Exposure Therapy
Anxiety Sucks
Let’s be real - anxiety sucks. It can creep up slowly or strike like thunder. It can possess us. Steal over our bodies, making our hearts gallop, palms sweat, hands shake, and send our guts into a sickening freefall. It can be powerful, debilitating, and all-consuming. It can be accompanied by intense worry, dread, panic, and a nearly irresistible urge to escape.
My Fear
Ever since I was a boy, I was afraid of heights. Exposed staircases, highrises, bridges, balconies, ladders - they all made me feel sick and lightheaded. I would grip the rail, knuckles white, and promise myself never to come back again. What else could I do? Had to live with it, I guessed.
But then I learned of Exposure Therapy: a process of confronting safe but feared situations with the goal of overcoming it. Apparently, it had been extensively researched and was considered the gold-standard treatment across a range of anxiety-related issues, including: Specific Phobias, Panic Disorder, Agoraphobia, Social Anxiety, Post Traumatic Stress Disorder, and Obsessive Compulsive Disorder.
From the sounds of things, Exposure Therapy worked - and worked well. Clients who underwent the treatment enjoyed significant benefits and often resolved their fears completely. It sounded good. It sounded great! The best weapon modern psychology had in its arsenal against anxiety. Only, I had faced my fear of heights many times throughout my life. Why wasn’t I better?
I did my homework.
Exposure Therapy
Exposure therapy involves confronting anxiety provoking situations and/or sensations to learn they are safe and tolerable. However, for optimal ‘safety learning’ (learning that a situation is safe), Exposure Therapy should have the following guidelines in mind:
1) Repeated – facing a challenging situation once is usually not enough. It needs to be faced and faced until your emotional system is convinced it is safe.
2) Prolonged - ducking in and ducking out won’t do. You need to stay in the feared situation and ‘rid the wave’. Just stay. put. It will rise, and it will fall all by itself if you stick it out. Stay until the anxiety comes down (at least by half, as a rule of thumb) or until your negative prediction is sufficiently challenged.
3) Graded - it often works well to start at the ‘shallow end of the pool’ and work your way up to the ‘deep end’ as you get more confident.
4) Eliminate Safety Behaviours - this is an important topic. It’s often what people - myself included - fail to address when facing their fears, and thus stay afraid. Safety behaviours are all the obvious and subtle things we do to suppress anxiety and ‘stop’ the bad thing from happening. If we leave a challenging situation, we feel instant relief. If we bring a ‘safety person’ with us to the party, we feel reassured. If we close our eyes and block out the dizzying height (I’m speaking about a friend, of course), the fear isn’t so bad. It makes us feel better. Why then are they a problem?
Well, safety behaviours might provide short-term relief, but they increase anxiety long-term because they stop you from learning: A) you can tolerate the anxiety, B) the bad thing probably won’t happen, and C) even if the bad thing did happen - you could probably handle it.
My Exposure
Knowledge in hand, I went to my nearest rock climbing gym to face the smallest (kids) wall. It was all of five meters. Not very impressive, but exposures need to be Graded after all. I then climbed half-way-up and froze - shaking, heart-racing, out of breath, my anxiety screamed at me to stop being stupid and come down immediately. Thankfully, I managed to stay there until my anxiety dropped by half (Prolonged). It took about five minutes for my negative prediction to be proven false (‘If I get too anxious, I’ll lose control of myself, slip, and fall’). I climbed down, had a breather, and did it again two or three times (Repeated), only this time I managed to get to the top (to thunderous applause from no-one).
Upon reflection, I noticed a few Safety Behaviours: I sought excessive reassurance from my belayer (my poor friend on the ground holding the safety rope), I always maintained stiff control of my body, I relied too much on rope tension and not enough on my own strength, I climbed excessively slowly, I didn’t look down, I mentally distracted myself (imagining I was only a meter off the ground), I climbed down rather than trust the rope and abseil… there were more, but I don’t want to bore you, dear reader. Let’s just say, I did my best to eliminate them all.
I then tackled the ten-meter wall, escalating the challenge, and repeated the process.
I then stared down the fifteen-meter wall, knees aknocking, and repeated the process.
After two hours, I was clinging to the top of the highest wall with only a tiny flicker of anxiety.
The following week I went back and climbed straight up the highest wall. There was a sudden burst of anxiety that wasn’t too bad, and it quickly vanished.
The anxiety never came back. I now regularly rock climb with 0/10 anxiety, 10/10 enjoyment, and 2/10 skill.
