think in many ways, many people we encounter who experience anxiety and related symptoms, because it feels so bad and they have such low distress tolerance, I think that they often feel isolated and like nobody can ever understand how I feel. And I just want to say to listeners that, number one, it's normal to experience anxiety. Many people who don't have disorders experience panic attacks. The bottom line are these are all things that we experience on a semi-regular basis, especially social anxiety. So number one, normalizing your experience.
Number two, you can be helped. And I think that is so encouraging, because CBT is the gold standard for a reason. If you're motivated, there are people, capable therapists out there, who have the expertise to be able to help you navigate these situations. And I love this. This is one of my quotes. I call it the emotional law of gravity. Always remember that what goes up must come down, and that's true for emotions, too. So in many ways, when we think about experiencing distress, know that though it's uncomfortable, it's not threatening, and this too shall pass.
Jennifer Ghahari: That's wonderful. Thank you so much. I really appreciate it. And thank you for being part of this installment of The Seattle Psychiatrist. Again, a lot of our clients reach out for help on these topics, so we appreciate your expertise in helping out.
Kevin Chapman: Well, thank you. It's a pleasure. Thank you.
Jennifer Ghahari: Thank you.
For more information, click here to access our article in “The Seattle Psychiatrist” Magazine: The Impact of Nervous System Attunement on Social Anxiety.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.