Exposure Therapy: Facing and Managing Your Fears
One of the main components of treatment for panic disorder is exposure therapy. This is where you face a feared situation in order to overcome your anxiety. While many people choose to work with a therapist, some people successful set up self-guided exposure therapy and work through the steps, increasing their interaction with places, situations and people to build their tolerance. But, this is only one part of the exposure process. In order for exposure therapy to be successful, you must learn how to manage your fears while in that situation.
For example, suppose you have a fear of going to the mall. You avoid shopping at the stores in the mall by either shopping online or going to smaller, out of the way shops. You plan your own exposure therapy, going to the mall for a few minutes longer each day. Each day that you don't experience a panic attack, you feel the venture was a success. Your goal is to spend an hour in the mall without having a panic attack.
But, your plan is missing the most important part of exposure therapy. It is missing dealing with your panic attack. No matter how much tolerance for a situation or place you build up, if you don't learn to manage and face your fears, you will still be controlled by your anxiety. Exposure therapy must include a way to face your anxiety as it happens. In the example of the mall, you can build up your tolerance to the point that you can spend several hours in the mall, but, if you don't deal with the symptoms of a panic attack, you still won't be prepared when it happens.
Preparing for Panic
Before you even head to the mall to face your fears, you need to have a plan. You need to know what you are going to do to manage your panic attack. This doesn't mean avoiding it by distracting yourself, it means facing it, head-on and learning that you can get through a panic attack.
Accept that panic attacks happen but they aren't dangerous. A panic attack feels awful. You might feel like you can't breath or feel dizzy. You might feel like your heart is beating so hard it is going to come out of your chest. You might feel like you are going to die. But, as uncomfortable as panic attacks are, they aren't dangerous. Usually, within minutes, they subside. The first step to getting past the panic is to accept that you can "ride it out" and nothing is going to happen to you.
Avoid fleeing. When panic sets in, your first instinct is probably to flee. You want to remove yourself from the situation, as quickly as possible so this terrible feeling goes away. But by doing so, you are giving in to your anxiety and allowing it to control your actions. In order to truly overcome your fears is to simply stay put. Part of your plan might be to stand (or find a bench and sit) in one place, allowing your fear to peak and then subside. Depending on the situation, this might be difficult, for example, if you experience a panic attack while driving, you might need to continue to drive or pull over - not to avoid the panic attack but to allow it to happen.
Pay attention to the panic attack. What happens before, during and after a panic attack? Keeping track of your panic attacks can help you learn how to best respond the next time. Ask yourself specific questions, such as:
- Where are you?
- What happened immediately before the panic began?
- What were you thinking immediately before the panic began?
- What did you think during the panic attack?
- What strategies did you use to calm yourself down (self-talk, deep breathing, becoming mindful of the moment, relax your body, etc)?
- How did the attack end and how long did it last?
- What can you do differently next time?
You should answer these questions during or as soon as possible after your panic attack. This gives you a more objective look at the panic attack and how you can, or should, respond to help lower your level of anxiety.
Take note of what strategies worked for you. Because everyone reacts to a panic attack differently, it makes sense that different strategies will be effective for different people. You might find that stopping and becoming mindful of the present moment works, while another person might find doing deep breathing and self-talk work better. As you keep track of your panic attacks you will learn what techniques work best for you and will be better prepared in the future.
Feeling Your Panic
Exposure therapy, therefore, is not to hope for the absence of panic but to place yourself in situations where you are sure you are going to feel panic and then deal with the symptoms. Remember, panic attacks do come to an end, even if you don't "do" anything. They start, peak and then subside. Your job during exposure therapy is not to avoid panic or run away from it, but to feel it, work through it and learn that you can and will survive.