Overcome Your Fears with Exposure Therapy

Fear is an inherently unpleasant sensation. Which usually react to it by either running away or fighting with what…

Conquering Your Fears

Exposure therapy refers to a process of confronting our fears. Traditionally, it has been used to treat phobias, panic disorders, social anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder, and generalised anxiety disorder. As you may already know, I consider these disorders to be concepts with no inherent, objective reality. They cannot be seen or measured. They are merely labels given to a set of symptoms. In fact, “disorder” is a concept too, a term used when symptoms negatively effect our day to day life, interfere in our relationships, or hinder us in the pursuit of our goals.

What all of these “disorders” have in common, is fear. What is fear? It’s an inherently unpleasant internal sensation to which we usually react in one of two ways; we run from or fight that which appears to have triggered the unpleasant feeling.

In many ways, these are primitive reactions that don’t serve us well in light of our ability to reason. For example, we don’t need to fear heights to know they’re dangerous. We don’t need to fear snakes to know they can be dangerous. We avoid things not because they’re dangerous in and of themselves, but in order to avoid feeling afraid. In other words, it is the bodily sensations associated with being in danger that we find so unpleasant we try to avoid what we think is causing them. The trouble is the cause is internal and we think it is external. So long as our mind / or brain is interpreting the person, place or thing as making us afraid, then there’s nothing we can do to change our response and avoidance is the most reasonable action to take. In truth, there are no “feeling molecules” coming from a plane, a snake, a spider, or from speaking in public that enter our bodies from the outside to make us feel anything. Fear is a response, and there is nothing in this world that can make us afraid without the mind first attributing some kind of meaning to what is happening.

Our biggest obstacle in overcoming negative patterns of thought and feeling, in general, is that we’re too scared of our own thoughts and feelings to explore them. Each of us have our own ‘window of tolerance’ when it comes to various emotions, and when we’re overwhelmed, or scared, we often resist awareness of the thoughts and feelings that make us uncomfortable. This resistance takes the form of blame, avoidance and distraction. This tends to make things worse because the mind is a machine of habit and familiarity and when we allow our actions to be motivated by fearful thoughts and feelings, we strengthen those neuronal pathways, validating fear.

So long as we don’t question the underlying assumption that the situation, or the thoughts and feelings themselves are dangerous (and they’re often not), we’ll find it very difficult to sit with this experience and understand we don’t need to fear our own thoughts and feelings.

Exposing Yourself to the Fear

In exposure therapy, we expose ourselves to the thoughts and feelings we’re uncomfortable with by approaching that which triggers them. This can be done in several ways. The goal for overcoming specific fears or phobias is to uncouple the fear response from the trigger. A broader, more spiritual goal of exposure therapy, is to become more comfortable with all our thoughts and feelings, which will ultimately break the cycle of blame, avoidance and distraction that perpetuates our maladaptive mental, emotional and behavioural patterns.

Imagined exposure: the mind cannot tell the difference between what is real and what is imagined, as is evidenced by dreams where we respond with fear or love towards people who do not exist. In imagined exposure, you may be asked to visualise whatever you’re afraid of. For example, imagining a snake, or imagining speaking in public. If the fear is related to a traumatic event, this may involve recalling the event and vividly imagining it.
Real life exposure: if you’re afraid of snakes, you may be asked to handle a snake. If you’re afraid of public speaking, you may be asked to give a speech.
Sensory exposure: the body produces certain sensations in response to the interpretation of danger, like a a racing heart, nausea, and sweating. Of course, we also experience these sensations in the absence of fear, for other reasons. To decouple fear from these sensations, a person might be asked to run on a treadmill and concentrate on associating these physical sensations with a non-threatening experience.

There are also different approaches to exposure. With graded exposure you would rank activities according to difficulty and begin exposing yourself to that which you deem least frightening. For example, if you were absolutely terrified of snakes, you might begin by imagining a snake. Then you might imagine touching the snake. Then you might get a rubber snake and trying touch it and maybe it would end with your finding a real snake to touch.

The term flooding refers to starting with the most frightening task, as opposed to the least frightening one. A good example of this is a set of diving boards. If you manage to jump off the highest one, even once, chances are your fear of the lower ones will lessen. With this experience, we often use the reasoning “if I could do that, then I can do this“.

Another approach is referred to as systematic desensitization and this combines exposure with relaxation exercises. Relaxation practices can be used when the exposure is deliberate, or spontaneous. In either case it has the power to help decouple the association of fear with the trigger.

Exposure therapy can lead to habituation (a decrease in fear over time), extinction (overcoming the fear altogether) and increased confidence from successfully confronting fears and managing anxiety.

Generally speaking, a panic attack need to be handled differently. Panic or anxiety attacks are the result of a positive feedback loop in which the mind interprets the bodily symptoms of fear, like a racing heart or quick breathing, as evidence there’s something to be afraid of, which produces more of the sensations. In other words, you could say our own fear begins to frighten us and we feel like we’re “losing control”. If this begins to happen, it’s no longer helpful to be thinking of the feared object. The best thing you can do is distract yourself from it completely by practicing a relaxation exercise while concentrating on something else.

