Twenty Questions with Michael Smith

The following includes excerpts from an interview completed October 8th, 1997 in Toledo, Ohio. The interviewer was Lucinda Bassett, President of Midwest Center for Stress and Anxiety. Michael Smith is a Mental Health Counselor with the #1 rated HMO in the country.

Q: Tell me again what you do, about your company and the ratings you've received.

A: My name is Michael Smith. I'm a mental health counselor at Group Health Cooperative, which is an HMO in Madison, Wisconsin. We just received a top rating, number one, by the National Committee of Quality Assurance. The rating 

 different healthcare companies, HMO's (etc...) surveyed, we were #1 in patient satisfaction.

Q: How did you first hear about the ATTACKING ANXIETY Program?

A: I've worked for Group Health Cooperative for 10-years, I've worked with many different people with different concerns. About four or five years ago, I was working with two gentlemen at the same time, both of whom had probably the most severe cases of anxiety I had ever seen. Both were relatively agoraphobic, they were really avoiding large areas of their lives. One of the men, for instance, was a kind of a typical Wisconsin man who loved to hunt and fish. He couldn't do either anymore because when he would go out into the woods or to the stream, he would start to have chest pains and become convinced he was going to have a heart attack out there. He would call 911, go to the emergency room, and this happened many times. I had been seeing him for a number of sessions. We had worked on relaxation, on what he was thinking about (etc...) but I just wasn't making much progress. Then, he came in one day and said, "I've heard about this program, what do you think about it?" I told him that I'd never heard of it and didn't know anything about it, but thought he might as well try it, so he went ahead and sent for the tapes. I would say about 4 or 5 weeks later he came back to see me and I said to him, "You look different to me, you seem different." He said, "Well I'm in the fourth week of this program and I'm really making progress!" We began talking about the program and he was at a point where he was using a little notebook, tracking his thoughts, thinking more positive. He clearly was different and I wanted to know more about this program. So, that's how I first heard about it.

Q: How did you get started working with it?

A: Well I started talking to my organization. I said, "I think this program treats the issues and the illness better than I do." And as I talked with this man each time he came in, he would tell me what he was working on, what the various tapes were about (etc...) He showed me some of the materials he'd gotten from your company and I thought, ATTACKING ANXIETY is really thorough. It covers all the things that I know about, but I usually don't get them conduced and delivered in an efficient way. So as I heard more about it, I started talking to my HMO and my boss about using this program. We started using it in May (97) of this year with a series of clients using the tapes and a support group as well. We started with about ten people, we're now up to nearly forty people. We've done two sets of groups and the groups have done absolutely fantastic. One of the things that's most interesting to me is the attendance. People come all the time, they want to be at the group and to share the news about what they're learning. The facility of the manual, the video and the audio tapes is so compact. It's so thorough that we all just kind of float along through these various stages and everybody gets better.

Q: Do people enjoy the tapes?

A: I think they do. I think initially they get more anxious as they start doing things that they haven't been doing for so long. Even just beginning to relax creates a sense of new anxiety, and it's always the first couple weeks. So we talk about that. They quickly - within 2 or 3 weeks - start to find that your voice and the messages on the relaxation tape become 'permission giving' for them. They actually start to give themselves permission to do less, go slower and relax. So they're enjoying it. They're coming in, they're excited to share their news. The problem is, I don't have enough time in an hour to go around ten people and hear everybody's story. They all want to talk now. They have a lot to say.

Q: Has this made your job easier?

A: Well it's made my job easier and harder. Now, I have more people who want to use the tapes. But it's made my job easier because I have a program I can offer that I'm convinced is going to help them.

Q: Do you feel that now when they leave you they have a resource. You don't have to be with them every minute now that everything you're teaching them goes home with them. Tell me about that.

A: Well it's like an encyclopedia that they're really buying, a reference book. In this circumstance, it's a reference set of tapes and they can go back to a topic that they find they're having problems with anytime, for the rest of their lives. The original man who four years ago brought me the tapes is now in one of our support groups. So, he's used these tapes at various levels of growth and development. He's doing much, much better, but he's still growing, he's still using them. So I can see how people are using it consistently over years.

Q: Tell me about the newsletter?

A: We have a newsletter in our agency, it goes out quarterly. The newsletter just talks about all the various programs that our HMO offers in terms of patient services. What we started doing in May was putting a fairly long article about ATTACKING ANXIETY; what the program is about, what are some of topics that are talked about in the tapes (etc...) so it gives people a chance to think. What we are finding is that the minute this newsletter goes out, we have a flood of phone calls within a week or two. More people than we can serve, because we're trying to do support groups. They come in and buy the tapes and they can use those individually. But in terms of the support groups, there's more people than we have group space for. Which is wonderful.

Q: Do you find that word is getting around? Like, are people who are going through it going out and telling other people?

