aerobat
09-15-2008, 10:13 PM
Self-Help & Professional Update (http://anxieties.com/newsletters/anxietyupdate_2008sept.php#U1): How to Keep Fear from Returning: A Challenge to the Basic Principles
by Dr. Reid Wilson
:thumbsup::thumbsup::thumbsup:
I. You don’t have to calm down to get betterWithin session habituation—that is, staying in the feared situation until you begin to become less anxious—may not be necessary. It might not even be the best strategy to lower the chance of fear returning. The mind is built to not extinguish a fear response. (Extinction is defined here as the progressive weakening of the fear response.) Survival required that we remember where the threats are, so modifying that guidance system can take some work. Maybe we need to stay anxious longer and focus on changing our belief instead. There have already been studies indicating that when you increase the arousal of mice (through a stimulating drug) during exposure, and maintain that arousal, they tend to override this natural tendency to slow the extinction process. I’m not saying mice operate out of a belief system. But I think we do!
Several clinical studies with panic disorder, OCD and several phobias showed that the requirement for within-session or between-session reductions of arousal may be overstated. It is possible, for instance, for someone to improve just as well (sometimes even better) when they keep their heart rate elevated throughout their exposure practice session instead of having their heart rate slow as time passes. And they may improve just as well, or better, if their heart rate is as high during the exposure in later sessions as it was in their first session. These results challenge our view of what “improvement” looks like.II. Disorganize your practiceWe typically do blocked practices: we work our way up the hierarchy of one context until fear declines, then take on the next. And we are more likely to conduct consistent practice: approaching each feared situation in the same manner. How can you mess with that design? You can practice facing your feared situations randomly, mixing them in together. And you can change up all the different ways that you approach each item (in the afternoon, then at night; approaching it slowly, then rapidly; plan a practice, then later do it spontaneously; modify the temperature; change the number of people involved.)
We are starting to gather evidence on some interesting hunches. For instance, we are looking for non-emotional learning (not based on the alarm response) which leads to self-efficacy, such as a message of “I can handle this.” Ideally, I want the client to have a simple supportive self-instruction that remains stable over time and can be applied across a variety of situations. That’s what random and variable practice do: They help the person hold onto that point of view over time. And the variable practice adds into memory a larger number of cues that will remind the person of their learning. On top of all that, random and variable practices help the person remain aroused throughout the treatment. That may embrace the extinction process, as I talked about in the previous point.
The punchline? If you focus on being more anxious during the practice, perhaps you’ll be less anxious over time.III. Mentally review your past successful practiceJust before you complete an exposure practice, do a complex imagery review of your previous practice, attempting to re-experience what you saw, felt, heard and learned. Then go try to get anxious again. Repeating that process will solidify your learnings and support the extinction process.
Conclusion
Let’s generate more flexibility in our model of the way to overcome a fear. How well one “manages” anxiety during an exposure, and whether one “cools out” by the end of the practice—these measures deserve to be challenged. If the goal is a stable belief of “I can handle this,” then we should take some practical steps. Purposely seek out arousal during practice. Mix up the format of your practice sessions. Visualize your successful practices to encourage the protocol. Here’s some additional advice: Those of us who are therapists can help people stay in a fearful situation beyond when they think they’ll fall apart, or repeat a behavior beyond the number of times that they predict will cause catastrophe. Life is more chaotic than we generate in organized exposure practice. Mess things up and challenge beliefs, especially your own.
...and a book review: :thumbsup:
The Mindfulness & Acceptance Workbook for Anxiety, John Forsyth, Ph.D. & Georg Eifert, Ph.D. (267 pages, paperback plus CD), Oakland: New Harbinger, 2007.
The brain is built to respond to all threat as a signal, instructing the body-&-mind to “take action now.” After a bit, the body-&-mind memorizes the signal-response pattern, and many of our responses become automatic. The brain is programmed to err on the side of assuming threat instead of assuming safety. This is a good thing for survival. But we end up responding to a lot of false positives. This is unfortunate when our automatic reaction to lots of situations becomes a sense of threat, anxiety, and avoidance. How to change this is very simple; we could send the instructions on a postcard. And when you follow the guidance of this wonderful workbook, by the end you’ll be able to fit the principles that guide you onto the back of a postcard, too.
The challenge, as they say, is in the details: how to change your mind so it lines up with those instructions. Herein lays the gift of The Mindfulness & Acceptance Workbook for Anxiety. Forsyth and Eifert intend to accomplish this task in a holistic manner. They know it will take persuasion, time, and patience. Influencing your point of view is what they are great at: metaphors, analogies, diagrams, cartoon illustrations, examples, written exercises and homeworks, within 270 workbook-sized pages. The accompanying CD contains 8 audio-guided meditations and the book’s 13 printable exercise forms.
