Helping Yourself to Overcome Your Anxiety Disorder:
Remember the basic rule for beating anxiety: Anxiety is maintained by avoidance; to overcome anxiety, you must move, in manageable steps, towards areas of greater discomfort. The more you expose yourself to your anxiety triggers, and the longer you are able to stay in the situation without running away, the more you will eventually overcome your anxiety.
In other words, the active ingredient for overcoming your anxiety is exposure. And practice is the way we get exposure.
But not all practice is the same.
I would like to introduce two types of practice: planned practice and incidental practice.
Let me start by explaining what I mean by incidental practice. Let’s suppose that you are afraid of taking elevators and you must attend a meeting in an office that requires you take one. (Like any good phobic, let’s assume that you have checked all the various ways of seeing if you can change the meeting location, whether you can take the stairs to the meeting, or if you can claim that you are ill and have someone else go in your place. In other words, is there some way to avoid taking the elevator?!). Since there doesn’t seem to be any way to avoid the elevator, you screw up your courage, grin and bear it, and–anxiety be damned–put yourself on the elevator and press the button for the correct floor. You do whatever you need to do to make it through that elevator ride, and then scoot out the door as soon it opens.
You have taken an elevator ride. You have exposed yourself to the source of your anxiety. But the exposure you have experienced is incidental to the larger goal—your real goal was to get to the meeting. And, there is a high probability that you engaged in lots of little avoidance tricks to get yourself through the ordeal. You probably breathed a huge sigh of relief when the ride was over. Unfortunately, you may not have gained many therapeutic benefits from the anxiety you experienced during this type of exposure.
I want to contrast this with planned practice. In planned practice, your goal is to practice exposure to the anxious feelings themselves. The triggers (such as the elevator) are important in that they cause you to feel levels of anxiety, but the goal has nothing to do with how many of these triggers you can tolerate. With Planned Practice, you do not need to go anywhere specific, or even do anything specific. Your goal is to experience anxiety for a planned period of time.
What is the optimal planned amount of time? While there are individual differences, almost all studies suggest that ongoing exposure for 30 minutes to an hour is most effective. If you are not a clock person, then your job is to try to stay in the situation until your anxiety starts to significantly decrease–although, as we shall see–there are lots of exceptions to this general rule.
Let me give you an example of how planned practice might proceed: Suppose you have a fear of driving a distance from your home when you are driving by yourself. You have a car that is parked in the driveway, but your fears have prevented you from driving for the past 6 months. Every time you think of getting in the car, pulling out the driveway, and getting into traffic, you begin to panic. You feel overwhelmed and completely unable to do something like that, so you simply “put off” that dreaded experience.How would you begin to practice conquering this fear using the principles of planned practice?
First, you would remind yourself that you are practicing in order to expose yourself to the anxious feelings themselves. This is the basic principle that underlies planned practice.
Second, you would try to disregard where and how far away from home you are going. The only thing important here is the anxiety your are experiencing.
Third, you would decide how much anxiety you feel capable of tolerating that day. On a scale of 0 – 10, let’s say that you can deal with a 5. (On other days, this number will change. On certain days you will feel much less hardy, and decide that a 3 or 4 is all you can handle. On still other days, you might feel like you can eat nails for breakfast, and a 7, 8 or even a 9 is tolerable). The important point is that YOU decided your own intended level each time to go out to practice.
Fourth, you get into the car, turn on the engine, and start to back out the driveway. As soon as you hit a level 5 anxiety (your previously chosen level), you stop the car and wait. Your goal is to keep the anxiety level as close to 5 as possible, as you practice your anxiety management techniques.
Fifth, let’s suppose that you reach a level 5 as soon as you turn on the ignition. (A level 5 is your maximum for that day.) So, you have already reached your goal, and all you need to do is stay in the car with the engine running for 30 to 45 minutes. You are then finished with a successful planned practice. This is one possibility.
Sixth, a much more probable outcome is that you start the engine, get a whoosh of anxiety, and soon feel much calmer. Let’s say you get down to a 2 or 3. Remember that your goal is to spend your practice time learning how to cope with a 5. So, your job is to do whatever you need to do to get your anxiety a little higher. You might begin to back the car down the driveway. Let’s imagine that your anxiety stays pretty low until you have to back into the street, and at that point it spikes to a 7. Now your job is to just stay there, waiting to see if your anxiety goes down to the targeted level 5, or if it stays at a 7. If your anxiety goes down to the 5, you don’t need to do anything else. If it stays above a 5, put the car into Drive and return up the driveway until you anxiety level comes down to the 5. Then you should stop and practice coping with the anxiety.
Here is the general rule. Try to keep your anxiety at or near the level you have chosen for the day. Sometimes you will expand your “safety zone” while doing this. Sometimes you will stay very close to home. That is not important. You are moving only to adjust your anxiety level as it changes up and down. After about a half hour–when you are at your predetermined level of anxiety–it is time to stay at that same physical location and allow your anxiety level to begin to decrease. By merely staying at that same location for a period of time, you will begin to habituate to the anxiety producing stimuli. You will start to feel less anxious. When your anxiety level decreases by a very noticeable amount (at least one third), you are finished with your planned practice session.
