Cognitive-Behavioral Therapy (CBT) for anxiety disorders often includes a component of relaxation, yet the key ingredient is without a doubt the exposure therapy part.
What Is Exposure Therapy?
Exposure therapy does not just deal with facing your fears. It’s much more nuanced than that. Exposure therapy is a systematic way of helping a person learn to overcome their fear. Typically, this involves exposures that gradually increase in intensity, are prolonged, are repeated multiple times, and occur in many settings and situations. I have written at length about this here.
We know that the treatment is highly effective for treating anxiety disorders. Unfortunately it is rarely used in the community by therapists. We’re talking in the range of 10-30%, which is shocking. When it is used, therapists often make a big mistake, and that is the focus of today’s anxiety shorts.
What Is The Most Common Mistake While Doing Exposure Therapy?
You may be surprised to read this, but it’s actually relaxation and deep breathing. Many clinicians only do relaxation as their intervention for anxiety. In fact, I bet that everyone reading this who has been treated for anxiety (or who has provided anxiety treatment) has been taught progressive muscle relaxation or deep breathing.
If you look at almost any anxiety treatment manual it begins by teaching these skills. Yet, we know that this is not the active component of treatment. Not only that, if you’re doing exposure therapy it can actually interfere with your treatment! Think about that for a second…The most common first step of anxiety treatment can get in the way of actual treatment…
Why Can Relaxation Be A Huge Mistake?
Exposure therapy involves activation of the fear network. It is actually critical that the treatment increase anxiety so that you can activate the fear network and habituate to a situation and/or violate your expectancies. Relaxation acts against this because it decreases anxiety. It can make the exposure too safe and controlled. Think of this a different way… If you continue to ride a bike with the training wheels on, you’ll never learn to balance.
If you’re a person who suffers from high anxiety in response to specific cues (e.g. panic, OCD, PTSD, social phobia, separation anxiety, etc), then exposure treatment is what you need in order to stop this happening. Relaxation provides short-term relief and people tend to feel better when using it in highly anxiety-provoking situations. However, it won’t help you in the long-term and it could prevent you getting the most out of exposure therapy.
The problem with relaxation is it runs counter to the goal of exposure-response prevention therapy: To face anxiety-provoking situations without the need to do anything to reduce that anxiety. It’s not that relaxation itself is a problem, it’s that it can be when used with exposure therapy. As a general rule, relaxation should not be used during exposure therapy.
If Relaxation Can Be A Mistake, Why Is It Used?
Some clinicians encourage relaxation while doing exposures in order to help tolerate the anxiety. Why? There are fears that people can’t tolerate exposures without it, but research shows that’s just not true! Similarly, there are fears that exposures lead to dropout, yet research doesn’t support this. Some worry that they will lose rapport, but again the research actually shows people rate exposure as very important.
When Should I Use Relaxation?
People use relaxation to manage anxiety in general. For example, if you’re a person who experiences high baseline anxiety, then relaxation can bring it down so you are able to function better, and it can help prevent you from getting overwhelmed. I know I’ve definitely used it in sports settings for this same reason.
I’m not against relaxation, as it can be helpful. In fact, it does help reduce anxiety in the moment because it’s an effective anxiety-management tool. It can bring high baseline anxiety down to a more normal level, and used in this way it is very helpful. However, when there are specific triggers that spike anxiety, it is exposure and not relaxation that should be the go to tool.
What Do I Do Instead?
Instead of using relaxation to try and tolerate an exposure, first see if you can do it without. You’d be amazed at how if you stick with a situation or a challenge for yourself, it gets easier over time and with repetition. We call this habituation. If it’s too hard though, rather than using relaxation, try instead do an easier exposure that can be tolerated. Remember, the point of exposure treatment is to allow yourself to feel anxious!
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