Got Anxiety? Exposing yourself to worry (health advice)
Mary B. Barmann, MFT
As we discussed in previous articles, feeling a sense of uncertainty (e.g., not being sure that an upcoming presentation might result in social embarrassment) will trigger reassurance-seeking behaviors and attempts at various forms of avoidance for those who worry about negative evaluation from others.
Both methods serve to create even more uncertainty, and heightened feelings of anxiety. What is needed is a strategy for moving TOWARD the very situations that act to trigger anxious arousal. When treating individuals within our clinical practice who experience chronic worry, one of our primary treatment methods involves the use of a technique referred to as EXPOSURE THERAPY.
RATIONALE FOR EXPOSURE
Eleanor Roosevelt once stated, “You gain strength, courage, and confidence by every experience in which you look fear in the face and state to yourself, I have lived through this horror. I can take the next thing that comes along.”
Briefly stated, Exposure Therapy involves intentionally facing situations that are perceived as threatening, such as: driving alone, being in crowded environments, touching certain objects, thinking about specific worrisome thoughts, etc.
No matter what the individual is being exposed to, the process is performed in a methodical manner, involving a pace which is acceptable to the person undergoing the exposure sessions.
The rationale is that over time, exposure will teach the person to (a) better tolerate a sense of uncertainty involving the feared situation, (b) habituate (get used to) the feelings of anxiety associated with the feared situation or object, and (c) realize that predicted catastrophic outcomes related to the feared situation did not occur.
Indeed, the worst outcome which typically occurs is that the person felt extremely anxious during the course of the exposure session.
Following several prolonged exposures, the individual habituates to triggers which, in the past, led to feelings of anxious arousal associated with the feared object, thought or situation.
Imagined Exposure: Involves imagining confronting a feared object or image for an extended period of time. This is frequently done in situations where it may not be practical to directly encounter the situation, such as having an intense fear of dying of cancer.
Situational Exposure: Directly confronting the feared object, such as volunteering one’s time to work at the Pet Network Humane Society, if fearful of dogs.
Auditory Exposure: Listening to a TV show discussing issues related to death and dying, for those dealing with health anxiety.
Written Exposure: Instead of thinking about a particular worry, journaling one’s worrisome thoughts for an extended length of time, followed by reading the words over and over again.
PRESCRIBING THE SYMPTOM
Remember what we said earlier; one of the most common responses when a person finds themselves becoming anxious is to RESIST the worrisome thought. Because we know this strategy does NOT work, try another approach to managing worry — one that is paradoxical in nature.
Why not “prescribe the symptom?” A paradox is a seemingly logical request that leads to a self-contradictory result, such as; “Be spontaneous now” or, “Act natural.”
We refer to instructions such as these as prescribing the symptom. The symptom in this case is the act of worrying. For example, we often ask our patients to intentionally FOCUS on their worrisome thoughts while, at the same time, having a brief conversation with us about some unrelated topic.
Following this paradoxical instruction, they find it extremely difficult to do so, and soon discover they keep forgetting to follow through with the instruction. That is, the person forgets about the specific worry despite being asked to make a strong attempt to focus harder on it.
Why? Because the act of trying to focus on the worry interrupts one’s effort to “stop worrying,” demonstrating that the strategy of trying to resist a worrisome thought is a key factor that acts to maintain the worry process.
Those who engage in “worry exposure sessions” soon discover that: (1) efforts to directly INCREASE levels of anxiety will LOWER its intensity level, and (2) efforts directed at REDUCING (resisting) anxiety will HEIGHTEN its frequency and intensity.
Thus, Exposure Therapy is designed to encourage a person to:
Confront the feared object/situation for as often and long as possible;
Allow the experience of anxiety to occur;
Make no attempt to resist or avoid feelings of anxiety; and
Observe the occurrence of anxiety reduction over time, along with an increased level of tolerance for uncertain outcomes.
Isn’t it time to not only read the words of Eleanor Roosevelt stated earlier in this article, but to also EXPOSE yourself to her message — look fear in the face, move toward it, stay with it, and remind yourself that you can handle the next challenge which comes your way.
Barry C. Barmann, Ph.D., is a Licensed Clinical Psychologist in Nevada and California. His wife, Mary B. Barmann, MFT, is a licensed Marriage and Family Therapist in California. Visit anxiety treatmentinclinevillage.com to learn more.
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