Do you experience symptoms that are different from those in the previous list? What are they? Write them down below.
WHAT ARE YOUR ANXIETY SYMPTOMS?
In the preceding chapters, you learned that mistaken beliefs frame what you avoid with fear and that avoidance behaviors lead to more anxiety. You learned how to change your mistaken beliefs and avoid avoidance. Now, you’re ready to take the next step. You will actually induce some of the physical sensations associated with anxiety and panic, so that you can habituate to them and neutralize their negative effects.
Because you have been working to change your automatic thoughts, assumptions, and core beliefs and have learned relaxation exercises, as well as breathing and positive self-talk, you’re now better able to cope with and adapt to the physical sensations you overreacted to in the past. Your new thinking skills have helped you understand that your physical sensations are nothing to be alarmed about. Now, your thoughts and emotions need to be integrated positively with your physical sensations. Because your thoughts often lead the way, and your emotions eventually follow, integrating positive thoughts are important when experiencing the bodily sensations you have been avoiding like the plague.
In this chapter, you’ll learn the skills necessary to accept the physical sensations associated with anxiety and panic, so that they can fade into the background and won’t continue to demand your attention. You’ll learn:
• why it’s important to face your physical sensations.
• that your physical sensations are not dangerous.
• how overreacting to physical sensations leads to panic.
• to break the panic cycle by riding out the physical sensations.
• how to use interoceptive exposure to habituate to your physical sensations.
These physical sensations are common to people familiar with anxiety and panic:
• lightheadedness
• dizziness
• blurred vision
• cold hands
• muscle weakness
• heart palpitations
• feeling like you’re not getting enough air
• numbness or tingling
• sweating
• difficulty focusing your thoughts
• choking
• shaking or trembling
• hot flashes
• nausea
• chest pain
Do you experience symptoms that are different from those in the previous list? What are they? Write them down below.
One of the factors that contributes to avoidant behaviors is referred to as anxiety sensitivity. If you think that any anxiety is bad and must be avoided, you cultivate anxiety sensitivity—you become hypersensitive to the sensations that you assume signal danger ahead. They are actually false alarms.
Here’s how it works: Let’s say you are anxious in social situations. You decide that you will engage in social situations only when you are free of anxiety, because you don’t want others to know that you are anxious. Each time you experience some anxiety, you experience it in an all-or-nothing way. Although there are actually degrees of anxiety, when you’re stuck in an all-or-nothing mode, a little feels like a lot. A little anxiety in a social situation becomes intolerable, because even a little anxiety is too much to handle. So you avoid similar situations. Then other situations that are the slightest bit social make you anxious, just by thinking about them. Soon the physical sensations that you associate with anxiety occur without provocation. When you try to avoid those sensations, your anxiety sensitivity increases. And, most important, your anxiety level increases because you fear the physical sensations.
Doug fell into this trap. He began feeling a tightness in his chest and some constriction in his throat. When he felt these sensations, he began to have trouble swallowing and began to breath quickly. Then, his heart started to race and he began to panic. Soon, Doug began to monitor and fear feeling tightness in his chest. Even a little tightness became too much tightness. He did whatever he could to minimize any chance of feeling this sensation.
Dr. David Barlow from Boston University pointed out the importance of differentiating between false alarms and real alarms. False alarms are learned (conditioned) alarms. A false alarm is like Doug’s feeling of tightness in his chest. When he felt his chest become tight, the alarm went off that something terrible was going to happen, and he began to panic. But nothing terrible did happen, so the alarm wasn’t real. When you avoid dealing with learned alarms, they can strengthen and become resistant to extinction.
A paradox occurs when you try to avoid your physical sensations. When you try really hard not to feel something, you’ll feel it even more. For example, try really hard to not sense the weight of this book in your hands. Try to block out those sensations! Because I brought the feel of this book to your attention and asked you to try hard to keep those sensations out of your mind, you noticed them even more.
A funny thing happens when you stop trying. Once you acknowledge and simply observe the sensations of the book’s weight and feel, they fade into the background. This is the principle used in many chronic pain programs. Chronic pain patients learn to stop trying to avoid or block out the physical sensations of pain and instead observe and accept them. This can be frightening for people who have been traumatized by debilitating pain. Why face terrible pain when they have had too much of it already? The answer is that by accepting the pain, it actually fades. This is one step toward making chronic pain tolerable. The same principle applies to the physical sensations you associate with anxiety. You want to stop trying not to feel those sensations. Instead, observe and accept them.
