part0012

Unsurprisingly, fear lives at the heart of every phobia. But it isn't the usual, healthy fear that everyone feels from time to time. Whereas healthy fear prompts us to make a decision and fades as we move forward, anxiety creates a fear that persists long after the trigger is behind us. It sticks to us like a shadow, and as time passes by it worsens until it's well beyond our control and has come to dominate our lives.

What many people find when they begin CBT is that when they stop to analyze what triggers their phobias and what thoughts said phobias produce, the fear is often both irrational and out of proportion. It's a tremendous relief to be sure, but how do we get to a point where we can even see the distortions that clearly?

Let's talk about the distortion first.

Fear, to a degree, is a healthy response to the things and situations we perceive as dangerous. It may influence a decision we make for a brief period of time, but once that decision is made it's gone. The prolonged fear through phobia follows us around because our attention is fixated on the trigger moment; we never give ourselves the chance to put the fear behind us. As a result, we feel as though we need to be constantly on guard. And as we keep thinking about it our brain scrambles to find more and more ways for what we fear to become a reality, limiting how we choose to live our lives.

Even more damaging is how we eventually find other things to become afraid of: “Well, this may not happen, but what if this does?” Because of the cyclical nature of our thinking, we seek these things out even though they make us totally miserable. It's almost like an addiction, and in short order, we have a list of reasons to be afraid that's increasingly more removed from where we started. To get on with living we need to take a step back and put them in a proper perspective. Generally, you can do this by trying one of the strategies outlined below.

Play the script until the end: This strategy involves examining what the worst-case scenario is in a given situation. It is especially helpful for those dealing with intense fear and anxiety. This exercise is beneficial in helping you determine what your underlying fear outcomes are. The idea behind this technique is to conduct a thought experiment or a ‘rehearsal” in your mind. You set out to imagine the worst possible outcome to a situation, and then let the event play out in your mind. By doing this, you can learn that no matter what happens, things will likely turn out okay.

To start, you will want to articulate what you're afraid of. Is it a consequence of something you think you've done? Is it how you perceive others will feel about you, and if it is, be honest with yourself and put it down on paper. The benefit of having your fear in a tangible form cannot be understated.

Now write how you think this could come to reality. This part proves to be difficult for some, but it's also very revealing as to how you think. How does what you fear become a reality? Explain it in fine detail. Connect as many dots, as many as there may be.

Finally, how realistic is the result? Let's say that, for example, you have a phobia regarding being around large groups of people and you avoid going out with friends. One of your fears could be that they'll learn of something embarrassing you did years ago and will think less of you because of it. How would they learn about it? Obviously, you don't want to tell them, so it must be some other way. Does someone else know? Perhaps an old friend you haven't seen in a long time was present. They could resurface ad decide to tell everyone. It's entirely possible, sure, but how possible is it? This is where the details of the previous step come into play. How many dots did you have to connect to make your fear reality? This is a useful way to gauge how plausible your fears may or may not be. Of course, because of the way your phobia distorts your thinking, you may find it difficult to see things as they really are. This is when an outside perspective—like that of a professional therapist—can be useful.

Situation exposure hierarchies: This exercise involves putting all of the things that you find yourself avoiding because of your current issues on a list, and then rate each on a scale from 0 to 10 in terms of how much trouble the list item causes you. For example, someone with severe social anxiety might place asking someone out on a date at the top of his list with a rating of 10, but asking for someone to hold the elevator might be at the bottom of the list with a rating of 2.

It is important to be thorough when you make your list so that you don’t have any serious jumps between numbers. The end goal of this exercise is to slowly work your way from the bottom of the list to the top so that each new activity slowly adds to your overall level of discomfort. The idea is that by the time you have mastered the activity you will have become used to that level of your specific stressor, so you can more easily move on to the next. As such, it is important not to get ahead of yourself and try and bite off more than you can chew. A slow and steady buildup is going to be far more effective than a dramatic spike all at once. Journaling is sometimes combined with exposure therapy so that you can record and understand how you felt during the exercise, and how you managed the feelings that you had.

An example of exposure therapy would be if you were afraid of bees and wasps and you eventually worked your way up to being able to put yourself in the vicinity of them to illicit the fearful response. Then, as you are in their presence and the fear begins to arise, you recall information about bees and wasps that remind you about how positive they are to the environment and how unlikely it is that you would be stung by one. Continue to remain in their vicinity and allow the fear to run its course.

Interoceptive exposure : Interoceptive exposure is another technique used to treat panic disorder and anxiety. It involves exposure to feared bodily sensations that simulate how they feel during a panic attack. The purpose is to then challenge the unhelpful and automatic thoughts that have been associated with these sensations, and to be able to manage them in a controlled environment. During interoceptive exposure, individuals learn to maintain the sensation without panicking and learn that the symptoms and feelings that they are experiencing are not, in fact, dangerous or threatening.

Therapists use this exposure to physical sensations as a way to simulate a panic attack in order to change the experiences associated with the attacks into more benign experiences. Physical symptoms associated with panic attacks include excessive sweating, elevated heart rate, dizziness, trembling, and chest pains.

Clients who suffer from panic disorders avoid situations that might cause panic attacks. An example of such avoidance is a person that gets into a car accident. Each time the person drove after that they were afraid of having an accident, which caused them to have anxiety. Due to anxiety, even small experiences while driving cause panic attacks. The person avoids driving altogether to avoid panic attacks. However, avoiding the situation only makes it worse.

In order to lessen the effects of the panic attack, the interoceptive exposure method imitates the physical symptoms of a panic attack. This can be done by holding the head down between the legs and pull up quickly to produce a head rush. Other examples are to breathe very quickly to induce hyperventilation or spin around in a chair to mimic dizziness. Repeated exposure to the physical symptoms makes panic attacks easier to deal with when they do occur.

Interoceptive exposure should only be done with the help of a licensed therapist. Clients unfamiliar with the technique could hurt themselves by attempting to reproduce the panic attack on their own and are unlikely to get any therapeutic value out of it. Before starting interoceptive exposure the client should discuss with the therapist the methods he or she plans to attempt.

To practice dealing with the issues that particular sensations call forth, practice the following:

Nightmare exposure and rescripting: Nightmares are unavoidable. Individuals are likely to have bad dreams if they are dealing with heavy issues in their lives. This is a technique that is used in CBT to help individuals replace the feelings they had after having a nightmare. If the nightmare caused intense fear in the person, the emotions could be redirected into something more positive.

In order to arouse the feelings you experience in relation to your nightmares, you must first begin to recall them in as much detail as possibly. As you do, the emotions accompanying the nightmares should begin to arise once more, typically overcoming you, sometimes in a rather intense manner. With these emotions now stirring up once again you can identify what emotion you would rather experience and develop a new image associated with your desired emotion. After moving back and forth through the process of awakening the emotions relating to the nightmares and then rescripting them with new desired emotions and images, you train your mind to adjust its focus each time the nightmare is aroused. Typically, what will end up happening during your sleep then is that if the nightmare begins to start up, your mind will naturally switch to the preferred emotion and image that you have rescripted it with. As a result, you should no longer experience disturbing nightmares.

Note that when you are dealing with nightmares, rescripting can take time since nightmares typically happen when you are asleep. It can therefore be challenging to tap into them with your conscious mind. You might need to continually use the rescripting method for several nights over before you find complete freedom from your nightmares. If you do not experience instant relief, you need to continue practicing your rescripting process until the nightmares begin to go away. Trust that as long as you stay committed they will disappear in due time and you will no longer have the disturbing or distressing experience of your nightmares.