Exposure Therapy: Walk through your fear

Deccan Chronicle.  | Swati Sharma

Lifestyle, Health and Wellbeing

Unending COVID stories have replaced anxiety with dread and complete avoidance of the outside world. Experts say there’s a way out of this

Picture used for representation

You badly want to visit a mall or a multiplex, socialise with a bunch of friends or go back to your work station and be in the company of your colleagues. And yet, there is that dread of contracting the virus, making you wonder how you’d re-enter public life. If the scenario compels you to simply ‘avoid’ the outsides, you’re not alone.
Lockdown, COVID fatigue from either contracting the disease of from listening to the innumerable stories of death and suffering from the virus, etc. have all taken a toll on all of us in some way or the other. For many, the dread has overtaken stress and anxiety to the point of no return.

Just when it seemed there’s no way out of this matrix, experts have reason to believe otherwise. Exposure therapy, a concept fast catching up across the world during these COVID times, could be of some help. It is important to note, however, that while behavioural experts can guide you on how to go about this therapy, it is you and you alone who needs to get a hold on yourself and get rid of this menace that’s affecting many in these turbulent times.

What to do now?

Anisha Jain, a senior psychologist at Mindtemple, points out that humans often avoid people or situations they’re afraid of. “While this is a natural response to protect themselves from the perceived threats, harms or dangers, exposure therapy is one of the effective behavioural treatments to overcome such fears, anxiety and escapist or avoidant tendencies,” assures Anisha. “Exposure therapy can be conducted in a live situation, via imaginations or even in a virtual simulation setup. However, choosing the type of exposure and how it is conducted depends upon the nature of the problem, its severity as well as the person’s goals and strengths.”

According to the psychologist, there are two types of exposure therapy:

1) Flooding: You are exposed to the dreadful event completely all at once till you feel calm in that situation. With time, you begin to relax after realising nothing bad has happened to you. The best way to do this in the COVID scenario is by going to crowded places.
2) Grading: You are steadily exposed to fearful events from low to severe intensity one at a time, until you can gain confidence with each exposure to be able to face the main dreadful event.
“For example, the first step would be to go down to a familiar building premise. The second step would be walking in the open neighbourhood and the third step would be entering a more confined area with people, like a shop and so on,” elaborates Anisha.

Therapy, therapy anywhere

Leading psychiatrist and psychotherapist Dr Anjali Chhabria has been treating people from all over the world by performing exposure therapy both online and offline.

“While on the one hand, parents are getting anxious about sending their children back to school, youngsters have been dreading venturing out on their own. However, both youngsters and parents have found exposure therapy helping them in resuming their normal activities,” she says.
Exposure therapy requires that people note down all the situations that make them anxious and rate them according to the level of anxiety felt by them.

Next, they need to pick one situation at a time, write down the date and time about when, where and how they are going to expose themselves.
It is important to stick to the schedule and let the anxiety build in (rate your anxiety every five minutes when exposing yourself to the situation).

Another clinical psychologist Himani Sharma points out that it is natural for negative thoughts to creep in and for the intensity of anxiety to rise at first. “But gradually, the person will start to feel less anxious. Once the person feels that their anxiety has come down by 50% from when they started, they can remove themselves from that situation. This has to be done four to five times a week (one situation every week),” Himani explains, “The process can be continued with other anxiety provoking situations as well.”

Making it effective

Behavioural scientists feel that there are several places where one can engage in therapy. However, one must note that not all therapies are effective for all individuals.

“Exposure therapy is particularly effective when combined with relaxation techniques. Sometimes, for instance, the exposure can increase the person’s anxiety if it is not equipped with coping skills to help the individual calm themselves at the time of facing the fearful event,” adds Mindtemple’s Anisha Jain.
According to Dr I. Bharat Kumar Reddy, Senior Consultant Psychiatrist, Apollo Hospitals, Hyderguda, the two parts to exposure therapy are 1) exposure and 2) response prevention.

“In other words, first you expose an individual to fear and then prevent the possible response to take the person over,” explains the doctor. “For example, if someone is scared of malls and crowded places, take them there and then prevent their response, which in this case would be to leave that place. By doing this, you generate intense anxiety in them and when it happens you support and reassure them about the situation so that the fear of that situation goes.”

All said and done, Dr Kumar advises that with the elderly it is always advisable to plan step-wise than sudden exposure. “If applied properly, this cognitive behavioural therapy technique is quite useful in helping people with who fear going outside in the current circumstances.”
So can exposure therapy still help now that we’ve entered the second wave? Experts think so, although they caution us not to forget our masks and sanitisers.

Benefits from exposure therapy

A therapist may use different types of exposure therapy — one may create a real-life scenario for the person to go through or use talking therapy to encourage the person to imagine situations or recall traumatic events.
People struggling with
post-traumatic stress disorder and anxiety disorders can significantly benefit from exposure therapy.