The key to accepting your physical sensations and turning off the false alarms is to shift from yes-versus-no, black-versus-white, and all-or-nothing frames of reference. Trying to feel no physical sensations, such as sweaty palms, for example, makes even slightly sweating palms feel like they’re dripping wet. It’s like a pendulum. The farther you push it one way, the farther back it will swing. The harder you try to push your sweaty palms out of your mind, the sweatier they become. As you become anxious about the physical sensations, your anxiety increases. The way out of this vicious cycle is to shift from the all-or-nothing perspective to a detached-observer perspective and simply note that your palms are sweating. Eventually, they’ll dry out.
The more you fear the physical symptoms of anxiety and panic, the more you become hypervigilant about them, and even normal bodily sensations become alarming. Doug’s fear of the tightness in his chest increased his anxiety. He began to fear other sensations, as well, which soon spurred panic attacks. This panic cycle is self-perpetuating. Here is a typical panic cycle:
You can break this cycle at any point along the way. Because the physical sensations can be false alarms, you’ll need to learn to detach yourself from them and ride them out. That’s where shifting away from the all-or-nothing frame of reference comes into play. By learning to accept your physical sensations, you put out the fire before you can pour gasoline on it.
Panic disorder results from being phobic about your own bodily sensations. Just as Doug became phobic about tightness in his chest, you can become phobic about physical sensations such as shortness of breath, a dry throat, or dizziness. If you suffer from panic attacks, you likely are constantly monitoring your body for any physical sensation that might “warn” you that an attack is on the way. You try to “make sure nothing terrible happens.” So you avoid doing anything that might stir up those bodily sensations, such as jogging, running up the stairs, or playing games that require a lot of physical exertion.
Panic attacks come seemingly out of the blue. They occur when you suddenly feel physical sensations that you fear. Consequently, you have a tendency to try to control the conditions in which these sensations occur. Because avoiding what you fear leads to the temporary belief that you are in control, your avoidance behaviors will probably increase. Yet, the physical sensations always seem to be around the next corner. You might even feel that they’re chasing you. So, you try to keep one step ahead of them by avoiding even more things that could bring them on again. There is a very basic problem with this: These sensations are not dangerous! They are dangerous only in your mind.
As you learned in the last chapter, the more you avoid what you fear, the more you will fear it. Avoiding fears is a short-term solution that creates a long-term problem and results in anxiety, phobias, and panic attacks. Avoidance essentially gets your amygdala over-sensitized to minor sensations. Then, your frontal lobes narrow your attention to warning signals that are really false alarms. For example, if, like Doug, you fear the sensation of your chest tightening, any semblance of a tight chest will activate your amygdala.
The way out of this trap is to become used to those physical sensations, so that they don’t trigger false alarms and result in panic attacks. You conditioned yourself to respond to these sensations as if they were of “alarming importance.” Now, you must “de-condition” yourself to them, so that they are just like any other sensations. Now that you understand this important principle, we can move to the technique called interoceptive exposure, which will help you habituate to your own bodily sensations, so that they won’t frighten you.
Anxiety specialists such as Drs. Barlow, Craske, and Zuercher-White point out that there are two main sources of fear that generate anxiety disorders: extroceptive and interoceptive. Extroceptive fear is about something outside of you. Interoceptive fear is about something inside of you. Extroceptive fear occurs when you overreact to feared objects or situations. For example, in social phobia, extroceptive fear occurs when you stand in front of a group of people giving a presentation. Interoceptive fear refers to your reactions to internal sensations, such as the physical sensations that occur when you stand in front of those people: a dry mouth, sweating, and butterflies in your stomach.
Interoceptive exposure is a process of systematically desensitizing yourself to those physical sensations; it helps you habituate to them. During interoceptive exposure, you restructure your thinking, using positive self-talk and narratives, while experiencing the physical sensations that arise. Developing new automatic thoughts and assumptions during interoceptive exposure exercises helps you gain confidence and learn to ride out those physical sensations, so they eventually become innocuous.