A: There are people who aren't in our HMO who also call up and say, "how do I get these tapes?" So, I can always give them the number of the organization in Ohio. It's something that people talk about with their friends. And the truth is, I learned things in terms of my own anxiety, so everybody can really use many different facets of this program. The piece of it that was so informative to me the first time through was time- management. I did the questionnaire in the workbook, I think there were 21 questions, and it said at the end, if you answered yes to 4 or 5 of these, you have a problem with time management. I answered yes to 19 out of 21! So I had a lot to learn. It was very useful for me to go through the tapes and to talk to the group about what they were doing to better take care of themselves. One of the metaphors in the tapes is, "you can't control the wind but you can control the sails." I'm learning a lot, all these people are learning a lot, about self-empowerment through these tapes.

Q: Why do you think people are uncomfortable going for help within the company? Is there a stigma? Are they afraid of being talked about? Are people afraid to go and talk about anxiety and depression?

A: Well there's a couple of different things that are happening within the medical care world. One of the things is we're simply more busy and there are less people providing services. So someone may come in presenting heart racing, but what they really need to talk about are things that will help them get more comfortable with themselves. So, they get a ten or fifteen minute meeting with their doctor, who talks about, "No you're not having a heart attack." But it doesn't really respond to what's causing that symptomology in the first place. The thing about the support group and the tapes is, they can listen to the tapes 5 times a day if they want to. And in fact, people do. It's real common for people. Of course, they are really perfectionistic. So one of the things I actually spend time doing is saying, "No, you don't have to listen to it ten times a day, maybe once will be enough," or whatever. But they have access to information and they have access to support, especially through the tapes when you interview other people who have similar problems. They realize, I'm not alone. This person had that problem and they're doing better now. And so they have that real easy access to support which isn't available anymore in the busy medical clinic world.

Q: Talk about the HMO world, the changes that are happening there.

A: Well, one of the things we're struggling with is we have more demand on us to meet more services in less time. And that's really a crunch because you want to really respond to the whole profile of the symptomology. What are all the things that are going on that are causing this person to have: loss of sleep, inability to go to a restaurant and eat a meal in public, or inability to relax and go out and take a walk in nature because they're afraid they're gonna have a heart attack. So all these symptoms are there and a person who, especially in the mental health field, wants to respond to all of that, doesn't have the time. Maybe they can only see that patient six times. Maybe they can only see that patient once a month. Either way, your finding the need and you want to talk about it and support them but there's no opportunity within the clinic. So the nice thing about the tapes is that a person can use the them alone. They can call in and talk about a question they might have or they can come in once a month and say well, I've gone through these five topics and these are the things I didn't learn, I don't understand. It's a very, very good way to educate. Well, you're also providing therapy.

Q: Do you think that by providing people this service you're saving the company money?

A: Actually the truth is the man who introduced me to this program was probably going to the emergency room 2 or 3 times a month, totally convinced that he was having a heart attack. After he used these tapes, he did not go back to the emergency room with any symptomology to the extent that he felt that he was going to die (from a heart attack). Which just in terms of ambulance services and emergency service visit to the ER, they stopped. His doctor talked to me during the earlier phase of our work together and he said, "I can't help this man, he's driving me nuts, he's calling me all the time, he's in the clinic every two weeks. I can't help him." Those visits and those phone calls have stopped, he doesn't do that anymore. He's still using the tapes, he's still working on the problem. But it's not at the level of symptomology that he sees it as a medical emergency.

Q: So what does this mean to your company monetarily? Let's be real direct about cost savings to your company as a result of decreased doctor visits, decrease needs for medications, decrease needs for the emergency room.

A: I think what's happening is because of the tapes, because of (our) focus on all the various pieces of information about anxiety. The actual problem is being diagnosed and anxiety and depression are not showing up as often in the office as, "I have a headache or my stomach aches or my heart feels funny." And so what's happening is, the doctors services are being used more appropriately in situations where a doctor can really make a difference. And the tapes and the supportive services of the mental health department are supporting the people - who are now getting some treatment and empowering themselves to have a more successful life and not have the kind of trauma and stress that they had before.

Q: Does this cut down on costs? In other words, people who are improperly diagnosed or they're not treated properly or they're not diagnosed properly are using the medical system ninety-two percent more than people who are helped. So let's talk about cost savings from a professional, corporate standpoint.

A: People (were) coming in to their medical personnel and complaining about symptomology physically, draining the services of those people. It really wasn't meeting any needs. It wasn't talking about, "What are you thinking?" or "Are you breathing or are you relaxing ever in a busy day." Those things weren't being addressed which was really the cause of the symptomology. So the services from the medical staff are more appropriately being used by people who have medical issues. And the program helps the people with anxiety symptoms take care of their life in a different way so they present medical issues much less frequently. It's very cost efficient. I think one of the things that all the HMO's in the country are trying to find is a way to save money and yet provide really high quality services to their clientele. And I think what this is doing is treating the problem directly, it's cost efficient because the people who are using the tapes and using the support through the tapes are getting better. And as they get better, they present less anxiety related symptoms to their doctors. So it saves money on two ends. On one end, it saves money because they (present) less symptomology. On the other end, it saves money because the doctors have more available time to see patients who aren't really dealing with anxiety related symptoms but have (real) medical concerns that they're dealing with.

