Embracing The Unknown
In the diverse tapestry of human experiences, anxiety, with its multifaceted expressions, is a common thread that weaves through many of our lives. There’s a sense of irony here; the very human experience of anxiety can make us feel isolated, even though it is an experience shared by many. You're not alone in feeling this way, and it’s crucial to remember that help and support are within reach. One form of support comes from a treatment known as exposure therapy, a form of cognitive-behavioral therapy that can be highly effective in managing anxiety. Let’s learn more about different exposure therapies, caveats, and finding the right therapist. First, let’s just check in regarding common symptoms of anxiety.
The Many Faces of Anxiety
Anxiety, by its nature, is a normal reaction to stress. It's our body's natural alarm system, priming us for fight or flight. However, when anxiety begins to disrupt daily activities and relationships, it becomes an anxiety disorder. Common symptoms of anxiety in adults can include:
Excessive worrying that's difficult to control
Feeling restless, on-edge or irritable
Difficulty concentrating
Racing or troubling thoughts that disrupts your day
Fatigue and problems sleeping
Muscle tension
Remember, everyone’s anxiety looks a little different, and that’s okay. The key is recognizing when it's time to seek help and support.
Unveiling Exposure Therapy
Exposure Therapy is a proven psychological treatment that helps reduce fear and anxiety. It involves confronting your fears in a safe, controlled environment, under the guidance of a therapist. Over time, this allows you to gain control and reduce anxiety responses to these fear-inducing situations. I always tell my clients that it is scary to confront your fears, however, they understand that it is a part of therapy. When I use this approach in therapy, I note that we are not “diving into the deep end of the pool” before we learn how to “swim” first.
There are two primary forms of exposure therapy that we'll delve into today - Exposure and Response Prevention (ERP) and Prolonged Exposure (PE).
Exposure and Response Prevention (ERP)
Exposure and Response Prevention (ERP) is a form of cognitive-behavioral therapy specifically designed to treat Obsessive-Compulsive Disorder (OCD) and other anxiety disorders characterized by avoidance behaviors. The basic principle behind ERP is to expose individuals to thoughts, images, objects, and situations that make them anxious and prevent them from performing their typical compulsive responses to reduce this anxiety. Again, going from the “shallow” end of the pool to the “deep” end over time and gradually.
By continually confronting what makes you anxious without resorting to compulsions, your brain learns over time that the feared outcomes are unlikely to occur, or even if they do, you're capable of handling them.
Here are some strategies used in ERP therapy to better understand how it works:
Psychoeducation - Understanding your symptoms and the science behind your anxiety and OCD is the first step in ERP. Psychoeducation helps demystify your experiences and makes the therapeutic process more transparent and collaborative.
Hierarchical Exposure List - Together with your therapist, you'll create a hierarchical list of anxiety-provoking situations, ranking them from least to most anxiety-inducing. This step is crucial for the gradual and controlled exposure process.
Graded Exposure - Graded or gradual exposure involves systematically confronting situations from your hierarchical exposure list. You start with less anxiety-provoking situations and gradually work your way up the list as your tolerance to anxiety improves. You will also work with your therapist to process each step in the exposure.
Response Prevention - This is the second critical component of ERP. While you're exposed to anxiety-provoking situations, you'll be encouraged to refrain from engaging in the compulsive behaviors (actions that are engaged in repeatedly and consistently) that you typically use to decrease your anxiety. This process can be challenging, but it's essential for teaching your brain that the anxiety can decrease on its own without the compulsion.
Mindfulness and Acceptance - These strategies help you remain present during exposures without judging or trying to escape your anxious feelings. Mindfulness and acceptance strategies can help you develop a new relationship with your anxiety, viewing it as a part of the human experience rather than something that must be eliminated.
These ERP strategies, while simple in theory, require commitment and professional guidance. Although the process can be uncomfortable, it's often incredibly effective, helping individuals with OCD and similar disorders to significantly reduce their symptoms and regain control over their lives. Always remember, it's important to undertake this journey with the help of a trained mental health professional.
