The focus of last week’s blog was why panic attacks occur. The focus this week will be on one of the most effective treatments for anxiety called exposure and response prevention.
One thing we know about anxiety is that the more you avoid what you are afraid of, the greater the fear grows. Imagine if there were a baby tiger outside your door. It growls a little, so you throw a little piece of meat outside the door to keep it away, then immediately shut the door. Now the tiger gets a little bigger, and growls a little louder, so you throw out more meat to keep him happy. Then before you know it, it’s a full-grown tiger and it wants a lot of meat on a regular basis to keep it happy. All it seems like you do is throw it some meat and slam the door.
Does this sound like your anxiety? Just like the tiger it gets bigger and bigger if you don’t deal with it. Exposure and response prevention helps you deal with that tiger instead of getting rid of it.
Why exposure and response prevention works
In order to work on the physiological effects of anxiety, you first need to get used to it (habituate). The goal here is not to get rid of anxiety, as we can’t. We are wired to have anxiety due to our fight or flight instinct, which helps us stay alive.
An example of habituation is walking into a gym. When you first enter a gym, you will notice a smell-perhaps sweat or mildew. However once you are there a few minutes, you don’t even notice it. This is because you habituate (or get used to) the smell. Anxiety is the same way. Once you get used to the feeling and learn that it cannot hurt you, you can habituate to it. You are actually retraining your brain and how it responds to the internal cues of anxiety. The information below comes from a handout on Internal Cue Exposure.
Exposure and response prevention exercises
When we do this we are targeting the various symptoms that people have with panic attacks. Everyone is different, so you may have some of these and not others. We are actually going to suggest that you induce these symptoms to train your brain to recognize these cues as harmless vs. setting off a panic response. When you do these you will feel a moderate level of anxiety, which is what we want.
Increased heart rate
A way to induce this symptom is to run in place, or run up and down steps for 1 minute. Take a 1-minute break. Repeat this exercise 8 times.
Feeling smothered or trouble breathing
Hold your breath for 30 seconds. Breathe regularly for 30 seconds. Repeat 15 times.
Or breathe through a small straw for 2 minutes, and then breathe normally for 1 minute. Repeat 5 times.
Feeling like you are choking or gagging
Put a tongue depressor on the back of your tongue until you start to gag. Repeat this for 15 minutes.
Trembling
Hold a plank position for 60 seconds, or until your body starts to shake. Or tense all the muscles in your body for 60 seconds, relax for 60 seconds. Do either of these exercises 8 times.
Sweating
If it’s summer in Houston go outside. Or sit in a sauna or a hot car until you sweat.
Feeling dizzy or lightheaded
Spin around in a chair that swivels for 1 minute. Stop for 1 minute. Repeat 8 times.
Or for 30 seconds shake your head from 1 side to the other. Stop for 30 seconds. Do this 15 times.
Or sit down and put your head between your legs. Then quickly sit up. Repeat 15 times.
Or quickly breathe in and out for 1 minute. Breathe normally for 1 minute. Repeat 8 times.
Derealization (when you do not feel that things are real)
Look at a light in a room for 1 minute; try to read for 1 minute. Do this 8 times.
Stare at your face in the mirror for 3 minutes, and then look away for 1 minute. Do this 8 times.
Put a dot the size of a dime on a wall and stare at it for 3 minutes.
Look at an optical illusion for 2 minutes, stop for 2 minutes and repeat 5 times.
How to put exposure and response prevention into action
Pick a trigger to work on. You want to start with the one that you are first aware of. You know the one that gets your anxiety going. Let’s say for the purpose of this example we are going to work on breathlessness. Look at the 2 options for inducing this-either holding your breath or breathing through a straw. Rate your anxiety level for each one on a scale of 1-10. Now look at the rating and pick one that is in the middle range, say 4-6. Rate your level before starting the exercise, during it and after it. You want to do this everyday for 1 week. As you continue to practice your exercises, your anxiety level will eventually come down. You can also do this with the rest of your symptoms of anxiety.
Working with a therapist
This is best done while working with a therapist, as there are other things to do in addition to these exercises that can be helpful. You can also do some of these exercises in the office if you are afraid to do them at home. Another goal moving forward is to begin exposing yourself to the place or situation that you are afraid of.
If this is something you struggle with, please give me a call at 713-304-6554.
Take care,
Debbie
