Desensitization/Exposure Therapy - How do you do it?

[DMT]

I've read about it, gone through this website, have seen a couple different therapists, I understand the logic behind it, but I just can't bring myself to get started! I created a hierarchy of fears, similar to the instructions on Sage's website from words, up through thoughts and real life situations. But I can't help but worry about doing something in the wrong order, and I've had trouble figuring out where things go (like there's a huge difference between words and general situations vs. my constant thoughts of past experiences and real life experiences that I am afraid are going to happen with my own kids). They don't even belong on the same chart in my opinion! And I can go over and over the words, but how do you desensitize the scary memories and horrific future events I imagine all the time??

And then I'm confused with how to actually do it. When it comes to words, I get that you repeat them until you're no longer scared of it (but I could probably repeat the words for 5 years and still be scared!) Same with videos and sounds. But what about the scary thoughts and memories that are always in my head? Do you just keep imagining the same thought over and over? (I've got like a billion of them, this could take forever!) And then what do you do after you have the thought or say the word, to calm yourself down? Do you get up and do something else to distract yourself? Do you do the whole exercise while in a relaxed state? (not really sure how that's possible). I just don't really understand how to even get going with it. I have a relaxation CD, but I'm not really into how that is going to help me. When a real life scary situation comes up, I'm not going to run and get my CD and lay down somewhere with it. And I'm just not the type that can easily relax anyway. That part of it just seems kind of hoaky to me. I'd rather just come up with a distracting thought or something, but I'm not sure what the right approach is.

My biggest problem is I'm just so particular and by the book (obssessive and need to be in control of everything - sound familiar?) so I just want to make sure I approach this the right way from the get go. But every time I try to get started, I just don't know what to do and then I avoid it altogether. Have you had your therapist work through this with you in your sessions? Right now we've just been talking - and I really like him. We figured out a lot, I understand why I'm like this, where it came from, what caused it, some of the behaviors I'm doing currently that keep this thought pattern up...but when it comes to the actual exposure therapy, it's been my homework. I haven't done anything with him in his office. Is this normal?

I also wonder what to do with some of the behaviors that I do to control things. Do I have to drop those cold turkey, or will they gradually fade as I become less scared through the desensitization? Things like disinfecting, hand washing, fearing taking my kids out this time of year to public places, birthday parties, etc. I think this would make me more anxious, and then they'd be more likely to get sick. But since I'm not over the fear part, I'm not sure how this will help me, I'll just be more scared all the time. I understand it's just another way of needing to be in control of the situation, but they're not just random OCD rituals that don't make any sense. These are real behaviors that I think keep us healthy, and I'm not sure how to cope yet when stopping them. Anyway, I just wondered how and where this fits in with the desensitization therapy.

If you've made it this far, thanks for reading! I just wonder how others that have gone through similar therapy have approached it.

[sage]

Hi dmt
have you been to my website? If you read through it all it should get clearer for you. Basically, you're a good example of why it's necessary to do this with a therapist (the memories/imagination part) They are trained in watching you closely, asking how anxious you are 0-10, and talking you down if your anxiety goes too high. They will help you put things in order, but since it's not an exact science you will get to make a decision about what you want to move on to next.

Distraction once you're anxious may work as a temporary bandaid but it will not help in the long run. Teaching your body to relax as in with your CD is a skill to be learned (and perfected). Running to the CD when you're anxious is like being asked to play the piano and running to a music book with finger numbers on it. Much like piano, you have to practice, practice, practice. Then one day you can play. There ism"quick fix" to playing piano just as there is none for being able to calm your anxiety right down to zero.


I give my clients relaxation tapes along with a checklist from 1-90. Listening once a day for 3months really gets that skill under your belt. Then it becomes "muscle memory" so your body can go to that relaxed place whenever you ask it to.

I would recommend that you talk with your therapist about ALL the concerns you've expressed today. They will help you throu this!

[andee]

Hi DMT and Sage. This was a great post because I am also going to start exposure therapy at an Anxiety Disorders Center in our state and with a new therapist. I have only been to one therapist for years and we did some CBT but not enough. Supposedly this treatment is around 20 sessions and deals with exposure. I am very afraid as well and don't see how I am going to fo it. After 30 or so years with this fear, I have little hope, I am sorry to say. BUT I am willing to give it a try and hope for the best...I guess I have never really faced this fear head on. What do you think Sage???

[sage]

Well, they say that the way the patient feels about how well the treatment will work is correlated to how well it does work. So you have to believe in yourself! And in your ability to fight back against this.

I'd be really interested to hear how you do with this, and what exactly they're using for exposure. Perhaps it's my stuff anyway...if so it's very gentle and gradual. Nothing majorly scary - you just go one step at a time.

Good luck!

[andee]

Thank you Sage...Are you familiar with the Anxiety Disorders Center at the Institute of Living in Hartford, Connecticut? The director is David Tolin, PhD. Yes, not sure what they do but the waiting list is at least 4-6 months. I was able to get in for this month on the 29th from my therapist.

[DMT]

Thanks for your responses. I went back and re-read Sage's website. I realized there was a lot I missed or forgot the first time when I looked at it several months ago. I also think I'm at a point where I'm more determined to making this work than I was when I first read it. And now that I found a therapist that specializes in phobias and fears and has helped me to figure out my past, I feel like it's a possibility that it actually can work. Before, it just seemed impossible. I figured we are the way we are and there's no changing it. Especially when the fear is this deeply rooted. So maybe my change in outlook made me miss some stuff before and feel too overwhelmed.

I do have a few questions though:
Would it be better to be proficient in a relaxation technique before beginning the exposure therapy? I know you mentioned to give it a week. But if I'm just not getting it, is the exposure therapy going to be a waste of time? The relaxation CD I have goes through all the body parts and has you release the tension (is this the type you'd recommend?). You would not believe how many times my mind drifts during this process. It's just the way I am, my mind never shuts off. Is there hope for me anyway?

I was very interested reading Sage's background and her story again. But since my case is different, I wonder if my treatment should be different? For example, I see her story was fearing death and the abandonment when she was a child. Vomiting=Death. For myself, it really is all about fearing being out of control - it's the way my whole personality is wired. I'm not afraid I'm going to die, I know it's not dangerous, I just DON'T WANT TO DO IT. I want to control it, and the germs that cause it. I want to control what my kids do to keep them from getting it and giving it to me. I guess it has to do with some situations I felt out of control with when I was a kid. I just couldn't handle not being in control, being around people that made me not feel in control, and I'm still that way. So if it really is a control thing and not a danger thing, is there still hope for me? Do I need to approach it differently? Gradually facing it to discover it's not dangerous and I'm not going to do isn't going to do anything for me because I already know that.

Could someone explain a little about EMDR therapy? I see it was helpful in this fearing death situation. Could it have a similar positive influence in a case like mine that isn't really PTSD related?

And my last question was geared towards working through the hierarchy. I just can't comprehend how you ever get your anxiety down to zero and are able to move on to the next level. Even if you finally get there in a particular session and feel ok about moving on to the next level, I would think if I went back to the same thing the next day, my anxiety would be high again and I'd just be working on the same level over and over and over. But maybe I should wait and see how I do with it. I just have to get started, instead of worrying about starting and how I'm going to do it.

Andee - please keep us informed. That program sounds interesting and I'd love to hear more about their technique and whether you see any improvement from it.

[DMT]

Sage, I also forgot to mention that I'm so amazed by how much time you devote in helping other people with this fear. I can't imagine how much effort, dedication and hard work making yourself available to the world like this would take. I'm truly in awe!