Anxiety and Exposures- Facing Fears

Anxiety and Exposures- Facing Fears 

When I explain that the way out of experiencing anxiety symptoms is doing things (exposures) that actually stimulate anxiety, I find that people just don’t want to go there.  I don’t blame them.  Doing things that scare you is really hard.

Exposure therapy is the process of starting with small actions that are scary and then gradually doing scarier actions associated with a fear.  It can be used with phobias like fear of driving, fear of going to the doctor’s office, but can also be used when you find yourself super anxious with the thought of talking to your boss, parent, friend or partner.

Timing and the level of exposure matters in exposure therapy. If you take on a little too much, you may not be willing to keep up the repetition it takes to achieve anxiety symptom reduction or better relationships or ability to do activities you fear doing. If you do things too little, it won’t address the anxiety issues. Let’s take driving anxiety.

Driving anxiety is pretty common. It comes in different forms- some people fear driving long distances, others on certain streets, specific lanes, at night, over bridges and overpasses, freeways/highways, traffic circles to name a few. The thing that they all have in common is the fear of driving a car in some way somewhere at sometime.

Let’s take driving on bridges for an example. People may have driven on bridges without a problem in the past and now it freaks them out so what do they do? Avoid driving on bridges.

Our anxious mind rationalizes this decision by making up all kinds of thoughts that increase the perception of a risk of driving on bridges. First, the intrusive thoughts- What if I accidently steer off the barricade? What if someone else causes an accident that makes me steer off the barricade? What if my car stalls and I can’t get off of the bridge leaving me stuck? Then the behaviors/responses- I will drive 30 miles out of my way to avoid the bridge and I really don’t mind it.  I’ll just listen to my audio book. Or I’ll take an Uber. Or just not go.

And here we go…avoidance, avoidance, avoidance.  

So, what can be done if a person just can’t drive over a bridge right now? Action…take small actions that involve a bridge. And continue the repetition of this behavior even when it makes you uncomfortable. But how do you know what level to start? You begin by doing behaviors that involve smaller levels of discomfort.

You start by doing behaviors that are less threatening than driving over bridges but involve bridges, like possibly the behavior of looking at bridges- online, pictures of them in books, or in real time from a distance. Maybe you draw a picture of a bridge.  Or listen to music with lyrics that involves a bridge or singing the word bridge.  Possibly saying the word bridge over and over and over again.

By talking, singing, looking, you entertain the idea of a bridge.  You don’t avoid it. The response prevention piece of this exposure puzzle is actively doing things that are not the avoidance behaviors associated with bridges. It’s a first step. And it’s not a “one and done.” You repeat these behaviors.

Working with a therapist who specializes in anxiety can be very beneficial here since you may have all kinds of thoughts and feelings associated with this exposure.  But it is not necessary. It is though super helpful, especially when it comes to figuring out what your next exposure will be, and attaining helpful education about anxiety and how it manifests in you. I mean after all you still aren’t driving on bridges.

The next step may involve imaginal exposure, where you close your eyes and imagine driving over the bridge. Recreate your seat in your car while sitting in your office, or actually sit in your car and do this imagery. Or maybe look at videos online that involve people driving over a bridge.  They are out there.

OK so you’ve looked at pictures, videos, and imagined yourself (or remembered yourself) driving over a bridge. Then what?

Here’s where the rubber meets the road.  You’ve got to drive.

Ok there are bridges and then there are bridges. Think about it- small bridges that cross over a creek, highway or gulch, and then there is the Golden Gate Bridge and Coronado Bridge in CA or the Overseas Highway, running from the Florida mainland to Key West that has 42 bridges, one of which is 7 miles long.

Obviously, you are going to start small.  Find a smaller bridge and drive over it.  Over and over and over.  This could happen over hours, days, weeks or months.  But until you do this regularly and repeatedly you likely won’t get over your fear of bridges and your anxiety symptoms that go with it.

Why does that matter?  Well, here is where the motivation comes in, and according to therapists Drew Linsalata and Joshua Fletcher, anxiety specialists, this ties into your values- what you think is important in your life.  Could be family, education, a job, leisure pursuits, nature, travel.  It is helpful to tap into the why so that you take the risk to expose yourself to the fear, or what therapist Rick Hanson terms “The dreaded experience.”

You must actually act, not just talk about acting.

You may want to consider scheduling some time devoted to doing exposures.  Because they are scary, your anxious brain is going to find all kind of excuses not to do them.  Not feeling well, not in the mood, don’t have the energy, I’m afraid it’s going to be too much, it wasn’t a good time, etc.  Some of these excuses feel more valid and reasonable than others. This is where you figure out a time that makes sense to you. Schedule it on a calendar, ask a friend or therapist to hold you accountable- whatever it takes.  And remember to use a great deal of self -compassion and self- kindness along the way.  This is really hard stuff. Support yourself by enlisting the help of others.

In addition, expect that you will get anxiety symptoms.  Shaking, sweating, rapid heart rate, stomachache- whatever happens to you, will happen. Those symptoms can be really difficult to tolerate. But this heightened state won’t last forever and you will be ok.  You will drive across the bridge successfully. Each time you do that, it is a reminder to your brain that driving across a bridge is ok, and you are ok, just highly physically uncomfortable.

Exposure and response prevention work is challenging. It’s really difficult to elect discomfort and stop doing things that in the short term make you feel better, like avoiding driving on a bridge. But it works and it is why it’s the gold standard in anxiety treatment. As therapist and anxiety specialist Kimberly Quinlan says, “It’s a beautiful day to do hard things.” Contact me for a free 15 minute consultation to explore how I can help you face your anxiety.