Prolonged Exposure (PE)
Prolonged Exposure Therapy (PE) is a type of Cognitive Behavioral Therapy (CBT) specifically formulated to help individuals living with Post-Traumatic Stress Disorder (PTSD), panic disorder, and other anxiety-related disorders. Developed by Dr. Edna Foa, the therapy's underlying premise is that repeated exposure to thoughts, feelings, and situations related to trauma can help reduce the power they have to cause distress.
Here are some key strategies used in Prolonged Exposure Therapy to better understand how it works:
Education - In the initial sessions when introducing PE, the therapist provides education about anxiety, PTSD, and the overall process of PE. Understanding the nature of your symptoms and how PE works can help increase your readiness for exposure practices.
Breathing Retraining - Breathing retraining is a simple yet powerful strategy often used as a grounding technique. This practice involves deep abdominal breathing to help manage immediate symptoms of anxiety and promote relaxation. This is an important step as you move through the other steps in PE with your therapist.
Imaginal Exposure - This strategy involves repeatedly recalling the traumatic event in a safe and controlled environment. While it might seem counterintuitive, the aim is to reduce anxiety and distress related to the memory over time. This is achieved as you learn to differentiate between the memory of the event and the event itself, understanding that remembering the event is not as dangerous as the event was.
In Vivo Exposure - In Vivo Exposure involves confronting real-life situations that trigger fear or anxiety, going from the “shallow” end of the pool to the “deep” end. For example, someone with a fear of crowds may gradually and systematically be encouraged to visit increasingly crowded places, starting from a small store, then a busier supermarket, and finally a bustling public event.
Processing - Processing takes place after each exposure (imaginal or in vivo). Here, you'll discuss the exposure experience with your therapist, examining any negative thoughts or unhelpful beliefs you might have and learning to reframe them in a more accurate or helpful way.
Each of these strategies is designed to help you face and gain control over your fear and anxiety. Through this repeated exposure, you learn that the anxiety and fear naturally decrease and you can handle feelings of distress in a healthier way.
Remember, PE should always be conducted with the guidance of a trained professional. While it can be challenging, many people find it helps them significantly reduce their anxiety symptoms and improve their quality of life.
Caveats to Exposure Therapy
Despite its efficacy, exposure therapy might not be the best fit for everyone. It requires confronting fears directly, which can initially intensify anxiety levels. If you have serious health issues, like heart conditions, it’s best to discuss this treatment option thoroughly with your healthcare provider. Additionally, exposure therapy requires commitment and consistency, which might be challenging for some individuals. You can raise concerns and discuss these with a therapist as well.
Finding the Right Therapist
Finding a therapist specializing in PE or ERP begins with a careful and intentional search.
Here are a few steps:
Start with online directories such as PsychologyToday
Check out reviews or testimonials of therapists, and even review their websites (like this one).
Contact potential therapists and ask about their experience and success with PE or ERP.
Most are happy to answer your queries over a call or an email. Often times, therapists offer a free consultation or introductory meeting (like this link) to review their practices in therapy, answer any questions you have, and ensure both of you are a good fit to work together.
Remember, it's crucial to feel comfortable with your therapist. If the first one doesn’t feel right, don’t hesitate to seek out others.
Taking control of your anxiety can feel like a daunting task, but with the right tools and support, it's an achievable goal. The journey may be challenging, but the destination—a life less burdened by anxiety—is well worth the effort.
Until next time, remember to be gentle with yourself. You're doing the best you can, and that's enough. In the realm of mental health, there is no one-size-fits-all, but there is always hope, resilience, and the promise of a more promising tomorrow.
Better Minds Counseling & Services provides exposure therapy to adults located in Pennsylvania through virtual therapy. If you are interested in learning more or scheduling an introductory meeting, use this link here.
Blog Disclaimer - These posts are not meant to treat, diagnose, or serve as a replacement for therapy. If you or someone you know is experiencing a mental health emergency, please contact your local crisis center or dial 911. Here are more immediate resources as well.