As the weekend draws close, don’t forget to pencil in your exposure work. Below are ten tips to help you along:
1. Learning occurs at moderate levels of anxiety and arousal. In planning your exposure work don’t make it too easy or too hard. If you pick something that doesn’t cause you any anxiety (a fear rating of 1 or 2) you can’t experience a drop in your fear rating because there’s really nowhere for it to go. As a result, you won’t unlearn anything. On the other hand, if you pick something that causes you a fear rating of 9 or 10 it may be difficult for you to do a long enough exposure to notice a reduction in your fear.
2. Exposure should be predictable. Plan your exposure work in advance and stick to the plan. Unplanned exposure does not work as well in part because when we plan an exposure, just having planned it makes it a bit more controllable and a little less frightening.
3. Set a goal for the exposure that you can reach. Set a goal for the exposure session such as staying in the situation for at least a certain amount of time or until your fear rating drops by a certain amount. Setting a reachable goal will give you something to aim for. Achieving your goals step-by-step will allow you to feel good about what you are accomplishing.
4. Stay in the situation until your fear goes down. This can happen in two ways. First, if you pick a situation for an exposure that causes you a fear rating of a 3 to 8, then after an hour you should be experiencing a drop in your fear rating. If not, maybe it was harder than you thought. However, there is another way to experience a decrease in your fear rating, which is to repeat the exposure again and again. So for example, if your anxiety doesn’t come down from an "8" in the first hour, try it again the next day. Eventually, if you repeat the experiment every day, it will start to drop. Keep track of your fear ratings during your exposure work by using the Exposure Worksheet.
5. If something is too hard, pick something just a little bit easier. If you end up having a fear rating of 9 or 10 for an exposure experiment, try to figure out what you could do that would be almost the same but would result in a fear rating of 7 or 8 instead. You can also consider adding a step to your treatment plan.
6. Keep track of your anxiety during exposure experiments by using the Exposure Monitoring Form. Every 5 minutes record how much fear you experience on a scale from 0-10.
7. Expect to experience some fear. If you're choosing experiments that cause you a moderate level of anxiety, expect to feel some fear. Don’t judge your success based on your experience during the exposure. YOU WILL FEEL BAD. Judge your success based on your ability to complete the exposure task. If you stayed in the situation as planned, you’ve succeeded in reaching your goal for that exposure.
8. Go with your fear. In an exposure experiment, you want your fear to happen. You plan the exposure experiment so that you experience some fear (but not too much). You can only experience a reduction in your fear if you let it happen. Try not to avoid your fear during exposure work by trying to distract yourself. Just let it happen and watch it go down. Common distraction strategies include reading, watching TV, listening to music, talking on the phone, or talking to a friend. TRY NOT to distract yourself during exposure work. Allow yourself o experience fear and a reduction in fear.
9. Exposure experiments work best when exposures are repeated often and are spaced closely together. The more you can repeat an exposure exercise and the more closely together you can space the experiments, the faster you will unlearn your fear.
10. Use the strategies you’ve learned to challenge your anxious thoughts during your exposure experiments. See what happens when you challenge your anxious thoughts during exposure.
Please feel free to tell us about your experiences thus far with exposure work. Running into problems? Have any successes?
Sarah, Health Educator
The following are some of the most common subtle avoidance strategies. While most people don’t recognize these subtle avoidance strategies, they use them to cheat or bypass fear during exposure work.
You may have to use some of these avoidance strategies at present. If you do, that’s OK! Just realize that at some point you’re going to have to go it alone.
· Avoiding the Physical Symptoms of Fear
The Safe Person
One of the most common subtle avoidance strategies is the safe person. The safe person is often a spouse, friend, or family member. People with panic disorder and agoraphobia may be able to face a feared situation as long as a safe person is with them, or as long as the safe person is close by. Some people with agoraphobia are unwilling to leave their house without their safe person.
If you need a safe person nearby while you do exposure work...no problem! Do what you have to do in order to get your exposure work done. However, if you use a safe person to reduce your anxiety in your feared situations, you’ll eventually need to do exposure experiments without your safe person. It may make sense for you to work through your exposure plan with your safe person until you gain some confidence. Then, start back at the beginning of your exposure plan and do exactly the same things without your safe person around.
When you're ready, you'll probably want to challenge that fear in a specific exposure plan. For example, at first you might challenge yourself to not know where your safe person is for 5 minutes, then 10 minutes, and so on. People with panic disorder often rely on being able to contact their safe person via cell phone. So, for example, you might experiment with having your safe person turn off their cell phone for 5 or 10 minutes and then gradually increase the time.
The Safe Object
Another common subtle avoidance strategy is to carry a safe object into a feared situation. The safe object is often medication or a medication bottle, cell phone, money for emergencies, or water. Although the safe object is carried into the situation "just in case," it’s usually never needed.
If you need a safe object right now...no problem! Do what you have to do to get your exposure work done. However, if you use a safe object to reduce your anxiety in your feared situations, you’ll eventually need to incorporate exposure experiments without your safe object. It may make sense for you to first work your way through your exposure plan with your safe object, get some confidence in your ability to do exposure work, and then start back at the beginning of your exposure plan and do exactly the same things without the safe object.
Symptom Monitoring
Some people with panic disorder and/or agoraphobia reduce their anxiety by constantly monitoring their symptoms. For example, a person with panic disorder might constantly check their pulse, blood pressure, or breathing for any signs of ‘trouble’.
When you always monitor you’re symptoms, you’re sure to find something out of the ordinary. This could lead to anxious thoughts, and possibly, an anxiety attack.
Remember: small changes in body temperature, heart rate, or breathing are normal. If you find that you constantly monitor your symptoms, you may want to develop an exposure plan that will challenge this kind of behavior.
Distraction
When you’re doing exposure work you want to allow yourself to experience a moderate level of anxiety. It’s only by experiencing a moderate level of anxiety that you notice a decrease. By noticing a decrease you can unlearn your fear. So, if you’re doing an exposure experiment try your best to concentrate on what you’re trying to achieve. People do all kinds of things to distract themselves from their fear during exposure work. Most commonly, people divide their attention between their anxiety and something else like watching TV, reading, or listening to music. Don’t distract yourself in this way. If the exposure experiment is too difficult to do without distracting yourself, add a step to your treatment worksheet and try something a little easier.
Avoiding the Physical Symptoms of Fear
We’ve talked about this before. People with panic disorder often avoid the physical symptoms associated with their panic attacks. For example, people with panic will often avoid exercise, sex, anger, and getting excited. People with panic disorder will also often avoid foods that contain substances that may cause them to experience physical sensations of panic (such as alcohol, caffeine, hot drinks and spicy food). We will want you to challenge some of this avoidance when you’re ready.
Look for Cheating
Look for the little things that you do to reduce your anxiety during exposure. The problem with subtle avoidance strategies is that they keep you from experiencing a reduction in anxiety. A second problem is that subtle avoidance strategies often make it hard for you to take credit for your efforts. A third problem is that if you don’t think about your subtle avoidance strategies you may have trouble moving through some of your exposure plans. Knowing your subtle avoidance strategies will help make your exposure plans more effective.
Hopefully this section has helped you recognize some subtle avoidance strategies that you may have been using. Take a quick break and think about how subtle avoidance strategies are affecting your treatment plan or exposure work. It may help if you jot down what you're thinking.
At this time, we encourage all members to share how, why and what they are avoiding.