Remember, the goal is not to eliminate anxiety but to reduce it and make it more manageable. Anxiety is a necessary part of life that can be used to keep you constructively alert and motivated.
Normally, a person without panic disorder appraises activated physical sensations, such as rapid heartbeat and shortness of breath, as innocuous. A realistic assessment of the potential danger of an anxiety-provoking situation derails the fight-or-flight response from being triggered. The brain’s hippocampus accesses memories and context that allow for such thoughts as, “Oh yes, I’ve had shortness of breath and a rapid heartbeat before. Nothing bad happened.”
Some researchers, including Dr. Albert Bandura of Stanford University, have pointed out that believing in your ability to succeed is the most important factor operating in anxiety disorders. If you think that you are unable to cope with anxiety in what you assume to be a potentially threatening situation, your anxiety increases. When you develop self-confidence, your anxiety decreases. In other words, when you believe that you are able to deal with the situation, your anxiety level goes down. When you observe and accept the physical sensations that arise, your sense of mastery over them makes your anxiety fade.
Bandura cites well-known studies that involved administering epinephrine (adrenaline) to subjects who were led to believe that they were either in a positive (controllable) or negative (uncontrollable) situation. Those who believed that they were in an uncontrollable situation experienced increased anxiety from the epinephrine. Those who were led to believe that they were in a controllable situation reported great pleasure. The point is that a shot of adrenaline doesn’t necessarily lead to anxiety. It’s all in how you interpret the sensations. If you interpret the physical sensations positively, or at least as a neutral experience, you won’t be plagued by anxiety.
Because your previous response to the physical sensations was to avoid them, what I am about to propose may seem counterintuitive. If you invite, accept, and do not resist your physical sensations, you will defuse, disarm, and diminish their negative effect. What you’ll learn to do is the opposite of what you feel is safe.
As a first step toward learning interoceptive exposure, let’s examine your current automatic physical sensations. In the left-hand column, write down the physical sensations that apply to you. These physical sensations can include sweaty palms, rapid heartbeat, and shallow breathing, among others. In the right-hand column, write down your usual response to these sensations.
| PHYSICAL SENSATIONS | RESPONSES |
| Shortness of breath | I breathe harder to get more air |
Now that you have identified what your usual responses are to physical sensations, it’s time to practice your coping skills. Use the following worksheet to identify the physical sensations and the newly learned skills you will use to cope with each one. This exercise will help you remember to use your coping skills.
| PHYSICAL SENSATIONS | RESPONSES |
| Shortness of breath | I’ll breathe abdominally |
The next step is to actually bring on the physical sensations and try out your coping skills. This shift requires that you move toward, not away from, the physical sensations that make you anxious.
This probably sounds like a frightening challenge. But don’t forget that rewiring your brain requires that you do what you don’t want to do. If you do what you feel like doing, you’ll continue strengthening old habits. We generally do what comes easily, and the more we do those things, the more we will do them again and the more they will eventually come easily. Change requires forcing yourself to establish new habits, especially when your old habits include avoiding discomfort.
I wrote the following paragraphs while stuck in an elevator in a Washington D.C. hotel (truly!). If I had been plagued by anxiety, I would have reacted to this experience with panic. But I decided to use this as an opportunity instead.
It is hot in here, and there’s little air to breathe. I am sweating profusely. Yet, I am not experiencing any anxiety because these physiological symptoms do not press the alarm button for me. Neither does the situation. I’m not trying to act macho by saying this. Rather, I am illustrating the point that we react to what we interpret as dangerous. This situation, for me, is not.
I can hear the fire department working to open the door. I don’t know how long it will take before they succeed. I can make this experience intolerable, or I can cope with it. I’m coping with it, not by distracting myself, but by focusing on the experience itself.
I’m observing that it is getting warmer, and the air is getting even more stale. I’m sweating, despite becoming dehydrated. This is a forced exposure exercise that includes one physiological sensation I have grown to dislike, dehydration. But I know that I can simply observe and accept these sensations. As I listen to the rescue crew yell to one another in frustration that it is taking longer than they expected, I can assume that I will be stuck in here for many hours, or I could just accept whatever happens. I will go with the latter because this is the only reasonable choice. Why fight what I cannot control?
