Act As If Your Anxiety Is Irrelevant

Hello Everyone,

I hope you are all doing well and that this post is helpful as you seek to manage your anxiety.

In this week’s blog post I thought that I would continue with my theme of expanding upon the suggestions in the recent PDF I wrote entitled Guidelines for Doing Exposure Therapy. If you haven’t already read my two previous posts on this topic you might want to check them out here and here. A point that’s worth mentioning again is the idea that though exposure therapy comes under the general heading of “psychotherapy”, it is not what most people think of as traditional therapy. With exposure therapy don’t just sit in an office and discuss your history or your feelings, it is much more action oriented and focused on how you can behave differently in the present to overcome and learn to manage anxiety.

If you’re following the points on the Guidelines for Doing Exposure Therapy document this post is about items 4 and 5: 

“4. We used to think it was important to stay with an exposure until your anxiety came down, but recent evidence suggests that is less important than we thought. Decide beforehand how long you’re going to do the exposure for and then do that. Don’t worry if your anxiety doesn’t come down, just keep doing the exposures.

5. The focus should be on living your life the way you want even if you are anxious.”

A Common Mistake

A mistake that many (most?) of my clients make is becoming totally focused on getting rid of their anxiety which,paradoxically, usually backfires and creates more anxiety. People can get anxiety about having anxiety which, if you think about it, only tends to add gasoline to the anxiety fire. When it comes to fixing something in our external world, such as perhaps a flat tire on your car, changing tires and eliminating the problem is the correct response, however, when it comes to “fixing” something in our internal world, such as anxiety, trying to remove it is the incorrect response. As I’ve mentioned in previous posts, acceptance and willingness almost always works better. You have to “feel to heal”. This idea has been around for a number of years (see Clair Weekes classic 1962 book Help and Hope for Your Nerves), but has been slow to catch on. 

What We Used to Think Worked

Earlier models of exposure, often called systematic desensitization, used a very different model than what I’m suggesting. This has often been called an “habituation” model wherein after being exposed to a scary stimulus of some kind it was thought you had to stay with the exposure until the anxiety came down to some degree before terminating the exposure. Dr. Craske’s work  suggests that this isn’t necessary after all. Her approach has been entitled “inhibitory learning”  and is based upon the idea that the exposure's purpose is to put new learning on top of old learning and it’s simply a matter of repeating the process over and over again.

What Works Better

So, in short, identify what you’re afraid of, perhaps create a hierarchy (I’ll discuss hierarchies in a future post), and then regularly and systematically expose yourself to what you are afraid of. Along the way make sure you're approaching the exposures within an accepting and willing posture toward your anxiety and let whatever feelings come up just come up and stay with it.

Another Common Mistake

Another mistake that my clients make is that they watch their anxiety level like a hawk. They closely monitor their heart rate, breathing, dizziness, etc. and by doing so remain completely focused on questions such as “Is my anxiety going down or not?”  A much better question to ask is, “Am I living my life the way I want?” Acting as anxiety is actually irrelevant is the position you want to take. 

The whole purpose of exposures is to allow you to live your life the way you want and it can derail your progress if you keep focusing upon anxiety reduction as opposed to living the life that you want.  While it is likely that following this process will ultimately lead to a reduction in your anxiety, that cannot and should not be your focus. The focus needs to be on doing what you want with your life irrespective of whether you have anxiety or not. 

This perspective takes some getting used to as it is not at all the perspective that most of my clients come to therapy with,  But I truly believe this is the perspective that offers the best long-term solution for managing an anxiety disorder.

An Additional Resource

Depending upon how much you want to learn about this topic of exposure therapy, here is a link for an interview of Michelle Craske, Ph.D conducted by Jacqueline Persons, Ph.D regarding Dr Craske’s 2014 research paper on the topic. Dr. Craske has been on the cutting edge of the research in this area and though this paper and interview may be a bit dense, they are both well worth the time to read and listen to. 

An interesting portion of this paper is the sample exposure exercises that are listed at the end. Samples of actual exposure exercises for OCD, PTSD, Social Phobia, Specific Phobia and Panic Disorder are provided. Much of my thinking about how to conduct exposure therapy has been greatly influenced by Dr Craske’s work and I will cover additional points from Dr Craske’s work in future posts.

As always, let me know if I can be of any help and I’m happy to answer any questions you might have. This post isn’t meant as a substitute for therapy and so if you’re struggling with anxiety/OCD please consult a qualified therapist.  

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If you’re struggling with OCD then you might want to consider attending the annual International Obsessive Compulsive Disorders annual conference this summer in Denver, CO. I’ve attended many conferences and this one is hard to beat.

Stay safe,

Dr Bob