Advantages of Planned Practice
The major advantage of planned practice is that it provides you with a systematic and manageable method to maximize your exposure to the feared situation. We have seen how incidental practice often minimizes exposure, and that we usually engage in a variety of avoidances during that type of exposure.
Planned practice also helps you cope with a phenomenon that I call the “raising the bar” syndrome. This is very common in these situations.
“Raising the bar” syndrome occurs after we manage to reach a specific behavioral target during our practice sessions. This can happen any time we practice exposure in a way that is not consistent with the principles of planned practice. As soon as we have reached that behavioral goal, from that point onward, we often feel pressure to at least reach that target in subsequent practice sessions. Paradoxically, that pressure acts to raise anxiety, and makes it harder to reach the same goal the next time. In effect, each time we accomplish a goal, we inadvertently raise the bar for future practices.
Let me be specific. Suppose you have managed to drive your car out of the driveway, and have reached the school that is 5 blocks away. The next time you practice, you feel a pressure to at least reach that school, and that pressure increases your anticipatory anxiety. As you back out of your driveway, you might feel a spike of anxiety. You might say to yourself, “Oh, no! I’ll never make it to the school if I feel this much anxiety and I’m not even out of my driveway yet.” These sorts of thoughts are the fuel that generates anxiety, especially anticipatory anxiety. You are getting away from the present and thinking scary thoughts about the future.
Other Benefits of Planned Practice
Planned practice helps you cope with anticipatory anxiety while practicing. As I have mentioned, anticipatory anxiety is a huge bugaboo in overcoming your anxiety disorder, and it adds to the difficulty of practice. Just imagine, for example, that you are claustrophobic and you are comfortably sitting in your living room. You remind yourself that you should practice the exposure of going on an elevator. Because of anticipatory anxiety, merely imagining going into an elevator brings high levels of anxiety, and you might think that you just aren’t up to dealing with such high anxiety. So, you put off the practice and have the experience of avoiding the (in this case, anticipatory) anxiety once again. Your avoidance has strengthened the anxiety, and compliance with your practice schedule goes down.
Planned practice also helps you keep you eye on your goal: Remember that your goal of practice is exposure: you want to keep in contact with your anxiety triggers so that you have the chance to habituate or desensitize yourself to them. Anything that takes you away from exposure is leading you in the wrong direction. If you focus on a behavioral goal (such as a location or a distance or a type of transportation), then it is natural to do what you need to do in order to get there. You will be strongly tempted to look for avoidances, safeties and reassurances in order to get to your goal. And let’s remember that all these avoidances tend to reinforce your anxiety, which is the exact opposite of our goal.
Additionally, if you do not use planned practices, the anxiety that you feel can easily turn into a test. Let me explain: Most people who practice are hoping reach their goal with lower anxiety, and are testing themselves to see how much they will react in the practice situation. If their anxiety is low, then they feel positive about the practice, and look at that as passing the test; if it is high, then there is a tendency to feel disappointed in themselves, to wonder what is wrong, and to give themselves a low or failing grade on this test. The interesting point here is that people grade themselves in a way that values getting lower levels of anxiety. This is exactly the opposite of what we want: we want to maximize your exposure to anxious stimuli. Once again, the basic rule we are working with says that we move to areas of greater discomfort in order to overcome anxiety.
Finally, the principles of planned practice completely change the definitions of success and failure. In general, people who are practicing feel like they have done better when they are able to reach their target with little or no anxiety. They feel like a failure, either when they feel extremely high levels of anxiety, or when they are simply unable to reach their goal. If you think about it, this is precisely the opposite of what is most therapeutic for you. The object of practice is to allow exposure to anxiety so that you can learn better ways of coping with it, and to allow your body to desensitize and habituate to your triggers.
However, with planned practice, there is only one way to fail: You fail a planned practice when you do not experience anxiety. Any practice that creates anxiety, no matter where that anxiety occurs, counts as a success. Anxiety is the mark of a successful practice. A successful planned practice maximizes the therapeutic benefits of exposure.
A Review of Planned vs. Incidental Practice
This table outlines the major differences between planned and incidental practice.
|Object is to expose yourself to a pre-determined level of anxiety
|Object is to go into the anxiety producing situation
|Reduces the desire to engage in mini-avoidances
|Reduces Anticipatory Anxiety
|Tends to increase anticipatory anxiety
|Eliminates the “raise the bar” syndrome
|Creates the “raise the bar” syndrome
|Encourages prolonged exposure to anxiety in manageable steps
|Encourages exposure to situations, and not on the feeling of anxiety
|Makes failure impossible so long as practice takes place
|Makes success or failure dependent on behavioral goals