Fear is a natural and valuable emotion. It has great survival value for human beings, preparing us to fight for survival or run away quickly from a threat. But too much fear in the form of chronic anxiety is incredibly painful and debilitating.
Anxiety is prolonged fear that persists in the absence of a real threat: after a threat is over, during situations that aren’t actually very dangerous, or before a potential threat in the future. When anxiety becomes chronic and dominates your life, it morphs into an anxiety disorder.
Research consistently shows that cognitive behavioral therapy (CBT) is the most effective anxiety treatment. It works better than drugs, psychoanalysis, hypnosis, and all the other ways we have tried to treat anxiety over the years.
Broadly speaking, two CBT approaches for treating anxiety have emerged: coping and exposure. Coping is changing how you think, evaluating threats more accurately, and building confidence in your ability to handle a threat so that you are gradually less afraid. Exposure is purposefully experiencing what you are afraid of, disproving your dire predictions of disaster, until your fear naturally subsides. The most recent data show that both approaches help, but exposure can work faster and results in larger, longer-lasting reductions in anxiety.
The first two-thirds of this book teach you everything you need to know to apply the latest and most effective protocol for exposure, called inhibitory learning. It was developed by a team of therapists and researchers (Craske, Treanor, Conway, Zbozinek, and Vervliet) who published their results in 2014. This special exposure process will help you overcome anxiety as rapidly and completely as possible.
This book also covers the most effective coping strategies used in CBT and related therapies: coping planning, defusion, cognitive flexibility, and distress tolerance. They are research-tested, highly effective techniques that will augment and strengthen your anxiety recovery program.
Using this book is simple: continue reading, working through the first six chapters in order. Do the exercises as you come to them, thoroughly and diligently, before going on to the next section or skipping ahead. Along the way, you may be advised to also work in chapters 7–10. Finally, read the final chapter on relapse prevention.
You are about to start a challenging but very rewarding journey. Here is a preview of the main attractions:
Chapter 2 goes into the details of the alarm response, how we perceive and appraise threats, the fight/flight reaction, and typical behavioral responses. It allows you to compare your symptoms to the six most commonly diagnosed anxiety disorders:
You will begin making a list of feared situations that you will carry forward into future chapters. At the end of the chapter is an exercise to help you identify your particular fear response and begin to shape your treatment plan.
Chapter 3 is all about assessment. You will begin an inventory of your feared situations, your level of distress for each, and which of several safety behaviors you tend to use:
By far the most common safety behavior is avoidance. The chapter concludes with a checklist to find out which types of avoidance you favor: avoiding certain situations, avoiding certain thoughts, or avoiding certain physical sensations.
Chapter 4 is where you will work to build motivation for facing your feared situations. You’ll assess the costs of your avoidance and other safety behaviors in nine domains:
You will also identify and rate your positive values in these domains and list the activities and accomplishments you have been missing because of chronic anxiety. Finally, you will consider the importance of willingness when facing situations you have been avoiding.
Chapter 5 is the planning chapter in which you will list various ways you plan to stop your safety behaviors and expose yourself to the situations, feelings, and thoughts you have been avoiding. For each of your planned exposures you will predict the worst possible outcome and set a percentage probability for the outcome happening as predicted. After consulting many detailed examples of inventories composed by people suffering from all the different anxiety disorders, you will arrive at the end of the chapter with your own detailed exposure inventory.
Chapter 6 guides you through the actual exposure process: when to do it, what to experience first, how to prepare for exposures, evaluating your results, how often to do exposures, and so on.
Chapter 7 is the first of the supplemental coping chapters. It explains how to increase your sense of efficacy by developing a coping plan for your worst-case scenario.
Chapter 8 teaches the cognitive skill of defusion, a technique for coping with fearful thoughts, adapted from acceptance and commitment therapy.
Chapter 9 corrects your anxiety lens by teaching you how to appraise threats more accurately.
Chapter 10 works on increasing your distress tolerance, using techniques from dialectical behavior therapy, such as mindfulness, self-soothing, and relaxation.
Chapter 11 guides you in crafting a plan for relapse prevention, so that you can deal with any anxiety that crops up in the future.
Appendices contain all the worksheets in one place for ease of photocopying, extra instructions for panic disorder, and some useful standard measures for mental health professionals to use.