Coastal Center for Anxiety Treatment

Name card of Dr. Eric goodman.

Exposure Therapy

People tell me all the time, “I’m facing my fear, have been for years, but it still terrifies me.” I can relate to this. I developed a phobia of flying back in undergraduate school. I spent the next ten years with my fear ratcheting up, but I was still flying once or twice a year when it was too impractical to avoid it.

Why did my fear continue to grow in the face of continued exposure? It was because of the laundry list of things that I did to “survive” each flight. Those of you with a fear of flying will appreciate this. I would fly only in “large enough” planes. I had to sit next to the window so that I could check outside during turbulence to make sure the plane was still horizontal. I would select rows at the front of the plane because they are less bumpy during turbulence. I would pay attention to every sound and movement of the plane (all fearful fliers become self-appointed deputy plane monitors). And, of course, when feeling uncomfortable (read—terrified) I would either desperately try to distract myself with magazines or conversation, or tightly grip the armrests (which is not only a poor attempt at self-soothing, but a primitive way to try to hold up the plane).

The end result of engaging in these sorts of “safety behaviors” is that at the end of the flight I felt like the fact that I survived was at least in part due to my behaviors. It’s not rational, but neither are phobias. There’s the joke about the guy who, being terrified of vampires, begins to wear a necklace of garlic cloves under his shirt each day. When his friend asks him how that’s working for him he says, “Great! I have not been attacked by a single vampire!”

The cloves of garlic, the safety behaviors on the airplane, all serve to reinforce the idea that we are in danger and that we need to do certain things to stay safe or else catastrophe will ensue. Therefore we do not learn that the situation is safe (or at least safe enough). Response Prevention is where we give up our safety crutches and truly go towards the phobia.

In order for Exposure Therapy to work we have to be willing to feel uncomfortable, uncertain, and unprotected. What’s more is that we must strive to feel these things, to accept them. Now, acceptance does not mean you like to feel these things, but that you understand that it is good for you to feel these things. Think about feeling sore following a workout the day prior. It’s not that you like sore muscles, but one might like what it represents, that they got a good workout and are on their way to being healthier.

So, exposure therapy works best when you practice doing what you are afraid of and practice not doing the safety behaviors that give short-term relief at the expense of long-term well-being. Then, if you are still feeling stuck and self-directed exposure therapy is not working, see a qualified anxiety disorders treatment specialist.

Eric Goodman, Ph.D.