Q: Who would you recommend use this program?

A: I think anybody can use this program quite honestly. When I started doing the support groups, I was kind of thinking that I wasn't gonna get much out of it. I clearly had probably 2 or 3 topics we addressed (that) were profoundly informative to me, about how my life was not being lived in a calm, peaceful way. So I think anybody can use it. I think the people who are gonna be drawn to it (most) are the people who are really beginning to notice that they are not relaxed, that their lives are on a kind of a treadmill and they never get a break. (Especially those) that come to a point where - because they are concerned about stress situations - they're limiting their lives. I see patients who don't go to restaurants. I see patients who can't take a class at the university. I even see patients who can't come to the clinic because they don't want to wait in the waiting room to see their doctor. So that's one of the nice things about using it through our newsletter, people can actually get in contact with the program, come in and get the tapes and go home and get better. So it really helps in that way too.

Q: What are the tapes like?

A: The truth...the way I describe these tapes to people who first come in to me? If they haven't seen the video tape and don't know anything about them, is I say, "Well I kind of feel like Lucinda's my aunt." If you listen to the tapes, you feel like you just sat down with somebody who's telling you a story about their life, some problems that they've had and giving you some advice about how you can get some help. So the thing I like about the tapes is that they're not academic. They don't talk over anybody. They're not heavily candid in terms of medical terminology or numbers. It talks about peoples lives, how peoples lives have been really disabled. And even Lucinda telling her own story about how she grew and about how she came to be more empowered. She interviews other people on the tapes who talk about their lives. So that the tapes are familial, you feel like your talking to somebody you know and you wouldn't mind spending some time with. And it's very practical stuff and that's what people want. They want to have some tools and these tapes are full of tools.

Q: Do you think most people got these tools (while) they were growing up? Or, do you think that a lot of people come in with no tools? And in a work environment, a work environment is very anxiety producing. We don't have security, it's a thing of the past, job security. There's so much stress on the job. Do you think these kind of tools would be appropriate in a seminar for a corporation, that kind of thing?

A: My feeling again, as I said before, I think everybody has anxiety in their life beyond what they need to have and that (many are) really suffering and limiting their life because of (it). So, the tools that are talked about on the tapes are tools that are profoundly needed in our current world where so much is going on. I'm always delighted to see a family where they're only working two jobs. Because now a days, a lot of people work two jobs (each). In a family, both husband and wife have a job and a second job. (These) kind of stressors in a normal family are just too much. And so what happens is, trying to meet those kind of needs in terms of expenses, people push themselves harder and harder and harder. What these tapes talk about is ways in which to approach those stresses outside yourself effectively and powerfully and to cope and go through your life and have a good time at the same time. They're very effective.

Q: ATTACKING ANXIETY is really disease state management for anxiety disorders. It represents the most comprehensive format treatment that exists for this disorder.

A: One of the things that I've noticed about the tapes, because I've read books about anxiety for the twenty years that I've been doing therapy, I have dozens and dozens and dozens of ways to help. All of those ideas were addressed on these tapes. They're very comprehensive. Just reading the topics that the tapes cover is like the major issues that stress people in our current life, in our current world. So one of the things that's a real selling piece for me is just showing somebody the outline of the topics of the tapes. And if they can't find one of those issues that really bothers them, they're a real unusual person. Because we're all bothered by those things.

Q: What if I told you we have just spent this past year totally redoing the ATTACKING ANXIETY program so that it now addresses depression as well and as extensively.

A: (That's) what happens with someone who's life is so limited. Really, and an example is a professional man who worked in an office who would always leave over the lunch hour because he couldn't sit and eat with anybody watching him. So here's a man who's incredibly limited. He couldn't take classes to advance himself in his career. What happened was he got less and less joy out of his life. He was bright, he was healthy, he was smart and he was actually losing ground all the time because he couldn't relate to his professional colleagues. So he got very depressed. He would spend more and more time in his apartment. He would spend more and more time not answering his phone but letting his answering machine answer his phone. He was really trying to stay where he thought he would be the most comfortable, which was kind of closed in his bedroom. So he became very depressed. Originally he came to me, well kind of on the edge of saying, "I think I want to kill myself because my life is not worth living." He couldn't even spend time with his family on bad days. And that was kind of his only contact with the world, was his sister and his mother. And when he had a bad day he wouldn't even see them. So he became very despondent, very isolated and very scared. And rightly so.

Q: Did he go through the program?

A: He was one of the two people who took the program up on his own and told me about it. And he is now in our support group and he's been, this is like four years later, he's still using the program and he's still getting benefits out of it. Now he's using the support groups as well and getting benefits out of that.

Q: Does he act like a facilitator in the group?

A: Very much a resource person. He talks about, "Well, this is how I was four years ago. Now I'm here, I'm better but I'm still not completely cured." So he's very much a co-facilitator of the group.

Thank you Michael, we appreciate your time and responses.