Structured exposure helps a patient to use techniques learned in cognitive restructuring when exposed to the object of their fear or anxiety. New neutral or adaptive thoughts and breathing patterns are utilized while a patient is gradually exposed to the anxiety inducing object or situation in structured and safe environments. Exposure is often imagined at first and then slowly a patient is introduced to a real object or situation. This can prove especially beneficial with specific phobias and agoraphobia.
Interoceptive Exposure
This process was touched on briefly in our chapter on panic disorder. Interoceptive exposure is similar to structure exposure in that it involves gradual exposure to panic inducing stimuli, but the difference is that this method is designed to decrease fear of the panic itself, rather than any external object or situation. Patients are asked to rank the symptoms of panic attacks into what they fear the most, and these symptoms are evoked in a safe manner, starting with the least feared. For example, dizziness may be created by asking the patient to sit in a chair or shortness of breath can be evoked through exercise or breathing only through a straw. Through this method, the patient can learn that these symptoms are harmless, decreasing the fear and anxiety that accompanies them until it has resolved completely.
Self Talk
One of the most destructive habits that often accompanies panic and anxiety is negative self talk. Many patients do not even realize that the exhibit this behavior. Learning positive self-talk can be extremely beneficial in helping to alleviate symptoms of panic and anxiety, and it is something that patients can safely work on from home whenever they feel symptoms starting to arise.
Whenever you feel anxious or panicked, try to sit back and observe your thoughts without judgment. Just be mindful of them as they occur. Many people with anxiety have a tendency to have negative thoughts more often than positive ones.
Some examples of negative self-talk include:
- I am going to die
- I am going to pass out
- Everyone is going to judge me
- I am going to do something embarrassing
- Everyone is staring at me
- I am not going to get through this
- If I don’t do this, something bad is going to happen
Thoughts such as these are incredibly common among people with anxiety and panic disorders, but they are also irrational. Practicing positive thoughts to replace them can offer great benefit. Positive self-talk isn’t about setting other unrealistic goals, such as “this will never happen again”, but is instead about looking at panic and anxiety in a completely rational and observational way.
Simply replacing thoughts of doom or death with the thought that “this is frightening but harmless” can offer great benefit in terms of making the symptom less fearful. The goal of positive self-talk is a lot like cognitive therapy- to replace unrealistic thoughts with neutral and adaptive ones. Practicing this at home can be greatly beneficial in reducing anxiety symptoms, and using positive or neutral self talk even in the absence of panic and anxiety can make it easier to utilize when it matters.
Try spending a day without using negative words such as “can’t” or “don’t” and replacing thoughts such as “I don’t like this” with neutral thoughts such as “this chore needs to be done”. The benefit of a positive approach to your daily life in resolving overall anxiety levels is surprising. Studies show that people with a negative attitude or style of communication are much more likely to experience anxiety symptoms.
Expressing Your Emotions
While we have touched briefly on the correlation between emotional expression and anxiety in this book, it is important to take a deeper look at this link. There are many studies that show that people who are not allowed to express their emotions are much more likely to develop an anxiety or panic disorder. There are many situations where emotions are unable to be expressed, whether it is based on assumptions of gender roles, the structure of the family environment, or even career. Many people in the military find themselves with significant anxiety following a tour of duty largely because many feel that there is no safe place to express or vent emotions that come with the things that they often see or do on a daily basis.
When you have no healthy outlet for your emotions, you learn to keep them bottled up. While this can serve an immediate goal, such as keeping in line with gender or family dynamics, it can be detrimental to your overall physical and mental health. Anger, sadness, and other emotions are a very necessary part of the human experience, and we need to be able to communicate them freely. Suppressed emotions lead to very high levels of stress, which can cause a number of anxiety issues as well as increase your risk of certain health conditions.
Learning not to express your emotions or feeling punished for doing so can create significant anxiety at the idea of expressing your emotions in the future. Many people with social anxiety disorder find that they are often afraid to express their emotions or worried that they will not express their emotions correctly. Some people even develop a tendency to have a panic attack whenever expressing emotions.
If emotional expression is difficult for you, it is important to bring this up with your therapist. Therapy can be incredibly effective at helping you to learn why expression is difficult as well as helping you learn the correct and positive ways to express your emotions. Whether you need to express sadness, anger, love, or any other emotion, you have to know the healthy and appropriate ways to do so. Learning to express yourself can help greatly reduce the symptoms and severity of your anxiety.