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Anxiety! Why We're Anxious and the Secret to Getting Better

Here is what I discovered about how to treat anxiety.

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This is exactly the response I’m looking for. I want clients to absorb the principles well enough to invent their own practice. Mary knows that seeing more light is a crutch that makes her practice easier. She’s now looking for helpful practice, not easy practice. When she noticed she wasn’t feeling panicky enough, she drove to the darkest place she could find. She’s incorporated the essence of the treatment in a single message: “I’m going to go toward whatever is frightening me.” Excellent! That’s a dramatic change in her relationship with her fears.

I said, “When you left yesterday I was feeling that I didn’t orient you enough. I thought, ‘Oh, she’s going to distract herself.’”

“No,” she answered. “Actually I turned the radio off and I left the windows up, which I never do. And then there was quite a bit of light coming through, so I went like this (she shades her eyes with her hands) and just concentrated on that really low, concrete ceiling. I tried to make it as unpleasant as I could, and sit with that for a bit. And I waited.

“You were saying what to yourself?”

“It was something like, ‘Stick it out; this is fine,’” she said.

Because she absorbed our general plan from session one, she instructed herself to refrain from the typical crutches she used to keep her feelings at bay—finding more light, rolling the window down, turning on the radio—and then she provoked further threat by directing her attention to her highest fears: darkness and low ceilings. She trusted that the treatment theory was valid, she committed herself to change her relationship with her threats, and then she found every opportunity to take the hit.

It’s that specific intention—to find a way to practice taking the hit—that distinguishes this work. In typical exposure treatment, the client is assigned tasks that generate discomfort. Instead, I’m intent on helping clients to change their point of view from “I know I’m supposed to face my fears to get better, so I guess I’d better go do it” to “Where can I find some more opportunities to face my symptoms?” It’s the difference between saying, “I hope I don’t get too anxious doing this” and “I hope I get anxious enough to make this a good practice; I really want to get stronger, and I believe this is a good way to reach that goal.”

“How did you feel when you drove out of the garage?” I asked.

“Well, I felt more empowered. I felt really happy about that,” she said.

Then I queried, “So, what do you think would happen if you don’t practice another garage for three months?”

She answered, “I’m not going to habituate.”

With Mary, I immediately reinforced her spontaneous-imagery rehearsal by keeping our conversation focused on the future. In traditional exposure treatment, the therapist’s attention is on implementing the proper procedures for the current practice. That task is critically important, but insufficient. By contrast, I continually elevate the discussion to principles that clients can adopt as a standard of living.

Later, I asked Mary, “If you had to put together a little set of guidelines for 10 people who are coming in tomorrow, facing these kinds of fears, what would you say are the most important principles of recovery?” She said:

Face your fears in small ways that you have control over, gradually do these things longer, and then do the harder things.

Talk yourself through it in a really strong, commanding voice.

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