Jonathan Barkin, Psy.D.
Partner, San Francisco Bay Area Center for Cognitive Therapy
Exposure therapy is often a primary treatment component when working on anxiety. Whether an individual is coming to treatment for a specific fear, social anxiety, OCD, or another type of anxiety presentation, exposure can be a critical aid in reducing distress. It can also significantly change our relationship with anxiety and the role it plays in our lives. In structured exposure therapy, an individual systematically comes into contact with anxiety-provoking situations in order to both reduce their fight/flight response and develop new learning about anxiety and anxiety triggers. Through this new learning, a different relationship with anxiety develops. We learn to recognize anxiety triggers. We learn to stay aware of our anxious mind’s desire to avoid, distract, and do anything it can to stay away from fear. And we learn tools to help approach fear and fulfill goals that are meaningful despite anxiety’s attempts to dissuade. For example, individuals often find that through exposure they can learn to approach social situations, drive over bridges, travel on airplanes, and sit with incredibly distressing thoughts.
Learning to approach fear and distress, allows us to begin to take the reins of our lives back and begin making our own life choices based on values rather than fears and aversions. Individuals who seek out exposure treatment often find that they can apply this experience more broadly to other areas of their livers. Anxiety is present in both overt and covert ways. It can alter or define small choices we make in relationships, professional situations, and just about any aspect of life. By applying some key strategies from exposure therapy, we can strive to improve our ability to make choices that are inline with what we want to promote in our lives.
Mindful awareness allows us to become more conscious of how anxious emotions influence our actions. While it may be obvious when anxiety is getting in the way of volunteering to give a speech to a large group, anxiety can be much more covert. It can influence the types of conversations we have with our spouse or the way we subtly avoid professional interactions. Since our problematic choices are often driven by uncomfortable emotions, trying to introduce emotional awareness as part of decision-making can be helpful. Emotional awareness allows us to step back from this automatic pattern and name the emotions before choosing a behavior. Jon Kabat-Zinn defines mindfulness as “paying attention in a particular way; on purpose, in the present moment, and non judgmentally.” With practicing mindfulness, we can become better at noticing when our actions are driven by anxious emotions and thoughts. It can be helpful to practice noticing patterns of when anxiety has the most influence over our actions. It may then make it easier to use mindful awareness when approaching those challenging situations.
Labeling the Value-Based Decision
As noted above, it is important to recognize when you are making a decision due to anxiety. That identification becomes easier and more meaningful when you can focus on making choices that are congruent with what you want in your life. We may have a clear idea in our minds of what is important to us; however, the flow of day to day life can often lead to choices that are not consistent with those values. There are a variety of exercises that one can do to help clarify values. To get started, take some time to think through the different domains of your life. What is important to you? How do you want to interact with others? In what way do you want to express your beliefs? After clarifying your values, work to identify the coordinating choices and actions. The more clarity we have on what choices are consistent with our values, the better we are at keeping anxiety from being in the driver seat and determining our choices.
Using Structure and Support Systems
Motivation is always changing. There is a reason most of us set New Year’s resolutions only to see them go by the wayside by February. It is difficult to consistently make choices that are inline with what we want. This is especially true when facing anxiety. We naturally avoid and move away from things that make us anxious. After all, keeping us safe is a major benefit of this emotion. But when anxiety is being triggered by situations that aren’t life-threatening and perhaps not dangerous at all, anxiety becomes problematic and interferes with our lives. That is why we need structure and support to move towards our values in the face of anxiety’s influence. In exposure treatment, the therapy helps to provide the framework as individuals work to create a system they can use well past the end of treatment. You can create structure and support in a variety of ways. Be creative. Here are a few starting points to consider in helping you with that structure:
- set clear goals
- make goals measurable
- track progress/outcomes
- technology/applications can be helpful tools
- build in rewards for yourself
- use family and friends to provide additional motivation/structure