In previous posts I've talked about some simple, fun and effective tools for managing fear and anxiety: Thought Shifting, Distraction, Threat Assessment, The Useful Thought Question, "Cats, Bats and Rats", and told some stories, among others. And while these can be very helpful in managing anxiety and getting through some difficult situations, they don't really teach us how to face down and overcome our fears. In fact, they can reinforce anxiety.
What? Wait just a minute! I've spent all this time talking about ways to manage anxiety and now I'm saying they can actually reinforce it. So what's the deal? Well, here's what happens. These tools work in the short term on a situation by situation basis and that's great, but wouldn't it be better to eliminate the anxiety entirely or at least get it down to a level that's just a brief blip on our emotional radar screen?
Negative reinforcement strategies provide temporary relief but may actually make the anxiety stronger. It's paying the bully. Examples are avoiding anxiety situations, escape, distraction, safety nets like taking a Xanax or flask of vodka along "Just in case" (Remember the Black Box Study in my last post?), safety-seeking behaviors such as reassurance-seeking, checking and rechecking, or having immediate access to medications, to name just a few. So now what?
I know that therapy is simple but hard work, frustrating, slow, and sometimes downright scary. But now it's time to bite the bullet and bring it on with THEFEARMONSTER. The way we do this is called Exposure Response Prevention or ERP. Simply put, we expose ourselves to an anxiety-producing situation-- such as ordering a Grande Caramel Macchiato at Starbucks--and learn how to not respond to it with anxiety or fear.
It's confronting fear and discontinuing escape responses while building anxiety tolerance through repeated exposure to the situation. Anxiety will go up for awhile so some calming and self-soothing techniques such as controlled breathing and repeating self-affirmations such as "This is uncomfortable but I can get through this" are helpful. And getting help from a trained professional therapist who teaches this technique.
I had a client whose wife was pregnant and of course he wanted to be with her in the delivery room when their baby was born. But he was absolutely terrified of being there during the delivery and experienced a near panic attack even thinking about it.But it was very important to both of them and he didn't want to let his wife down and miss out on one of life's greatest experiences. So together we came up with a plan (actually this was his idea).
He made a list of his anxieties about childbirth from least distressing to absolute worst, an anxiety hierarchy. He decided that seeing pictures of pregnant women was least distressing and being in the delivery room was the absolute worst. Then he set about looking at pictures pf pregnant women in parenting magazines, on the internet, photos of pregnant celebrities in checkout stand magazines. And he did this until he was able to see pregnant women without becoming overwhelmingly anxious.
Then he moved on to tackle the next fear on the hierarchy until he could manage it. He kept practicing this, moving up the fear hierarchy (fortunately, he had several months to work on it), doing things like driving by the hospital, parking in its lot by the labor and delivery entrance, getting out of his car and walking up to the door, going inside and riding the elevator to the maternity floor. In his last task he went to the maternity floor reception desk and explained to the staff that his wife would be giving birth there and went on a tour of the ward, including the nursery and actual delivery room. So little by little, through Exposure Response Prevention, he was able to overcome his anxiety about being at their baby's delivery.
So, you're probably wondering, how did he do when the baby came? I don't know, I never saw him again. But I did get a photo a few weeks later of him in surgical gown and mask with his wife and new baby girl in the delivery room.
Next Time: DEFEATING THEFEARMONSTER