Just as I’m doing now, your job is to turn each experience into a positive. I turned this into an opportunity to write a little sidebar for this book. Each situation can yield its own opportunities. By shifting to acceptance and observance, you permit yourself to make your experiences positive.
They’re now yelling to me, “Are you all right?”
I yell back, “Take your time. I’m fine.”
A few minutes go by, and they open the doors. I jump out of my writing chamber and thank them for their help. Secretly, I thank them for the opportunity to write this section.
In the following pages, you will be using a variety of methods to induce the physical sensations you fear. It’s time to gain mastery over these false alarms. You’ll soon learn to habituate to the physical symptoms to which you’ve been overreacting.
Listed below are some things that will be useful to have available for the exercises, along with some things to keep in mind as you prepare for the exercises.
• Use the worksheets in this chapter to help demonstrate gains as you practice the interoceptive exposure exercises.
• In addition to the worksheets, you might need the following items: a timer, a pencil, and a straw.
• There is a major difference between anxiety and sensation intensity. Anxiety is uncomfortable at best and frightening at worst. Sensation intensity (shortness of breath and dizziness) need only be uncomfortable at its worst. To see this difference, observe your SUDS score go down, despite the physical discomfort.
• Some people like to have a coach available (a friend or family member) to give encouragement. You may want the coach to do the exercises with you.
• It’s common to experience anxiety and/or panic the first few times you perform the exercises. This a great opportunity to practice the anxiety-reduction techniques you learned in the previous chapters. You need practice!
• Allow yourself to fully experience the symptoms. Trust your ability to succeed. The idea is to habituate to the sensations. You want the full benefit of the exposure.
• Keep doing the exercises until you get your SUDS down to 20.
• The exposures should be regular and graduated in intensity, versus sporadic and intense. In other words, you’ll need to do them often and increase the difficulty level steadily. Don’t practice sporadically, and then try to make up for lost time by going from 0 to 60 in intensity.
• Apply coping skills, such as abdominal breathing and positive self-talk, during the exposure exercises. Say to yourself, “Oh, this rapid heartbeat is no big thing. I’ve experienced it many times, and nothing terrible happened.”
• Stay focused, to maximize the involvement of your frontal lobes and memory, so you can allow yourself to increase self-efficacy during the exposure. Pay attention and observe yourself as you perform the exposure.
The interoceptive exercises include:
• overbreathing
• running in place
• holding your breath
• spinning
• swallowing quickly
• tensing your body
• standing up quickly from lying on the floor
• staring at one spot
• shaking your head from side to side
• putting your head between your legs, then sitting up
There are a few exclusions for these exercises. If you are pregnant or have asthma, a heart condition, low blood pressure, or epilepsy, don’t engage in these exercises. Ask your doctor whether these exercises put your medical situation at risk. Overall, however, most people without these conditions should be able to perform these exercises without risk.
The worksheets that follow are designed to demonstrate your progress and to show you how you can improve. Each of the exposures, such as spinning or overbreathing, should be performed repeatedly and as instructed. Don’t forget that the physical symptoms are not dangerous! Getting your heart rate up, for example, will not cause a heart attack, hyperventilating will not cause you to pass out, and swallowing quickly won’t make you choke to death. For each worksheet:
• Jot down your symptoms.
• Give them a SUDS score.
• Write down your worse fear(s).
• Estimate the odds that it will happen.
• Note whether your worst fear occurred: Y/N.
• Write down what you did to cope.
After each exercise, I’ll describe what Carol, a person who attended my class, said about the exercises, so that you can see how someone else reacted. Not everyone responds in the same way. So if your reaction is different, there’s nothing to be worried about. Your goal is to repeat each exercise until your SUDS score goes down to 20. Don’t try to do them all in one day, at one go. Carol performed each of these exercises over a period of weeks, then practiced them at home between classes.
