Exposure Therapy Requires Dedication

There are a many factors that go into how quickly a person feels some relief from anxiety once they start treatment. One of the most crucial factors, one that seems to go the furthest in facilitating reduction of distress, is PRACTICE--that is, being willing to work hard and do exposure exercises often. Maybe you've started therapy, you're understanding why avoiding anxiety doesn't work, and you're getting on board with this whole counter-intuitive concept of doing exposures. If you need a little encouragement to keep it up, read on. 


1. You are building new neural pathways. It takes so much repetition for your brain to catch up to your behavior and realize "oh hey, I don't actually need to be so afraid of my anxious sensations and thoughts."

The analogy I use most often is "the path in the woods." It is easy to walk down a well-trodden path that has already been created for you. To create a new path, you'd have to tromp through areas of ground cover, bushwhack obstacles like branches and vines, and then repeatedly tread the same path until it became clearer and more defined--more inviting each time. 

Our brains are beautifully efficient. They will do what is easiest and most readily available as a course of action. If we've spent our whole lives avoiding the feeling of anxiety and anxiety-provoking situations, it is going to take some effort and repetition to create these new neural pathways and make them more natural, for learning to take place and become calcified in our very wiring. 


2. Not practicing is essentially making the problem worse. The more you avoid and resist exposures, or take "breaks" in between (e.g., "I did one Sunday and it really took it out of me. That was enough. I'll do another on Thursday."), the more you are reinforcing the idea that your fears are real, anxiety is dangerous, and that you can't handle the discomfort of feeling anxious. 

3. Fear-learning is context-independent; safety-learning is context-dependent. What this means is that your brain's tendency to learn to be afraid of something, and associate a fear response with that thing, is far more trigger-happy than its inclination to learn to feel safe and relaxed. That fear response gets generalized and applied to a variety of situations, warranted or not, and is hard to unlearn. To learn that a certain sensation, thought, or situation is actually safe/tolerable/not dangerous is more challenging and requires exposure in a variety of situations.

For example, if you have a fear of stairwells, chances are that all stairwells produce anxiety. The one at work, the one at your kid's school, the one in the doctor's office, the one at the gym. Your anxiety response happens regardless of the specific stairwell. To learn that a stairwell you are facing is actually not dangerous, or more appropriately, that you can handle the uncertainty about its safety, as well as handle your anxious response in the moment, you would want to practice exposures in as many different stairwells as possible. You might start with the one at work, and after several exposures, start to feel more comfortable, but BOOM, now you're at the gym and that stairwell is still pretty frightening. That safety response you reached with the stairwell at work has to be learned in each new context in order to compete with the powerful fear response. 

For more a more in-depth explanation of this concept, check out this OCD Stories podcast with Dr. Johathan Abramowitz (specifically around minute 40): http://theocdstories.com/podcast/dr-jonathan-abramowitz-getting-over-ocd/

4. You are not simply learning a new skill, you are shifting your mindset. I look forward to delving into this concept in future blog posts, but this is a biggie. While, yes, exposures are a "technique" or an "exercise," what they are really leading your towards is an expanded way of interacting with your anxiety. A way that puts you in charge and gives you a confident, secure way of thinking about anxiety that you can carry throughout your life. 

You are adopting a new mindset, one that permeates various situations, not just discrete moments when you enter into an exposure zone.

So stick with it!! It's not easy at first. Doing exposures requires sacrificing that sweet graspable short-term relief that comes from avoiding or reassuring. But it is so worth it.