While many panic disorder and agoraphobia sufferers have tried exposure therapy and succeeded, many have tried and called it ineffective or a failure. Often this is simply due to misconceptions about what exposure is designed to do and mistakes in exposure technique. Exposure therapy is – as part of an overall cognitive behavioral therapy strategy – one of the most effective tools we have to deal with our anxiety issues. Mountains of clinical evidence backs this up.
What Is The Goal?
The goal of exposure therapy is not to make your anxiety or panic go away. The goal is to teach you not to fear those things and to change how you react to them. HUGE difference. As is so often the case, many are primarily interested in stopping the symptoms and sensations of anxiety stop. This is often a frustrating endless game of whack-a-mole. Instead we’re better served by learning through direct experience that there’s no reason to be afraid. You can close your eyes tightly and hide under the covers all night or you can just look under the bed to see that there’s really no monster there.
There’s A Reason They Call It Exposure Therapy
Exposure means confronting your anxiety and having intimate contact with it, with each session lasting a bit longer than the last. This is the key, and where most make the fatal error. Exposure is not an arms length hit and run affair. Driving to the supermarket and virtually running through the frozen foods department in an effort to get back home as quickly as possible might be OK in your first few sessions, but the real goal is to start to slow down and to stay longer and longer in the situation you fear. This is the way we learn that being in the supermarket won’t kill or hurt us.
Quantity Is As Important As Quality
This isn’t something you hear often but in the case of exposure therapy it’s true. One trip to the dreaded shopping mall every two weeks when you feel up to it isn’t going to be terribly effective. You must push yourself to practice every day no matter how you feel. If that sounds hard, it is, but that’s how it works. Effective exposure is always gradual but is almost never easy or comfortable – especially in the early stages.
This is a debated issue. Safety devices, safe people and safety rituals might be used to help you get the ball rolling, but you’re going to have to leave them behind and go it alone and “raw” at some point. Being able to pick up your kids from school only if your mother or girlfriend is with you is better than not going at all, but that’s not really your goal is it? Just as a child must take off the training wheels to learn to ride his bicycle, we must ultimately drop our shields and rituals to achieve our goals.
(Special note regarding stopping medication: If you’ve been taking a benzodiazepine (benzo) like Xanax or Valium or Ativan regularly (i.e. once or more every day, or ever other day) for any length of time, you can NOT simply stop taking it. Stopping a benzo cold turkey can be dangerous. Please involve your doctor should you decide that you do not want to take your benzo any longer. The same applies with many classes of antidepressants, which must be tapered slowly in order to avoid problems.)
When Failure Isn’t Really Failure
If you’ve decided that exposure doesn’t work for you, ask yourself if you’ve fallen into any of these traps. Were you doing the “hit and run” thing to escape your fear? Were you waiting for “good days” to do your exposure work? Were you expecting your anxiety to go away after five trips to the mall? None of this makes exposure therapy – or you – a failure. They’re very common mistakes and misconceptions that ambush lots of smart people. Maybe it’s time to reevaluate and make a new plan. Success might be right around the corner for you!
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