I remember my first panic attack like it was yesterday. I was 13 years old and home alone.
I was living with my dad who was a shift worker at General Motors so he worked late some weeks on a rotating shift.
It was just a general day for me, catching up with a friend after school and then getting home to an empty house and it hit me out of nowhere.
I had no idea what was happening, or why it happened so suddenly. I still didn’t really know after the fact. This was the first visit to the hospital who concluded it was just anxiety.
I had no idea what that meant in reality though, it turned out to be no big deal to me and then life went on normally for another period.
It wasn’t until a few years later when I was around 16-17 when panic disorder visited me again. This time in the form of standing in lines.I remember my first panic attack like it was yesterday. I was 13 years old and home alone. Click To Tweet
Once again I didn’t really know what was happening, or why it was happening, so I did what anyone else did – I assumed something was wrong with me but mostly managed it through avoidance.
This went on for a while but each time I would get over it, and then it would just come back usually a few years later. I never sought help or looked to understand what it was or why it was happening, though.
During my early 20’s I was practically living a hermit’s life. Rarely interacting with real people, just doing all my work at home as a remote worker. Human interaction was limited to a few minutes a day getting lunch close by, usually. This turned in to a period of agoraphobia.
Looking back I now recall what exactly happened each time I got caught in a cycle, and each time I got out of the cycle without even realising.
During the cycles of anxiety, I was consciously afraid. That is, I was always re-enforcing my situational fear cognitively and this was conditioning me to be afraid and reach levels of panic.
But at the same time, each time it “went away” it’s because of the desire to do something more override that cognitive re-enforcement. Each time, I basically engaged in living.
That’s no surprise because one of the core aspects of Acceptance and Commitment Therapy is to follow your values and live a meaningful life, regardless of your thoughts and feelings.
When you are in “flow” as psychologists refer to it, you aren’t caught up in your mind trapped by anxiety or other thoughts and fears. I see now that I was going in and out of flow as the years went on.
It wasn’t until I was around 37 when I experienced the big one, home alone at around 1 am in the morning. This was the one that changed everything and I sought help to face head-on.
They say thing’s get harder before they get easier, and this was very much true. I stopped working from the office. I experienced agoraphobia at malls and comfort-zone based panic where I couldn’t drive, or walk too far from home.
I realise, in the past, I was exchanging short-term discomfort for long-term discomfort. While avoiding, or fleeing discomfort I was providing myself with short-term relief. But this was having long-term effects over the years.
It wasn’t until I sought help that I learned exactly what was happening, why it was happening, and how to face my fears once and for all.
What I now know, you can avoid your fears, living around them, managing them, and letting them condition how you live your life, and they may even go away for years at a time, but they will never be truly gone as long as you allow them to live deep inside your belief system.
How Does Exposure Therapy Work?
Exposure therapy works to reverse the conditioning of anxiety, much in the same way that anxiety disorders are created.
By continually exposing a person to their fear, they can gain learned experience that their fears are unfounded and there isn’t really any danger in most cases.
The idea is that most of our anxiety based fears are created in our head. Until they are disproven, they remain there being re-enforced but untested. The more we think about them, the more we believe they are true.
But by facing your fear, we can retrain this false assumption with the stimuli and when the brain learns that the expected reaction didn’t occur, the fears are challenged.
Of course, we have generally had months, if not years of creating these false fears, so it generally won’t happen over time. Nor can we throw someone into the worst case scenario right off. It will generally be too overwhelming.
This is why we work up to it using smaller, less intense steps. Because the most important part of exposure therapy is not to flee from the experience.
By fleeing from the experience, you may just re-enforce the false assumption that there really was a danger, but it’s okay, you are safe now.
You need to stay with the experience until the anxiety subsides. This means you have sent a message and started the process of re-learning that there was no danger to begin with.
Exposure Therapy and Phobias
Phobias come in all shapes and sizes, but a common theme is so-called dangerous animals.
Snakes, spiders, possibly even dogs are often phobias. Water such as the ocean, lakes or swimming pools is also common.
Exposure therapy works very well with phobias because it’s very easy to find varying levels of intensity for the step-ladder approach.
Quite often, exposure therapy for phobias will start right back in the safety of a psychologist office simply visualising the stimuli.
Over time, exposure intensity can be increased by introducing more difficult levels of stimuli.
Here is an example exposure therapy process for a phobia of spiders:
- Visualisation: The patient will simply visualise spiders walking around, possibly crawling over them. The visualisation should be able to introduce an anxious response and may need to be increased until one is felt.
- Spider in an adjacent room: The patient may sit in an adjacent room from a spider looking from a distance, again we are looking for an anxious response. We need to feel anxious in order for the exposure to be successful.
- Spider in the same room (glass box): A spider is introduced into the same room as the patient, but it is safe and secure inside a glass box or container. It should be visible but clearly restrained.
- Spider in the same room (loose): Once again, the spider is in the same room but this time it may be crawling upon the desk or somewhere at a small distance away.
- Spider is allowed to crawl over the patient: Finally, the spider is allowed to crawl over the patient and actual contact is made. This is obviously the highest level of exposure.
It is important to remember that it may not be linear, and each step may be done more than one time.
Even though there is only 5 steps, the whole process may take over 15 sessions or possibly longer. Everyone is different.
Exposure Therapy and PTSD
Exposure therapy works with PTSD by exposing the patient to their traumatic event.
Again, this may take place with visualisation to start, gradually moving up to more real-life interaction such as visiting the place of trauma.
If there are certain triggers such as loud noises or experiences then these may also be used as exposure points.
