Exposure therapy for anxiety has given new insights on how you start having panic attacks. If you are an anxiety sufferer you have learned the “art of panic”. That might sound ridiculous but panic attacks literally develop and manifest because of a form of learning that human brain does automatically.
I know this is very difficult to believe. When I got to know this I was surprised to the extent that I felt this is a mockery by psychologists and doctors. I was annoyed and a few questions instantly popped up in my mind.
- What learning has to do with panic attacks?
- Is there any specific reason to point out for my suffering?
- Where did I go wrong that I have to bear such intense fear and symptoms?
- What was my mistake that led to panic attacks that are almost unbearable?
There was a queue of questions where every question produced another question but no answer satisfied me!
I wanted someone who understood what I wanted to say and appreciate my questions. Soon after reading works of people like Claire Weekes and David Burns I understood that I needed to pay attention to what they were saying with their research on exposure therapy for anxiety. And I did just that to understand if their concepts were real or not.
Some insight from the exposure therapy for anxiety
The human brain has evolved for billions of years and it has a dedicated system that protects us from dangers so that they do not cost us life. For example, we are naturally scared of heights because if we fall from heights we can die. The so-called our “monkey brain” (i.e. the primitive part of our brain) scares us when we climb heights or confront heights so that we move away from heights and we become safe immediately.
And this system does not have the power of “thinking,” It only has the power of reacting. It does not think before reacting because it is designed to act only instantaneously in a fixed pattern. It only understands instincts and behaves accordingly. It is programmed just to create an emergency that creates an alert to fight or flight. This understanding is core to exposure therapy for anxiety.
This means that the fear system in the brain follows a specific reaction pattern to stressful situations.
But to your surprise, though this system is instinctual it can be trained to react.
Actually, it gets trained during some specific kinds of mental experiences.
And how that training occurs?
Well, that has to do with the purpose the system has been designed for.
The fear system is stubborn: it does not listen to the conscious mind!
You often say that there is no reason for you to panic and that you do not know exactly what is bothering you. Panic attacks come out of the blue and create a hell for you…that too for a considerable amount of time. You expect that panic attacks should not happen to you. You resist them. You avoid the places, events, and thoughts that invite anxiety and panic but still, you suffer hell. Panic attacks do not seem to go away.
That fact is the fear mechanism that is responsible for panic attacks does not understand what the conscious mind says or wants. It does not follow the rule of “reacting with reasoning.” It does not have the capability to obey what the conscious mind wants or expects. It will do its job what it’s made for regardless what is expected or what is right or wrong. That is the reason exposure therapy for anxiety was needed since there is even no question of the rationality of thought.
Want a very common example?
A horror movie in a movie theater:
Remember how do you get scared in the theater while watching a horror movie. There is no danger to your life. Still, you panic for a few moments. Can we say that you are programmed to fear the sights of devils and ghosts in some way? Probably yes because we never take any training to panic at the sight of a ghost on a movie screen. It happens automatically as if the pattern is programmed in our brains. When the ghost flashes on the movie screen we get frightened in an instant. We do not think and panic.
Now that you experienced the fear of watching a worst deadly ghost with very scary sounds in a dark movie theatre, you have got a fearful memory of the ghost/situation. Even if you know that the ghost is not real now you are scared to stay in the dark room of your own house! You imagine that some spirit is watching you when you are alone in the house. This means the fear you experienced in the movie theater has taught you to get scared even in the absence of the image of the ghost or the situation shown in the movie. (This is called Fear learning),
Now when you go to a scary movie next time you panic even more because the fear of ghosts already exists in your mind and the scary scenes from another movie add up to your existing fear or trigger additional fear. So the conclusion is- You didn’t leave the experienced fear in the movie theater during the first time. You brought it home! You didn’t bring it home consciously but your brain carried it.
Same is the case with panic attacks. The first few panic attacks can be called as the ghosts of the first movie and the next panic attacks can be called as the expectation of fear during the second scary movie that is more precisely the “fear of fear.”
You can better understand this with the illustration below.
Panic attacks result when the fear system (fear mechanism) is triggered and it keeps in the triggered mode for a long time
The fear mechanism learns to react to particular feelings and sensations:
The fear mechanism is programmed to react in a way that arouses fear instantly. Along with this programming, it also learns to react depending upon the way you perceive fearful events. Panic attacks are a result of an association between you feelings & sensations and a bad outcome. For example, when you start having lightheadedness you conclude that you are about to faint, when you have chest pain you conclude that it can be a massive heart attack, etc. It is shown in the picture below.
Michelle Craske Ph.D, a well-known researcher of exposure therapy for anxiety while treating anxiety sufferers found that their mind associates uncomfortable feelings and sensations with the negative outcomes or dangerous events immediately.
While researching the effectiveness of exposure therapy for panic disorder her team found a very surprising fact. It told them that anxiety and panic sufferers have a deficit in unlearning the fear association. Meaning, they find it difficult to break the above illustrated relation between uncomfortable feelings and sensations with the negative outcomes or danger to their life. It can be understood well from her video below.
Michelle Craske: Exposure therapy for anxiety – State of the Art
Fear is actually a memory that is recalled in every corresponding stressful event. Panic attacks are nothing but a pattern of the repetitive surfacing of the fear memory (not the literal meaning of memory). It is the fear of the fear itself and exposure therapy for anxiety resolves it. When you are scared during the panic attack you are scared because of your past experience of panic attacks. But you mistakenly fall prey to the feelings and think that you are about to lose control, have a heart attack or die. Panic attacks are very scary and uncomfortable but they never do any harm to the sufferer.
Now it’s your turn to think…
Are you in danger or it is just that your brain has learned to react to sensations and feelings?
Let me know in a quick comment below…