Treatment of a Specific Phobia - Session 2

Gerald Tarlow, Ph.D. Health Guide
  •      In my last sharepost I introduced you to Karen who I am treating for her fear of flying.  The first treatment techniques I want Karen to learn are breathing and relaxation training.  These techniques are aimed at reducing the physical symptoms of anxiety.  As you may remember Karen complained of rapid heart beats, perspiration and difficulty breathing when she is flying.  These techniques are designed to help prevent the physical symptoms of anxiety from occurring and to help her manage any physical symptoms that of anxiety that do occur. 

         Breathing retraining is a powerful tool that can very quickly eliminate physical symptoms of anxiety.  In my office Karen was breathing at 16 breaths per minute.  This rate tends to be on the high side for a non-anxious situation.  So, the first thing I want Karen to learn is to slow down her rate of breathing.  My goal is to get her to breathe 8-10 breaths per minute.  I instruct her to try to inhale and exhale for three seconds with a slight pause between the inhale and exhale.  This will get Karen's rate of breathing down to 10 breaths per minute.  Next, I instruct Karen to inhale and exhale only through her nose.  If she breathes this way it will prevent hyperventilation.  Finally, I instruct her how to breathe diaphragmatically instead of through her chest.   Karen then practices this new way of breathing in the session so that I can see if she is doing it properly.

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    Karen is then given her first homework assignment.  She is to practice breathing twice a day for five minutes each time.  I tell Karen that the more she practices the breathing in neutral, non-anxious situations, the easier it will be to use the technique when she does get anxious.  So far, Karen is enthusiastic about learning the techniques.  I will know by next session if she is able to follow through on her homework assignment.   

              The rest of the session is spent introducing Karen to relaxation training.  Progressive Muscle Relaxation (PMR) is a technique that has been used in the treatment of anxiety disorders since the 1950's.  Patients learn to relax all the major muscle groups in their body by first tensing their muscles and then letting go of the tension.  Relaxation is the opposite of tension.  The technique focuses on 16 major muscle groups.  It takes about twenty minutes of the session to do this initial relaxation exercise.  It is important for me to see that Karen is doing the exercise correctly and feels more relaxed after completing the exercise.  In my next session I will give her a CD with the PMR instructions so that she can practice at home. The next session will also introduce Karen to cognitive therapy.

Published On: September 12, 2008