Since Halloween is this month, I thought the topic of treating fear would be appropriate. We as humans are hard wired to experience fear. It’s a survival mechanism that helps keep us alive (i.e., We should be afraid of what would happen if we skydive without a parachute or try to pet a bear while on a hike.) However, for some people, fear starts to consume them and overtake their lives. They find themselves avoiding people, places, or situations to alleviate their fears. So, how do we address fear that’s starting to overwhelm? The short answer is Exposure Therapy. Through research, Exposure Therapy has been shown to be the most effective treatment we have for treating fear.
The Role of Avoidance
Here’s what happens when we experience fear:
- We come across a feared situation.
- Our anxiety rises, and that is an unpleasant sensation.
- We have the choice of avoiding the situation, so we do.
- Once we avoid, the anxiety calms down, and we feel much better.
- That decrease in anxiety feels so good, that the next time we come across that same feared situation, we are likely to choose avoidance.
- This cycle repeats over and over, and thus entrenches our fear more and more.
Long story short, the more we avoid, the more intense our fear becomes.
Breaking the Cycle
Here’s where Exposure Therapy comes in. In order to treat the fear, we need to stop the reinforcing experience of choosing avoidance. That means we need to expose ourselves to the feared situation over and over and not let avoidance be an option. That’s right. We intentionally induce anxiety and experience it until it starts to die down. This is something people in general don’t know about anxiety: It will de-sensitize over time and over repeated exposure to the feared situation. Usually, the first exposure is very anxiety inducing, but we keep intentionally interacting with the feared stimuli, and slowly but surely, the anxiety decreases.
The Fear Hierarchy
You’re probably reading this and thinking “Yikes! That doesn’t sound like fun,” or “I think Lindsey just likes to torture people.” I understand those sentiments Yes, I’d be asking you to engage in a treatment that will make you uncomfortable, but in the long run, your fear will become less and less of a presence in your life. Here is how we deal with some of the discomfort that’s inherent in Exposure Therapy. We don’t just dive into the worst-case scenario when it comes to the feared situation. We start slowly by developing a fear hierarchy. We take the feared situation and talk about how to experience it in increasingly scary ways. We then start with the least feared version, do exposure exercises, let the anxiety de-sensitize to about half of the initial rating, then we move to the next more difficult version, do exposure exercises, let the anxiety de-sensitize to half, and continue to work our way up the hierarchy. For example, take the fear of driving. Here’s what a fear hierarchy might look like (from least feared to most feared):
- Watching other people drive cars
- Sitting in a car with the ignition off
- Sitting in the car with the ignition on
- Driving in an empty parking lot
- Driving around the block
- Driving on a busy street
- Driving on the interstate
In Exposure Therapy, the client would do each of these tasks to conquer their fear of driving. This basic formula can be applied to effectively treat a wide variety of fears.
If you’re struggling with fears and want to work on them in counseling, I’d love to chat with you. Please give our office a call, and we can discuss further.