Cognitive Therapy Basics

Exposures involve voluntarily bringing on a mild to moderate level of anxiety In other words, exposures show you ways to face the demon, challenge him head on, and kill him once and for all.

There are two keys to exposures:

1. They have to be voluntary (which means that you can’t do them all the time, because you won’t always be in the mood)

2. If you imagine your anxiety from a 0-8 (with 0 being calm and 8 being a panic attack), you want to hit a 4 during any given exposure (because if you go above a 4, the anxiety might get ahead of you and no longer be voluntary and under your control).

Exposures are used to gain mastery over any phobia. They work for panic disorder because the core of panic disorder is usually phobia as well: A phobia to certain physical sensations. Whether it’s a racing heart, dizziness, nausea, a choking sensation, or a certain pain, every panic disorder patient has at least one or two physical symptoms that trigger their panic cycle. Exposures show you how to experience these sensations in such a way that you finally stop being triggered by them. After 1-2 months of exposures, most patients find that coping techniques begin to be effective (i.e. the shield actually starts working). Once patients are good at exposures, they can often use them to actually stop a panic attack that is coming on. In other words, once the demon appears, they can turn the tables on the demon, challenge it, and get it to run scared with it’s tail between it’s legs. After several months of exposures, most of my patients become completely panic free (and can usually be taken off on any panic-related medications they have started).

Exposures are at the heart of Cognitive Behavioral Therapy, and they are by far the most useful techniques for killing the Demon and gaining mastery over panic once and for all.

Notice: The following is presented for informational purposes only. Assessment and treatment should always be directed through one-on-one consultation with a trained professional.

This is one of my favorite questions and obviously one of the most important ones for people who are trying to gain mastery over panic.

There are basically two options for what to do when you feel a panic attack coming on. The first is to use a coping technique. The second is to do an exposure. And yes, I will explain what coping techniques and exposures are! But first, let’s start off with my favorite analogy:

The Demon Analogy

Panic disorder can be thought of as a demon. There are two ways to fight this particular demon. The first way is to use your shield — Using your shield means using medications (such as Xanax), leaving the situation for a while to calm down, using relaxation techniques, and/or talking back to your anxious thoughts to quite them down. In the next part, I will describe these coping techniques in detail including their pros and cons. But apart from your shield, there is also a second way to fight this particular demon – it turns out that every time you face the demon head on, he gets weaker. Each time you challenge him, he gets smaller. That is where exposures come in to play. Exposures involve turning the tables on the demon by jumping him, challenging him, and saying “Bring it on. Is that all you’ve got?”

Initially, most coping techniques alone are actually not strong enough to stop a panic attack . For example, you may try relaxation to stop a panic attack but it’s just not working. The demon is so large, that he just swipes your “shield” aside. However, usually after one to two months of starting to face the demon (i.e. doing exposures), the demon become so small that the shield techniques finally start working! And after several months of exposures, the demon typically becomes so tiny that he stops coming around at all and eventually dies.

These combined tactics of using your shield and periodically facing the demon head on will help you gain mastery over panic once and for all. If you learn these techniques (in a type of therapy known as Cognitive Behavioral Therapy) it is very likely that you can eventually enjoy going out with your friends, driving your car, flying overseas, and enjoying a sunny day at the beach without having to worry about panic any more.