Four Things To Ease Anxiety: Part Two

Photo by Miroslava on Unsplash

A Training Regime To Destroy Fear

In the first article in this series, we talked about Cognitive Behavioural Therapy (CBT) theory which says that your anxiety is simply a mistaken judgement. You evaluate a situation and come to believe that it poses a threat to you. This evaluation is at a bodily level. You feel genuine fear because your body feels genuinely at risk.

We all tend to trust our feelings instinctively, but sadly, they are often plain wrong. So, you (probably) know in your mind that this fearful situation is not actually as threatening as you feel it is, but your body persists in treating it like a threat to your life and setting all your fight or flight hormones going.

The takeaway message from the last article was: don’t trust your feelings.

The solution was to identify and label each time your body makes this mistaken judgement, hold it up to the light and see through it.

I said you might have to do this a lot. I bandied the number ten thousand at first, and then I mentioned research that suggests it’s a bit less than ten thousand. Either way, the message was to practise this skill. Get good at it.

Now, the CBT deconstruction of your erroneous feeling set out last time might have been enough for you, and you might now be feeling a lot better. I hope so.

However, it is possible that just thinking it away doesn’t totally get rid of it. I am convinced that practising the skill of identifying and labelling a problematic emotion is very helpful, but my experience is that some people need something more.

Don’t worry. We have more.

Exposure And Response Prevention

In this article, I’m going to talk about graduated exposure methods, or as we are calling it these days: Exposure And Response Prevention or ERP.

Therapists recommend ERP for Obsessive-Compulsive Disorder (OCD), but I’ve found it helpful with all sorts of anxieties and phobias.

One of the drawbacks I find is that CBT as set out last time generally requires some ability to conceptualise thoughts and feelings. CBT purists will say that everyone can do this, but I’m not convinced.

I remember working with a psychologist with a group of older adults, who had low formal education and who were not used to theoretical conceptualisation. Never mind how many times the psychologist tried to drill the difference between a thought and a feeling to them, they kept getting it wrong.

So we need an approach that doesn’t require high cognitive ability. The thing I’m going to talk about now, ERP, is it. You don’t have to be a theoretician to use it, but, after saying that, it can work for mathematicians too because they too have bodies.

The Mind and the Body are not separate things; they are an integral system.

In the last article, we talked about the importance of repetition and training, but repetition and training are equally important in ERP.

Back and Forward

All living things have only two basic directions: forward or back. That goes for bacteria, amoebas, people and chickens.

Forward is associated with reward, food, novelty but also risk, danger and uncertainty.

Back is associated with safety, and comfort, but also lack of opportunity and stagnation.

Jordan Peterson, in his Maps of Meaning, talks about this too. Outward from safety to face the Dragon of Chaos. Chaos is risky and scary, but that’s where you find the treasure. Risk is an opportunity.

Retreat gives comfort and safety but also the dead hand of the Tyranny of Law.

There are brain structures associated with forward and back; neurochemical structures that reinforce brain circuits. Each time you go back, you reinforce retreat; each time you go forward, you reinforce advancement.

Every time you back away from risk, you hardwire yourself to see that situation as risky. Even if it isn’t.

So, say you have a car crash, and the car was red, and the blood was red, and the shirt you were wearing was red. You create an association between that event and the colour red. Red is not inherently dangerous, but you now have a link between red and anxiety. You start avoiding red, and each time you do that, you reinforce that link and effectively tell your body “Yes, red is dangerous.” So when you see red, you feel fear.

  • The feeling associated with retreat is anxiety.
  • The feeling associated with advance is confidence.

Remember that this all happens at the level of the body; it’s before rational thought.

That’s the bad news. The good news is that you can also reinforce advancement.

Photo by Frederik Löwer on Unsplash

Should I Go, Or Should I Stay, Now?

Each time you face a scary situation but advance into it without anything terrible happening, you reinforce the forward circuit without having to think about it. You tell the brain and body that “This is not dangerous. I survived it.”

Eventually, with enough advances, the anxiety diminishes until it’s hardly there. I think a residual circuit remains. At least it seems that way, so if once again you start retreating from the feared situation, you will be reinforcing the withdrawal circuit.

ERP is a training programme to overcome anxiety.

How I would do it is get you to draw up a list of 5 situations. There is no set number. If you can think of 10 and think 10 would be easier, then set out 10.

Then I would ask you to grade them, with the highest number being the most anxiety-provoking. Something you just couldn’t do right now. Then I’d set 1 as the least anxiety-provoking.

It has to generate some anxiety because if you’re not anxious, then the training doesn’t work.

So, let’s say you are agoraphobic. Currently, you simply can’t get out of the house.

  1. Step out of the door. Stand at your front step for three minutes. Tolerate anxiety. Nothing bad has happened. Do this for a week, or until the anxiety is gone. Then you can proceed to number 2
  2. Walk to the first lamp post. It depends where you live. Maybe you don’t have any lamp posts. But pick something a short distance away. Do this every day for a week. If you fail one day, just add that day on. It might be it takes you three weeks to complete number 2. That’s fine. It’s not a defeat. It’s a training programme. Keep on until you extinguish the fear.
  3. Go to the local bus stop. Stand there for five minutes. Do it all week or until the anxiety is gone.
  4. Walk to the local shop. Look in the window. Then come back.
  5. Get on a bus and take it for one stop. Then walk back.
  6. Get on the bus for three stops. Get the bus back. Buses are an issue because they are ‘trapping’ like trains. You feel you can’t get off, but a local bus with lots of stops is easier. Keep repeating until the anxiety is gone. It doesn’t matter if you can’t do it one day. It doesn’t matter if you don’t manage it and have to get on early.

What you’re telling your body is that nothing bad happens. The anxiety is a mistaken evaluation. It will learn

Think of your anxiety like a horse and you as the rider. The horse sees a bit of plastic flapping and panics, treating it as a threat to its life. Which it isn’t. You as the rider soothe the horse. Soothe, soothe, soothe. Stroke that horsey neck. “There you are, Dobbin. Nothing to worry about.”

7. Go into town. Walk down the street. Return.

8. Get on a train to a bigger town. Just come straight back.

9. Get on the train to the bigger town. This time, have a wander around.

10. Go to the bigger town. Go into a big store there. If you like, buy something.

You get the idea.

If you have a driving phobia, then maybe No 10 is to drive on a busy highway. Perhaps 1 is to drive around the corner.

If you have a bridge phobia (another trapping situation). 1 is to look at the bridge. 10 is to saunter over it and back.

If you have a spider phobia. 1 is to look at a picture of a spider, 3 is to watch a video of a spider, 6 is to go to the zoo and see a spider in a glass case, 10 is to have the spider run over your hand.

This Stuff Works!

ERP works. I promise it works. It takes practice. Keep practising. There are no defeats. Any times you don’t manage the task, just tack it onto the end of the week. If it takes you ten weeks to master one step, that’s okay. You have ten weeks. You’ve got the rest of your life. And if you master your anxiety, you will have the rest of your life to do what you want, not what the fear allows you to do.

It takes courage to do this. I know that. You need to be brave, but that’s all you need. You don’t have to be smart, and you don’t have to have superpowers.

Find the courage, and the rest falls into place.

Courage mon brave!

Next time: Slaying Safety Behaviours.




Author, Psychiatric Nurse, Narrator. I also produce the Classic Ghost Stories Podcast. Link Tree:

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Tony Walker

Tony Walker

Author, Psychiatric Nurse, Narrator. I also produce the Classic Ghost Stories Podcast. Link Tree:

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