Because of the complexity and severity of PTSD, it should only be undertaken with the strict guidance of a clinical psychologist or trained professional.
Exposure Therapy and Panic Disorder
Panic disorder is quite often initially caused by a reaction to a physical symptom.
Unfortunately, the mind is quick to respond to this symptom and get carried away by re-enforcing the fear.
We then end up with fear upon fear and like a boiling kettle, the level of anxiety increases more and more until panic levels are reached.
Fortunately for exposure therapy, these symptoms can often be easy to replicate. Everyday activities such as feeling dizzy, or lightheaded can often be replicated through exercise and other techniques making exposure therapy an excellent component of panic disorder treatment.
Other techniques include fast, shallow breathing trying to hyperventilate. Spinning on a chair is also quite common to experience forced dizziness.
No matter what the technique used, the goal again is to experience the symptom and then not to stop but to keep going as long as possible.
If anxiety is felt, then that is great, we should continue more and more until the anxiety subsides.
I have personally used both of these techniques.
Exposure Therapy and Agoraphobia
Agoraphobia can be categorised by fear of leaving a safe place. This is often ones home. The bounds of safety differ from person to person.
Some people are completely homebound, while others have a safe-zone outside but close by, for example, restricted to their town or suburb.
Exposure therapy is a great treatment for agoraphobia because again there are lots of levels of exposure to work with.
Generally being distance based, we can increase the distance and challenge the perceived notion of safety bit by bit.
I personally used exposure therapy to overcome agoraphobia simply by walking and driving. I did this while still working full-time from home, and using mornings to practice walking, and lunch-breaks to practice driving.
Each morning I would attempt to walk around the neighbourhood, generally experiencing high levels of anxiety and sometimes reaching near panic levels, and I would just keep walking.
During lunch-breaks, I would drive across the suburbs, and over time keep increasing the distance driven each time.
I would also sometimes cycle and because I knew what my limits were, each time I would purposely leave the so-called safe zone and go farther and farther.
Even during the weekends, going out with my partner and the kids would quite often be an exposure challenge.Each morning I would attempt to walk around the neighbourhood, generally experiencing high levels of anxiety and sometimes reaching near panic levels, and I would just keep walking. Click To Tweet
Going to a busy mall or a small road trip. No-one but myself knew it was an exposure challenge, but we never know what anyone else at a busy mall is experiencing either. Quite often, there will be others also experiencing anxiety, too.
Exposure Therapy and Obsessive Compulsive Disorder (OCD)
OCD has two aspects. Obsessions and compulsions.
So which is applicable to exposure therapy?
Fortunately, both are. While obsessions are generally mental, thought-based anxieties, compulsions may be fear of germs or rubbish sitting around.
In the case of obsessions, exposure to the thoughts can be provoked by purposely thinking about them over and over until the thought no longer creates anxiety.
Compulsions can be challenged in a similar way, by simply exposing the patient to the compulsion. Again this can be done with varying levels of intensity.
How to Perform Exposure Therapy at Home
Depending on your type of anxiety disorder, and the severity, exposure therapy is generally very safe and easy to perform at home.
First and foremost, if you are really unsure or afraid you should consult the help of a trained clinical psychologist.
In fact, you should consult one anyway to ensure there are no deeper psychological issues and exposure therapy is safe and applicable to your anxieties.
Once this has been established, they will introduce you to the concept of exposure therapy in the context of your problem as a starting point.
But once you have an idea of how exposure therapy works specific to your situation, and possible tasks to try, performing these regularly at home during most days is very important.
Graded exposure is often referred to as the stepladder technique because of the way exposure therapy is performed. Tasks or experiences are added in a gradual manner from lowest severity to the highest severity.
For example, if you are afraid of large crowds you could make a list of possible experiences where crowds will vary in size.
One experience could be to visit a place on the lowest night, where you will only be exposed to a few people.
A different night might have a few more people, so on and so on. You can rate each experience as to how potentially anxiety-provoking it is for you, and then add them in order to a list.
You don’t have to climb the ladder rapidly either. You may, and in fact, should attempt each step multiple times until you are completely at ease with it.
If one step is too overwhelming, while you should make every attempt to face the fear there is no shame in moving back down a step either. Things are rarely entirely linear.
As you climb the ladder, you will gain more and more confidence from the step below it until eventually, you have conditioned yourself to withstand the highest step – your fear without fleeing.
Exposure therapy is a long established cure for treating anxiety and specific exposures.
From my own personal experience, I can also attest to its effectiveness. Not only is it logical in the way it works, to de-condition yourself from the fear, but you can also just take a look at the thousands of DARE members using it every day.It won't always be linear, and it definitely won't be easy - it wasn't for me but with consistent, regular practice and the right attitude, it will most certainly be effective. Click To Tweet
Everyone’s fear is different. Some are physical, such as certain animals, reptiles or insects, but many are “false fears”, that is fear without danger, which seems 100% real to the sufferer.
In this instance, it is where exposure therapy has the most power. It’s very easy to perform a variety of tasks every day to re-condition one’s anxiety through experience to educate the brain to override the natural tendency to react before thinking.
It won’t always be linear, and it definitely won’t be easy – it wasn’t for me but with consistent, regular practice and the right attitude, it will most certainly be effective.
It may take time, it may take a long time. I still practice exposure therapy to this day to ensure I keep growing.
No matter how comfortable your life is, there will always be room for bigger, richer, more fulfilling experiences.
Do you have a specific phobia or have you tried exposure therapy before? Let us know how it worked for you in the comments below!