Hello, friends! This is a re-release of episode 98, which is an episode that I refer back to quite often on the show. I talk about the concept of exposure as it relates to anxiety and take you through different techniques for lowering your sensitivity to anxiety. This is must-know information for those that are serious about taking their lives back from anxiety.
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There’s a common misunderstanding regarding treatment and recovery from anxiety that the main objective is to get rid of 100% of all anxiety symptoms that you experience, and once you’ve found a way to do this then you’re recovered. Unfortunately, that’s just not the case. It’s definitely important to have your coping strategies and breathing exercises, mindfulness etc. but there is one aspect which seems to be commonly missed – Exposure.
What is exposure?
As well as learning how to manage anxiety, it’s also really important to build a tolerance for anxiety. Therefore, you’re not just learning how to decrease the amount of anxiety you feel in the moment, but find a way to help you withstand anxiety and understand that it’s not the most dangerous thing in the world and you’re going to be okay. That’s where exposure comes in. The term exposure refers to the process of exposing yourself to your feared stimulus, the thing that generates anxiety in you. By exposing yourself to it, you can take back some control over anxiety.
When we have anxiety about a situation we often tend to avoid it…anxiety tells us that it’s unsafe in some way, even though this is probably untrue. This reaction is linked to our fight or flight response and is designed to keep us safe. The problem is, anxiety tells us a lot of lies. It wants you to think that situations are dangerous, that you’ll freak out and lose control, even when this isn’t the case. This leads to avoiding scenarios that might be anxiety provoking. When you avoid something, anxiety says, “See that? I kept you safe. That would have been bad news.” And so you’re reinforcing your anxiety and it gets stronger and stronger as you keep letting it influence your decision to avoid things. Then before you know it, you’re not really controlling your behavior…your anxiety is.
The point of treating anxiety or recovering from anxiety is not just to get rid of all these sensations that you’re experiencing, it’s also to stop valuing them so highly and to stop letting them control your behavior. By doing so, you start to take control back. Exposure is one of the tools you can use to do this. Research has demonstrated time and time again that exposure is one of the most powerful tools for recovering from anxiety. What you need to remember is that anxiety itself is ordinarily not dangerous. As mentioned, it will try to convince you that you are in danger or that potential scenarios carry a great deal of risk, when in reality they don’t. Basically, when you do exposure exercises you call BS on your anxiety in order to prove it wrong. There’s no doubt that this takes courage, but by inviting anxiety in and allowing it to happen without running away, we can actually reduce the impact that anxiety has and build a tolerance to it.
There are two main approaches to exposure work – flooding, and systematic desensitization.
Flooding is where you jump into the anxious scenario and sit with it. It’s definitely a more intense form of exposure where you dive directly into the situation that causes you anxiety. In turn, this leans on your body’s tendency to want to achieve homeostasis (your level, stable baseline). Therefore, you wait for your body to adjust and self-regulate. A really good example of this is when flooding is used to treat phobias. If you’re placed in a room with something you fear, your body is at first going to freak out. However, when continually exposed to this situation for a long period of time, these levels will gradually decrease until they eventually reach your baseline. Basically, if you don’t escape the situation, or avoid it as you usually do, your body is going to figure this out and you’re going to prove to your body, and to your mind, that there is nothing inherently dangerous about this situation. Eventually, your body will get sick of being anxious and you will realize that the thing that is making you anxious won’t hurt you…it’s just the anxiety wanting you to believe it will hurt you.
Systematic Desensitization, also referred to as gradual exposure, is often the more preferred method of treating anxiety as it isn’t as intense. Instead of diving in headfirst, facing your fear and letting your body down-regulate, systematic desensitization is where you take a step-by-step approach and develop a plan to systematically build tolerance to the stimulus that causes you anxiety – you start off small and gradually work your way up to the real thing. In essence, you find a smaller version of the thing you fear and expose yourself to that. Then you gradually work your way up until you reach the real situation.
To do this you need to create a hierarchy, or courage ladder. Here you break your anxiety provoking scenario into 12-15 steps. To achieve this, first grab a piece of paper and brainstorm all of the possible exposure activities that are related to your anxious situation or might simulate that experience. Once you have a list, you need to re-order them from least to most anxiety provoking. The first step on the ladder should be something that generates a moderate level of anxiety. To track your anxiety level we can use something called a SUDS rating – Subjective Units of Distress. In this case, it can be a 0-10 rating of anxiety, where 0 is totally calm and 10 is having extreme anxiety or a panic attack. So your first step should be somewhere between a 4-6…we don’t want to overload you as that won’t be helpful. The point of this is not to put a strict timeline on each task. What you’re working towards is mastery – you’re going to work at this step until it becomes easy for you, reducing your anxiety rating. Once you’ve confidently halved your anxiety rating for that task, you can move up to the next step and so on.
Frequency and duration are key
There are two things to watch out for that people often get wrong and can actually limit your success. These are frequency (how often you do the exercises) and duration (how long you do the exercise). The more you put in the more you will get out. Ideally, you would practice the exposure exercises every day for a period of time, such as 30 days. It’s not going to be pleasant – ultimately you’re inviting anxiety in. But you want to try and do it daily to get the most out of this process. For duration, you want to aim for 20-30 minutes per session. Too short a session and you can actually have a negative impact, too long and it starts to enter the flooding side of things, so 20-30 minutes is a good benchmark.
That is the basic framework for Systematic Desensitization – develop a hierarchy, order them according to how anxiety provoking they are for you, engage in the first activity for 20-30 minutes and see how you feel. If it’s too much then don’t worry, you can revisit your hierarchy and sub-divide it a little more and find something that generates a moderate level of anxiety. Then you’re going to work at that every day, continuing to expose yourself to that until you can reduce your anxiety rating by half…at least three times in a row. Then kick it up a notch and move up to the next step in your hierarchy. Keep challenging yourself and I encourage you to enlist the help of family and friends if you are able to.
Things to watch out for
Before we finish, just a couple of things to look out for. Firstly, we often use safety behaviors such as checking our phone (e.g. if your agoraphobic and go to the mall, but you’ve got your headphones in the whole time, looking at your social media feed). These prevent us from engaging with the situation and so you aren’t really exposing yourself to the situation so you can learn how to cope. Therefore, be wary of avoidant behaviors like this. Another thing people often do is to take a security person with them. Maybe you can’t go out in public by yourself, but you can if you bring a parent or a friend. Again, this reduces the impact of that anxiety and limits the amount you will benefit from that exposure exercise. Finally, watch out for using medications like Xanax or other meds that are designed to quickly reduce your anxiety. Some people will think about doing their exposure exercise, get really worked up, take a Xanex so they’re calm and then do the exposure exercise. When you do this you’re not really giving yourself the full dose of anxiety that you’re trying to learn to tolerate, and so it’s counter-productive. Certainly, if you’re midway through your exercise and you feel panic, unsafe or that you can’t cope at all, then yes use that medication. But be careful of reducing the impact of that anxiety…the point isn’t to get rid of it, it’s to invite it.
And remember the goal isn’t to remove the anxiety symptoms completely, it’s to learn to tolerate them. You are still allowed to use your coping skills. You can do deep breathing, challenge your assumptions, and use any other skills that help you to reduce the sting of anxiety. However, you do want to be challenged. This shouldn’t be easy. You want to feel the anxiety so that you can build up a tolerance for it. If you’re finding it tough to do on your own, then definitely consider looking for a therapist to help you along the way. And of course, all this and more is covered in my course, Kick Anxiety’s Ass.
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