Overbreathing leads to lightheadedness and rapid heartbeat. This overbreathing exercise can illustrate how to unlink hyperventilation and panic. Your task is to hyperventilate by breathing quickly, with an emphasis on the exhale, for 1½ minutes. Alternatively, you can breathe through a straw for 1 minute. Hold your nose while breathing through the straw, and try to get as much air as you can.
| EXERCISES | DESCRIBE YOUR SYMPTOMS | SUDS | WORST FEAR | ODDS OF THIS HAPPENING | DID IT HAPPEN? | YOUR COPING SKILLS |
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| Trial #3 | ||||||
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| Trial #5 | ||||||
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| Trial #9 | ||||||
| Trial #10 |
Carol described her physical symptoms after the overbreathing exercise like this: “That got my heart racing, and my mind was right behind it.” She also said that she started sweating and felt dizzy. Her hands shook, and her throat went dry. She gave it a 98 on the SUDS for the first trial.
During trial number 2, it went down to 81. Her mind did not race, but her heart rate remained high. After trial number 3, her SUDS score went down to 63. She was amazed that it was getting easier. On trial 5, she said, “I’m getting the hang of it now. I’d say this is a 20. Maybe less!”
Jog in place vigorously for 1 minute, to increase your heart rate and cause hyperventilation. Of course, how intensely your heart races and how hard you breathe are reflections of how fit you are. Base how intensely you jog on how much physical exertion you can expend. You want your heart rate up! Don’t forget that an increased heart rate is nothing to panic about.
| EXERCISES | DESCRIBE YOUR SYMPTOMS | SUDS | WORST FEAR | ODDS OF THIS HAPPENING | DID IT HAPPEN? | YOUR COPING SKILLS |
| Trial #1 | ||||||
| Trial #2 | ||||||
| Trial #3 | ||||||
| Trial #4 | ||||||
| Trial #5 | ||||||
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| Trial #10 |
After trial number 1 of this exercise, Carol said, “I’m out of shape. My heart started racing, and I couldn’t get enough air!” As she caught her breath, she said that her thoughts also began to race. She wondered whether she did damage to her heart. She wrote down 95 for her SUDS. I reminded her of the changes she had made in her automatic thoughts, assumptions, and core beliefs—moving from negative to positive. “I feel tired—that’s bad” changed to “Feeling tired is okay.” She also changed her assumptions, from “I’m tired, I could have a heart attack” to “This feeling of tiredness is good. I’ll sleep well tonight.” And, finally, her core belief shifted from “I’m so out of shape that I’ll never be able to get back in shape” to “I’m a healthy person and can get in better shape.”
Abdominal breathing helped slow her breathing rate down. After waiting about 5 minutes, she tried the exercise again, and it got easier. Although she rated trial number 2 a 72, she did not have the catastrophic thoughts about damaging her heart. With trial 3, her SUDS dropped to 51. On trial 4, it went down to 8, and she felt no anxiety symptoms.
Hold your breath for 30 seconds. This tightens the chest and leads to a sense of suffocation. This exercise probably sounds like an odd one to induce the physical sensations associated with anxious feelings. But tightness in your chest and the accompanying sense of suffocation can cause you to gasp for air and begin to breathe quickly to compensate. This can lead to a variety of symptoms that can trigger a false alarm and cascade into panic. By practicing this exposure, you can shift this sensation from being a trigger for a panic attack to simply an innocuous sensation.
| EXERCISES | DESCRIBE YOUR SYMPTOMS | SUDS | WORST FEAR | ODDS OF THIS HAPPENING | DID IT HAPPEN? | YOUR COPING SKILLS |
| Trial #1 | ||||||
| Trial #2 | ||||||
| Trial #3 | ||||||
| Trial #4 | ||||||
| Trial #5 | ||||||
| Trial #6 | ||||||
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| Trial #10 |
After holding her breath for trial number 1, Carol said, “That forced me to start breathing fast, and that got my heart pumping, too!” She rated it an 80 and worried that she had damaged her lungs. But that fear quickly faded. Trial number 2 was easier. She didn’t resort to breathing quickly, and her heart rate was stable. For trial number 3, she decided to see whether she could hold her breath for longer than the 30 seconds. This got her heart rate up again, and her breathing quickened as she gasped for air. Her SUDS score rose to 80. She was quite relieved when her SUDS score for the next few trials dropped quickly.