Try it For Yourself

Think of something that frightens you and visualise yourself in that situation, but see yourself as feeling really calm and relaxed. Do this for five to ten minutes everyday for a few weeks.

The most important thing is maintaining a pleasant or relaxed feeling in your body as you do this. Imagine yourself feeling and responding to the situation in the desired way. When you feel afraid or anxious, say “I notice I feel afraid and that’s okay”. It is okay, because it’s just a feeling and you’re not in any danger. Remind yourself this feeling’s nothing more than a sensation. You might want to say, “I notice my heart is beating hard, and that’s okay”. Tell yourself it’s just a feeling, that you’re okay, and that there’s nothing to be afraid of. If the fear or anxiety feels overwhelming, you can distract yourself by concentrating mindfully on something present in the room, something beautiful, something soft. When you feel more relaxed, you go back to the thought of that which frightens you and try remaining calm as you imagine it by keeping some awareness in your body or the sounds around you and by taking slow, long even breaths. By doing this repeatedly you’ll weaken the fear response. At some point you may want to confront the fear in “real life” if that seems appropriate.

A Personal Example of Graded Exposure

I’ve always loved to dance and music makes me want to move. This started triggering anxiety when I was listening to my iPod in public, because I wanted to dance, but knowing people were around who might pay attention made me feel self-conscious. Intellectually, I couldn’t think of any good reason not to do it. After all, dancing isn’t going to hurt anyone. I wanted to feel free and not let fear control me.

First, I imagined dancing in front of other people, and I imagined their possible reactions, positive and negative, and I explored the reasons why I should and shouldn’t care what other people think. Then I started dancing in the street when I knew no one was around. Once I got comfortable with that, I started dancing a little at the bus stop when people were still driving by, and to my surprise, people often smiled or waved which was encouraging… though of course some people laughed or gave me funny looks. Whenever their reactions made me uncomfortable I would simply ask myself, “has their reaction hurt me?”, and reason my way through it. Then I started dancing at the bus stop or on the sidewalk when there were other people there. This culminated in my working as a GoGo dancer in a night club, just once, to overcome the fear completely. The fear faded over weeks, months and years.

Now I can dance wherever I want, whenever I want, without any fear. I find this freedom to express myself to be very liberating.

Our Resistance to Negative Interpretations

While part of us believes the negative or self-limiting narrative we have, our inherent wish to be truly happy causes us to resist them. In fact, we are in perpetual resistance to fully accepting negative conclusions about ourself and life. Our responding to negative ideas and unwanted events with negative emotions is proof of our resistance and reluctance to believe these thoughts.

For example, if we were able to believe and accept that we’re unworthy, unloveable, or “not good enough”, we would, paradoxically, be at peace. We would think, “I’m not good enough, and that’s okay”. The fact these thoughts upset us, that they make us feel sad, angry, or ashamed, indicate we don’t accept them. The fact we often seek validation through our own achievements or through others feelings for us means we’re searching on some level for evidence with which to challenge our self-destructive notions. The therapist’s role is to exploit these acts of resistance in deconstructing the undesirable narrative and in creating a new more desirable narrative that is largely independent of relying on external measurements.

A Personal Example of Systematic Desensitization

One night I woke up very early with a terrible pain in my stomach. I responded to this pain with intense fear and my heart started racing. The pain lasted several hours, went away, came back, went away, came back, and in a matter of two weeks, had become reoccurring. I was having panic attacks in response to this stomach pain, but why?

As I write this now, I still have an unexplained case of chronic gastritis (stomach inflammation). For the first five months I’d often wake up in pain and instantly panic. My heart would start racing and I’d feel incredibly anxious. I wasn’t having any thoughts however. I wasn’t worried about anything, other than not knowing what was wrong with me. The fear seemed particularly unusual because I’ve spent years confronting fears. I meditated on it, and couldn’t find any thoughts or beliefs triggering the fear.

I honestly thought it must be neurological. It seemed so me as if something physiological was causing my stomach to hurt or affecting my heart rate, and like a really primal part of my brain was interpreting those sensations as proof of danger, leading to a positive feedback loop. The symptoms induced fear, and the fear increased the symptoms. That is the nature of a panic attack. I read later on that many people with chronic gastritis develop panic and anxiety disorders. I also read that inflammation can affect the vagus nerve, which would explain the heart palpitations, among other things.

Seeing there were no thoughts or beliefs to work with I had to take a new approach. I told myself when going to bed, that if I wake up in pain, the very first thing I’m going to do is relax. And so, whenever I’d wake up in the night, I took deep breathes and big sighs. I told myself, “I am so relaxed”. Sometimes I would clench and relax every muscle of my body in a kind of body scan. I would rub my hand back and forth on the blankets, appreciating how soft they are.

It didn’t take too long for this practice to start working. The panic attacks and feelings of anxiety began to diminish and eventually ceased altogether and even though the pain remained, it lessened, probably because I was less stressed.