Exposure Therapy | Self Help | Phobias | Fear
There is a type of phone call I receive at least a half dozen or more times a year. It sounds something like this:
Caller: Hi, I’m calling about a problem I have, and wondering if you do this.”
Me: Sure, what is the problem?
Caller: Well, I feel kind of embarrassed to say this, but I am afraid of [insert fear]. I don’t even know what can be done about it.
Me: OK, thank you for sharing what you are afraid of. Up to now, what have you done to address your fear of [insert fear] so far?
Caller: Mostly, I just try to avoid it.
Me: OK, how’s that working for you?
Caller: [laughing] Obviously not too well if I’m calling you!
Me: Fair enough!
Caller: So, do you offer any help for this? Like, do you do some kind of desensitizing program?
Me: Do you mean, Exposure Therapy?
Me: That depends on the type of response and the type of phobia.
After we get to that last sentence, everything afterwards is dependent on the type of phobia and the individual’s response to that phobia; everything else is generalized information that isn’t specific enough to be helpful. Over the course of my counseling practice, I’ve been able to help individuals confront specific phobias by creating in vivo and systematic desensitization scenarios, and watched phobic reactions decrease so that the former terror associated with those situations turns into a whisper.
In other words, Exposure Therapy often works because I apply it to those who have the highest chances of responding well to it, and I don’t recommend it for those who have a low chance of a extinguishing that fear response using Exposure Therapy alone.
To give you an idea of what Exposure Therapy is like, and why guided Exposure Therapy might be of help to you if you have a phobia that you’d like to seek treatment for, read on for my personal experiences with Exposure Therapy.
Aquaphobia and Exposure Therapy
In 2012, I finally came to terms with identifying and seeking treatment for Aquaphobia, the fear of swimming in deep water even if there is no imminent danger involved. As I stood on the beach shore of the Mediterranean watching others playing and swimming in the beyond the surf break, my feet remained glued to the sand. Each time I got even a few inches out of depth from where my toe could touch, I felt a wave of panic. While I could breast stroke and keep my nose and mouth above the water’s surface, I felt the immediate need to be standing on solid beach.
When I say panic, I mean all-out, “I feel like I’m gonna die” dread. For many people, the experience of this level of fear is overwhelming and debilitating. One may laugh at it, but for the person experiencing this level of fear, it is an all-consuming sensation. The only way to stop the feeling is to be completely removed from the trigger. Hyperventilation, dizziness, nausea, hysteria, a sensation of suffocating, and crying are some of the symptoms one can observe in someone who is experiencing this level of fear.
Six months later, I stood on a beach in Maui on a sunny morning, watching others playing and swimming in the ocean’s calm bay, and again, I could not leave the shore. Even with fins on, I was too scared and panicked to put my head in the water. When I got back to Seattle, I made a commitment to spend 100 hours in the water — pool, lessons, lake, and ocean — and learn to swim a mile in open water.
I would need to use Exposure Therapy to reach my goal. First, I read a book called The 4-Hour Body by Timothy Ferris (the link is to his article on how he learned to swim effortlessly in 10 days). As one of the goals in the book, Ferris documents how he studied open water swimming by learning the Total Immersion method of swimming, and then chose an open body of water to swim. In ten days, he swam one mile in open water. I then selected a swim instructor and bought four private swim lessons in a pool to help me learn how to relax in the water first, then learn the basics of the Forward Crawl (freestyle).
Each time I got in the water, I guided myself through a short relaxation routine involving the following steps:
Breathe. Two to five minutes prior to swimming, I used deep breathing to create relaxation and calm the nervous system down.
Visualize. I used visualization of happy creatures in water, such as the manatee and an imaginary creature, an underwater dragon. I visualized swimming along with these creatures, relaxed and happy.
Float on my back. Once in the water, I floated on my back until my body relaxed and I did not feel any tension.
Float face down. Once I felt relaxed on my back, I turned face down and blew bubbles, watching the bubbles float away, and helping my lungs feel relaxed.
Interrupt negative memories and sensations. Any time a negative thought about swimming or an uncomfortable sensation arose, I would interrupt those thoughts with the word, “Stop!” or with a question, “Is whatever you are thinking about absolutely true?” Usually the answer was, “No,” and I could continue swimming.
Introduce positive memories and feelings associated with water. After any negative thoughts are addressed, I replaced it with a positive thought, such as, “Each day, I am getting better and more comfortable with swimming.” This helped my mind reframe thoughts about swimming, which kept me relaxed and positive about being in the water.
By the end of my Exposure Therapy, I was about to complete my first Sprint Triathlon and swim in open water. Since then, I’ve gone on to swim in a variety of locations including some rough water entry ocean swims.
From this summary, you can see why Exposure Therapy is popular as both a self-help tool, as well as guided Exposure Therapy. It is a powerful way to extinguish negative associations with phobias and replace them with positive and relaxing thoughts. The brain can’t compete, and drops one thought over the other.
Cynophobia and Exposure Therapy
Because I love all the animals and creatures so much (OK, I admit some trepidation over certain spiders and insects), it has been a heavy and burdensome process of realizing that I am no longer comfortable with dogs that I don’t know. The past seven months since being bit by a dog has changed everything, and to this day, I still have pain in the dog bite injury itself, where scar tissue continues to pull on the surrounding tissues. Each time I see a dog, I think of being in the hospital again, in pain and sicker than — well, a dog!
Not wanting to suffer from a fear of dogs for years to come, I’ve used the method of Exposure Therapy to address this fear. For now, each time I encounter a dog on the trail with its owner, I go through a short routine that is similar to the one I set up for overcoming anxiety to being in water:
Observe a well-trained dog as a neutral, non- threatening creature
Interrupt negative thoughts
Replace negative thoughts with positive thoughts
Lather, rinse, and repeat for 50-100 hours. However, unless I own a dog (I do not), getting enough exposure to a dog in a short period of time involves some planning! Enter my friend Cindy, who needed a dog sitter for a few weeks. Given that her location is in a sunny area of the country that I just happen to love, I was looking for a dog I could take care of, AND I have met her dog before, I jumped at the chance to pet sit for her. Oh, and did I mention she adopted a cat, and Dog and cat get along nicely?
While not every phobia responds to self-guided Exposure Therapy, the ones that do allow you to take control of the exposure and watch the phobia decrease over time. If your phobia is more deep seeded or complex, such as a fear of flying in planes, you may need to sign up for a specific program to structure your exposure carefully and have others helping you.
Are you considering Exposure Therapy to extinguish your phobia? I’d love to host a complimentary consult to see if I can be of help. I’m looking forward to the month of May while dog sitting in sunny Tucson, Arizona. Because my therapy practice is all online, I will still be seeing all of my clients virtually. I can host your consult during office hours (and in the month of May, Arizona is one hour ahead of Pacific Standard Time).