Exposure Therapy
for Fears and Phobias

by Dave Carbonell, PhD

Exposure Therapy has been shown to be the most effective anxiety treatment for people with many anxiety disorders. You might already know that it involves practicing with what you fear, in order to become less afraid. But how does it work?

Exposure Therapy helps you retrain your brain. It's not just about "getting used to" the fear. It's about retraining your brain to stop sending the fear signal when there isn't any danger.

People struggle against anxiety attacks and phobias because they recognize that their fears are exaggerated and illogical. They try hard to talk themselves out of the fear.

But that doesn't help. So they end up trying to avoid the fear, and that, unfortunately, just strengthens it.

Exposure Therapy will help you retrain your brain to let go of phobias, anxiety attacks, and other forms of anxiety disorders.

Let's see how Exposure Therapy works.

Fight or Flight

When your brain gets a signal of danger, it triggers an immediate response, the familiar Fight or Flight response. That's a good thing, because when we face danger, we need to react quickly and powerfully.

Humans evolved in a different world than the one we inhabit today. It was a world full of predators, without police or deadbolt locks. Our main job was to get enough to eat each day without becoming food for somebody else. We needed a good emergency alert system to keep us out of the jaws of predators.

If we had relied on the thinking, intellectual part of our brain, called the cerebral cortex, to keep us safe, we'd be extinct. It's too slow. It's good for writing a speech, and figuring out your income tax, but not for making snap decisions about danger.

The part of your brain that handles these Fight or Flight responses is very different from the part of the brain you're most familiar with.

The Amygdala

The Amygdala, a little almond shaped part of your brain, is what makes these Fight or Flight decisions. The Amygdala works quickly, without your conscious awareness, because speed is vital in protecting against threats. You only find out what the Amydgala did when you feel its effects in your body (all the familiar panic sensations) and in your behavior (duck, run, escape).

Whenever we make a decision, there are two possible kinds of errors. One is a false positive. If you decide there's a tiger hiding in the tall grass, when there isn't one, that's a false positive. When you make a false positive error, you get afraid in the absence of danger, but you don't get eaten.

The second type is a false negative. If you decide there's no tiger hiding in the tall grass when there really is one, that's a false negative. When you make this false negative error, you feel okay, but you're gonna get eaten.

Your Amygdala doesn't care how many times it scares you unnecessarily. It just aims to keep you alive. It doesn't want to make any false negative mistakes.

If you experience phobias and anxiety attacks, and want to overcome them, you need a form of anxiety treatment which will retrain this part of your brain. The most direct and systematic way to do that is Exposure Therapy.

How Your Amygdala Works

Always Watching

Your Amygdala is always watching, passively, in the background, for some sign of danger. When it sees one, true or false, it presses the "fight or flight" button and fills you with fear. When the danger is real, that's a good thing. But your Amygdala works like it's still 27,000 B.C., and will often make the mistake of seeing danger when there's none.

It Learns by Association, not Reason or Logic

When you run away from whatever the apparent danger is, the Amygdala stands down and goes back to quietly watching. If you ran away from a mugger, that's a good thing. But if you ran away from a grocery store, or a dog on a leash, that's a bad thing. Now your Amygdala will be conditioned to see the grocery store or the dog as dangerous, and will make you afraid next time you see one.

The Amygdala learns by association. It associates the crowded store, or the dog, with danger. It doesn't learn by conscious thought. This is why you can't simply talk yourself out of a phobia or anxiety attack. The fear memory is stored as a conditioned fear, and can only be relieved by more conditioning, not discussion or reason.

It only Learns When You're Afraid

The Amygdala only learns when it's fully activated, when it spots something it considers dangerous. It only forms new memories and associations, new lessons, when you've become afraid. The rest of the time it's on autopilot, passively watching.

Do you see what this means? If you stay away from what you fear, your Amygdala will keep on "believing" the same old mistakes, without a chance to learn anything new.

How Can You "Talk" to Your Amygdala?

Your Amygdala only learns from experience. If you flee the scene every time you have an anxiety attack, your Amygdala learns that you should leave to be safe.

How can you get your Amygdala to learn something new? You have to activate it by exposing yourself to a trigger that gets you afraid. If you have a dog phobia, that would be a dog. If you have anxiety attacks on subways (or highways), you need a subway (or a highway). And you need to stay there with that fear until it gets a lot lower.

That gives your Amygdala the chance to learn that it got all worked up about nothing. That way, it can learn that dogs (or highways) aren't the threat that it had been conditioned to believe. And, with repetition, it will develop a new memory, one that lets you get on with your life without being disrupted by phobias and anxiety attacks.

Retraining Your Amygdala
with exposure therapy

That's how Exposure Therapy works. Exposure Therapy retrains your Amygdala.

You don't have to do this radically and quickly. What you need to do is to continually arrange to activate your Amygdala by exposing yourself to what you fear, and then stay in place, making sure that the fear leaves before you do. You can use a variety of coping steps to help you do that, or you can just "float", as Claire Weekes called it, and wait for the fear to subside. Either way, Exposure Therapy will enable you to retrain your Amygdala with new learning in ways it can absorb.

I offer this treatment in the Chicago area, and if you're looking for help here, you can contact me by phone or e-mail. If you want to learn to do some of this on your own, my Panic Attacks Workbook will show you how.

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