Spin around, either while standing or in a swivel chair by pushing around with your feet. After spinning, attempt walking. The most common symptom of spinning is dizziness.
Some people feel dizzier than others. Other common symptoms include nausea and blurry vision. Don’t forget that dizziness is nothing to panic about.
| EXERCISES | DESCRIBE YOUR SYMPTOMS | SUDS | WORST FEAR | ODDS OF THIS HAPPENING | DID IT HAPPEN? | YOUR COPING SKILLS |
| Trial #1 | ||||||
| Trial #2 | ||||||
| Trial #3 | ||||||
| Trial #4 | ||||||
| Trial #5 | ||||||
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| Trial #10 |
After trial number 1 of the spinning exercise Carol said, “That got me dizzy too quickly. My vision is blurry. I feel nauseous.” She had to wait a few minutes before trying it again. After trial number 2, she explained that she got dizzy on rides at amusement parks and her nausea would often linger for hours. We decided that she would move on to the next exercise without any more trials.
Swallow quickly four times in a row. This can cause you to feel a lump in your throat. Some people wonder what swallowing could possibly have to do with anxiety. Others know all too well that a dry throat and an interruption in their breathing can trigger other symptoms that they fear. Swallowing quickly, having a dry throat, and feeling a lump in your throat are normal sensations, and your task is to learn to react to those sensations as normal feelings.
| EXERCISES | DESCRIBE YOUR SYMPTOMS | SUDS | WORST FEAR | ODDS OF THIS HAPPENING | DID IT HAPPEN? | YOUR COPING SKILLS |
| Trial #1 | ||||||
| Trial #2 | ||||||
| Trial #3 | ||||||
| Trial #4 | ||||||
| Trial #5 | ||||||
| Trial #6 | ||||||
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| Trial #9 | ||||||
| Trial #10 |
Carol kept on swallowing after the initial four times. This disrupted her breathing pattern, and she stood up abruptly, as if that would clear her throat. She looked at me, wondering how to stop swallowing. She gave her first trial a SUDS score of 80. She went on for ten more swallows, fearing that she couldn’t stop. Trial number 2 was easier for her. She stopped at four swallows without a problem.
While sitting, tense your entire body, making fists and bringing your shoulders forward. Tighten your chest and entire body. Body tension can trigger a false alarm because during periods of anxiety your body can tense up. The associations that you make when you tense up can unconsciously remind you of feeling anxious. But they need not lead to anxiety. In this exercise, you’ll learn to make sure that they don’t.
| EXERCISES | DESCRIBE YOUR SYMPTOMS | SUDS | WORST FEAR | ODDS OF THIS HAPPENING | DID IT HAPPEN? | YOUR COPING SKILLS |
| Trial #1 | ||||||
| Trial #2 | ||||||
| Trial #3 | ||||||
| Trial #4 | ||||||
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| Trial #10 |
Carol said, “Oh, I don’t know how I’m going to get my body any tenser.” Her worst fear was that she would make her muscles spasm, then have a heart attack or seizures and die. She rated trial number 1 at 95. “I felt like my body locked up! Why did you ask me to do that?”
She was able to loosen up after a few moments of constricted breathing and feeling that she was trapped in her own body. After trials 2, 3, 4, and 5, she loosened up more quickly and rated her SUDS at 80, 71, 50, and 33, respectively. She said, “You know, that’s a funny way to relax. I think I’ll do it more often.”
Standing up quickly from lying on the floor can cause dizziness. You might also find yourself becoming a little nauseous and blurry-eyed, sensations that can lead to panic. Standing up quickly is something you’ll do throughout your life. This will help you get used to the temporary dizziness and other sensations that result from it. If you have low blood pressure, this exercise can be particularly difficult; you might want to skip it.
| EXERCISES | DESCRIBE YOUR SYMPTOMS | SUDS | WORST FEAR | ODDS OF THIS HAPPENING | DID IT HAPPEN? | YOUR COPING SKILLS |
| Trial #1 | ||||||
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| Trial #10 |
Carol said she had bad knees and that it would be difficult to perform this exercise. Her worst fear was that she would injure her knees or back. Nevertheless, she tried it. To her surprise, her knees and back were fine, but she was dizzy, and her vision was blurry. “I feel lightheaded, like I’m going to faint.” She gave the first trial a SUDS of 90. By trial number 6, the dizziness had passed, and her SUDS was down to 20. She said, “Maybe this will end up strengthening my knees, instead of hurting them!”
