Case in Point: Exposure Therapy for Anxiety

I think my abnormal psychology students are sick of hearing it after two weeks of discussing anxiety based disorders: exposure is the treatment for anxiety. This is not just for those affected by serious mental illness, but for all of us who have, at one time or another, developed fear or anxiety about a particular issue. 

Picture from AAroads.com 

Picture from AAroads.com 

Imagine you were driving to work yesterday on the speedway known as I-76 that runs right through Philadelphia. While traffic was tight, it was moving along at a quick pace. Out of nowhere someone moves into your lane throwing both of your cars into a tumultuous accident. Despite being physically unharmed, your nerves are on edge from this near-death experience. You go home and try to get some rest. The next day you get up, you realize that you are a bit anxious about driving on I-76 again. You have to get to work regardless of your fear and anxiety, so you opt to take Kelly Drive as it might not be so fast paced and you get to work unharmed, although a little late. You feel better about having gotten to work without getting as worked up from the drive and decide to take Kelly Drive from now on. In later drives to work, you find yourself getting anxious about taking Kelly Drive. People still drive too quickly on it and it reminds you of the fear and anxiety you had when trying to drive on I-76. You decide to start taking the train into work instead of driving. You have to get up much early, but, hey, at least you don't have to worry about driving. 

What has happened to you in the above example is what we call avoidance conditioning, one of the factors that maintain anxiety and fear. Because a situation has been associated (through Classical Conditioning, thanks Pavlov!) with fear/anxiety, you avoided that situation so you didn't have to feel those feelings (called, negative reinforcement, a part of Operant Conditioning). Gradually, this avoidance becomes habit and all of a sudden you no longer drive because the fear associated with it (this is a basic explanation for Mowrer's Two-Factor Theory). 

Therein lies the problem: your avoidance of the feared situation prevents you from conquering your anxieties and fears in the moment. In walks exposure therapy as the way to overcome this. Exposure therapy operates under the tenet that the key to overcoming your anxiety is by facing it. Rocket science, right? Well, In reality, people do not realize how difficult it can be to face the fear that they have conditioned themselves to avoid. I have seen people go through extraordinary measures to avoid issues like confronting a friend, processing intense emotional grief or trauma, asking someone out on a date, making a move towards leadership in their school or work, and following through on necessary changes in their lives. When asked if these situations would be good for them, they exclaim, "Of course, but change is hard!" 

Someone I worked with once gave me the perfect way of describing how exposure works. Consider a day that you have spent at the beach and how hot you are around noon after you have been laying in the sun tanning or playing volleyball with friends. When you get into the water to cool off, how do you do it?

Do you run into the water knowing full well that the cold will be a shock to your system that will sooner or later subside as your mind and body get used to it? This is what we call flooding, in which the person is put in the situation that they fear with the understanding that their anxiety will likely skyrocket but that sooner or later it will come down. After multiple experiences of flooding, people's fear and anxiety tend to reduce to manageable levels. This can be difficult to undertake when the emotional and physical consequences for people are more severe than running into an ocean. Flooding can be overwhelming to people and is not used with everyone. 

Do you creep up to the water slowly, gradually letting your body get used to varying degrees of coldness, willing yourself to go futher until you feel comfortable going all the way under the water? This is what we call graded exposure, in which people slowly introduce themselves to the anxiety provoking situation allowing them the control to decide what they think they can handle. This type of method allows people to control how much they are willing to take on. This can be difficult because people may change their mind about going all the way, something that happens at the beach as well.

Or do you decide to not go into the water at all? Some people will live their lives "not going into the water." For them, it's not worth it to face the fear, discomfort, and other associated thoughts, feelings, and sensations related to overcoming their fear or anxiety. Unfortunately for them, to continue with the analogy, they miss out on the fun and excitement of getting into the ocean. 

Albeit a very basic understanding of exposure therapy, keep in mind that a complex application of these concepts have been used to treat a variety of anxiety based disorders (i.e., specific phobias, PTSD, Panic Disorder, etc) and has been proven to be highly effective.

Consider how this might be applied in your own life with something that brings you fear or anxiety. When did you first start to fear or become anxious about it? How do you continue to consciously or unconsciously avoid it? Would you be more prone to flooding or graded exposure techniques? Or are you just going to continue sitting on the beach?

 

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