Feeling anxious from time to time is a completely normal part of the human experience. However, sometimes those feelings of anxiety can reach a frequency and intensity such that they interfere with how we’d like to live our lives.
When anxiety is severe and/or chronic, it can be hugely restrictive and stop us from engaging fully in relationships and activities that matter to us.
Thankfully there are effective therapies for when anxiety gets in the way of life. Cognitive Behaviour Therapy (CBT) has clearly demonstrated effectiveness for both adults and children experiencing a range of anxiety-related concerns. In this article, we focus on avoidance, which can serve to keep anxiety going, and Exposure Therapy, which is often an important component of CBT for anxiety.
“You’ve just got to face your fears!” You may have heard some version of this advice before. Is it really that simple? To address this idea, let’s look at the role of avoidance and exposure in relation to anxiety.
Avoidance might be of anxiety provoking places, situations, experiences or even feelings. Avoidance can stop us from travelling to certain places, expressing our opinions, being flexible in our routines, or being spontaneous. Avoidance may provide short-term relief from uncomfortable feelings and thoughts but in the long run actually increases anxious feelings.
Imagine you’re walking through your favourite park. A dog runs up to you and aggressively barks at you, and you have an understandable fear response. The next day, you think of going for a walk and you experience some anxiety thinking about going to the park. An avoidant behaviour here would be the choice to stay home; the anxiety drops as you think ‘there’s no chance of an encounter with the dog’. In this case, you’ve learned to get rid of the anxiety through avoidance. However, as long as the association between “park = aggressive dog & anxiety” remains unchallenged, anxiety about going to the park may well continue. If this continues, you may find that going to your favourite park becomes simply too anxiety-provoking. In some cases, this anxiety and avoidance strategy might ‘spread’ to other situations where dogs may be present (the beach, for example) and the anxiety has now taken an increasing hold in controlling the person’s life.
This pattern of avoidance and increasing anxiety over time is common and does not just apply to parks and dogs, but to many other situations. For example, it might be that you feel anxious about conflict with others and avoid conflict by agreeing and not voicing your opinion. This may help your anxiety in the short term but likely means that you miss out on learning to be assertive and learning to cope with. Or perhaps you feel anxious about failure and so become unforgiving and perfectionistic to avoid the discomfort of making even small mistakes. These unrelenting standards can lead to a build-up of stress and increasing far of failure over the longer term.
So – just pull yourself up by your bootstraps and go head-first into the fray, right?! Well, not quite...
Exposure to anxiety is a common and effective component of working to reduce anxious responses. However, there are a few important considerations to make when it comes to confronting these situations. The way you face your fears can have a large impact on how successful exposure is.
First, remove the judgement. Judgements regarding avoidance being a personal ‘failure’ or weakness are common. These judgements are also quite unhelpful. Exposure can be hard work and managing the judgemental thoughts that arise is crucial for overcoming intense anxiety. Speaking to a psychologist can be helpful when it comes to identifying and managing these judgemental thoughts around avoidance and exposure.
Next, have a plan. Exposure is not simply jumping in the deep-end. It is a precise, structured, and thought-through intervention that prioritizes your wellbeing and goals. Working with a psychologist, you can:
- Identify specifically what is causing the anxiety, and identify specific anxious predictions.
- Identify specifically why this is a problem and what the motivation to change is.
- Collaboratively define what could be the initial steps in exposure. therapy. You may decide to start small, noticing that repeated and proactive exposure tends to lead to a lower anxiety response over time. As your confidence builds, you will take steps toward your goal in a structured and thought-through way. Part of this will include developing strategies to better manage feelings of anxiety as they arise.
- Test specific predictions – do they hold up? Where did they come from? What can be learned from this?
- In an open and curious way, discuss the barriers that might arise and consider how an exposure schedule might be modified as a result
Your psychologist will have a good understanding of how to design an exposure program and will work with you to make sure it fits with your specific situation. You are the expert on your situation, and your input will be invaluable when designing an exposure schedule.
Finally, circle back and reflect. After each attempt at exposure, there is a wealth of information about your personal experience that can be gained by asking reflective questions about the outcome. What was the experience like? What was harder or easier than predicted? What did you gain from being in that situation? What did it cost you? What should you do next?
Anxiety is a normal human experience, but it can come to interfere with our daily lives. Yes, part of the treatment for anxiety is exposure to anxiety-provoking triggers. However, this is rarely as simple as facing your fears like a Hollywood action hero. Exposure is a carefully planned, collaboratively-defined and supportive intervention that can provide lasting change. It utilizes both your willingness to face fears as well as an evidence-based understanding of human behaviour.
For a detailed look at treatments for anxiety, click through to Beyond Blue’s summary of the evidence for anxiety treatment.
Written By Jakub Dammer, Clinical Psychologist (Registrar)Blog overview