Pick a spot on a blank wall and stare at it without deviation for 2 minutes. This can simulate the feeling of being trapped. Those with claustrophobia might find this exercise particularly troublesome. Try to keep at it, though; in the long run, it can help you lessen the effects of claustrophobia. The feeling of being confused and trapped can trigger anxiety and the need to look away as a means to calm yourself down. Resist this temptation. Remember we want to stir up disturbing sensations, so that you can eventually habituate to them.
| EXERCISES | DESCRIBE YOUR SYMPTOMS | SUDS | WORST FEAR | ODDS OF THIS HAPPENING | DID IT HAPPEN? | YOUR COPING SKILLS |
| Trial #1 | ||||||
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| Trial #10 |
The idea of staring at a spot on the wall as an anxiety exercise struck Carol as a joke. However, as she was getting ready for the first trial, she asked, “What if I need to look away?” I told her that this was the point—she can’t. She reflected anxiously for a moment. “What if something happens?” She rated trial number 1 an 87 on the SUDS scale. She reported that her heart started racing, and she started hyperventilating. On trial number 2, she found herself beginning to relax. Her SUDS score went down to 70. By trial number 4, she was down to 20 with no symptoms and said, “That was kind of a meditative exercise.”
Set a timer for 1½ minutes. Shake your head from side to side. Lower your head and shift it from side to side. When the timer goes off after 1½ minutes, raise your head. This exercise is similar to the standing-up exercise, in that one of the most common symptoms is dizziness, followed by blurry vision. Think of it as a good neck exercise, but do it slowly so you don’t pull a muscle. Don’t forget that you want to induce uncomfortable sensations so that you can habituate to them.
| EXERCISES | DESCRIBE YOUR SYMPTOMS | SUDS | WORST FEAR | ODDS OF THIS HAPPENING | DID IT HAPPEN? | YOUR COPING SKILLS |
| Trial #1 | ||||||
| Trial #2 | ||||||
| Trial #3 | ||||||
| Trial #4 | ||||||
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| Trial #6 | ||||||
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| Trial #10 |
Carol found this exercise distracting. In fact, after trial number 1, Carol reported both blurry vision and dizziness. She rated it a SUDS of 83. By trial number 4, she was down to a 20 rating on the SUDS scale. This exercise made Carol laugh. “You gotta be kidding! What does this have to do with anxiety?” But after trial number 1, she felt lightheaded and dizzy. She said, “My heart skipped a beat! That was a 90.” But she rated trial number 6 a 15.
Sit in a straight-backed chair and put your head between your legs. Make sure that your head is below your heart. After 1 minute, sit up straight. Like the standing-up exercise, this creates an abrupt change in the blood flow to your head, resulting in lightheadedness, blurry vision, and a little dizziness.
| EXERCISES | DESCRIBE YOUR SYMPTOMS | SUDS | WORST FEAR | ODDS OF THIS HAPPENING | DID IT HAPPEN? | YOUR COPING SKILLS |
| Trial #1 | ||||||
| Trial #2 | ||||||
| Trial #3 | ||||||
| Trial #4 | ||||||
| Trial #5 | ||||||
| Trial #6 | ||||||
| Trial #7 | ||||||
| Trial #8 | ||||||
| Trial #9 | ||||||
| Trial #10 |
These exercises should be practiced regularly, especially if you have suffered from panic attacks. Practicing rewires your brain to establish the new healthy habit.
You’ll have plenty of opportunities for interoceptive exposure when you don’t plan it. The physical sensations you feared can still occur spontaneously. When they do, you will probably feel a little more anxious. That’s okay, and it’s expected. You can now react to them as false alarms.
Consider spontaneous events as opportunities to practice your new counter-conditioning skills. You’ll get better at dealing with them as you practice inducing the symptoms. The more you practice, the more prepared you’ll be to derail a potential panic attack. By practicing the interoceptive exposure exercises with the techniques you have learned in the preceding chapters, your panic attacks will probably fade away.