Here’s what this workbook isn’t: a set of skills to practice in order to control anxiety. Instead, this is a framework to orient you toward the rest of your value-filled life. You will be taken on a journey. Go. Because if you win at this task of uncoupling from your anxious reactions to life, it will be because you have altered your consciousness. No small task! It takes a student’s mind and a willingness to be coached. Fortunately, you will find these authors to be trustworthy and competent guides.
by Dr. Reid Wilson
:thumbsup::thumbsup::thumbsup:
I. You don’t have to calm down to get betterWithin session habituation—that is, staying in the feared situation until you begin to become less anxious—may not be necessary. It might not even be the best strategy to lower the chance of fear returning. The mind is built to not extinguish a fear response. (Extinction is defined here as the progressive weakening of the fear response.) Survival required that we remember where the threats are, so modifying that guidance system can take some work. Maybe we need to stay anxious longer and focus on changing our belief instead. There have already been studies indicating that when you increase the arousal of mice (through a stimulating drug) during exposure, and maintain that arousal, they tend to override this natural tendency to slow the extinction process. I’m not saying mice operate out of a belief system. But I think we do!
Several clinical studies with panic disorder, OCD and several phobias showed that the requirement for within-session or between-session reductions of arousal may be overstated. It is possible, for instance, for someone to improve just as well (sometimes even better) when they keep their heart rate elevated throughout their exposure practice session instead of having their heart rate slow as time passes. And they may improve just as well, or better, if their heart rate is as high during the exposure in later sessions as it was in their first session. These results challenge our view of what “improvement” looks like.II. Disorganize your practiceWe typically do blocked practices: we work our way up the hierarchy of one context until fear declines, then take on the next. And we are more likely to conduct consistent practice: approaching each feared situation in the same manner. How can you mess with that design? You can practice facing your feared situations randomly, mixing them in together. And you can change up all the different ways that you approach each item (in the afternoon, then at night; approaching it slowly, then rapidly; plan a practice, then later do it spontaneously; modify the temperature; change the number of people involved.)
We are starting to gather evidence on some interesting hunches. For instance, we are looking for non-emotional learning (not based on the alarm response) which leads to self-efficacy, such as a message of “I can handle this.” Ideally, I want the client to have a simple supportive self-instruction that remains stable over time and can be applied across a variety of situations. That’s what random and variable practice do: They help the person hold onto that point of view over time. And the variable practice adds into memory a larger number of cues that will remind the person of their learning. On top of all that, random and variable practices help the person remain aroused throughout the treatment. That may embrace the extinction process, as I talked about in the previous point.
The punchline? If you focus on being more anxious during the practice, perhaps you’ll be less anxious over time.III. Mentally review your past successful practiceJust before you complete an exposure practice, do a complex imagery review of your previous practice, attempting to re-experience what you saw, felt, heard and learned. Then go try to get anxious again. Repeating that process will solidify your learnings and support the extinction process.
Conclusion
Let’s generate more flexibility in our model of the way to overcome a fear. How well one “manages” anxiety during an exposure, and whether one “cools out” by the end of the practice—these measures deserve to be challenged. If the goal is a stable belief of “I can handle this,” then we should take some practical steps. Purposely seek out arousal during practice. Mix up the format of your practice sessions. Visualize your successful practices to encourage the protocol. Here’s some additional advice: Those of us who are therapists can help people stay in a fearful situation beyond when they think they’ll fall apart, or repeat a behavior beyond the number of times that they predict will cause catastrophe. Life is more chaotic than we generate in organized exposure practice. Mess things up and challenge beliefs, especially your own.
...and a book review: :thumbsup:
The Mindfulness & Acceptance Workbook for Anxiety, John Forsyth, Ph.D. & Georg Eifert, Ph.D. (267 pages, paperback plus CD), Oakland: New Harbinger, 2007.
The brain is built to respond to all threat as a signal, instructing the body-&-mind to “take action now.” After a bit, the body-&-mind memorizes the signal-response pattern, and many of our responses become automatic. The brain is programmed to err on the side of assuming threat instead of assuming safety. This is a good thing for survival. But we end up responding to a lot of false positives. This is unfortunate when our automatic reaction to lots of situations becomes a sense of threat, anxiety, and avoidance. How to change this is very simple; we could send the instructions on a postcard. And when you follow the guidance of this wonderful workbook, by the end you’ll be able to fit the principles that guide you onto the back of a postcard, too.
The challenge, as they say, is in the details: how to change your mind so it lines up with those instructions. Herein lays the gift of The Mindfulness & Acceptance Workbook for Anxiety. Forsyth and Eifert intend to accomplish this task in a holistic manner. They know it will take persuasion, time, and patience. Influencing your point of view is what they are great at: metaphors, analogies, diagrams, cartoon illustrations, examples, written exercises and homeworks, within 270 workbook-sized pages. The accompanying CD contains 8 audio-guided meditations and the book’s 13 printable exercise forms.
Here’s what this workbook isn’t: a set of skills to practice in order to control anxiety. Instead, this is a framework to orient you toward the rest of your value-filled life. You will be taken on a journey. Go. Because if you win at this task of uncoupling from your anxious reactions to life, it will be because you have altered your consciousness. No small task! It takes a student’s mind and a willingness to be coached. Fortunately, you will find these authors to be trustworthy and competent guides.