Updated: Dec 16, 2019
Exposure Therapy has been shown to be the most effective anxiety treatment for people with many anxiety disorders. They can also help with closely linked conditions like eating disorders. Most people know now that it centres on working with what you fear, in order to become less afraid. But how does it work?
Exposure Therapy helps you retrain your brain. It's not just about getting used to whatever it is that triggers you. It's about retraining your brain to stop sending the fear signal when there isn't any danger.
We struggle against our anxiety, against our fear of eating carbs, or fats, or our phobia of increasing to a healthy body weight, because we know these fears are exaggerated and illogical. We spend hours agonizing, trying every way we can think of to talk ourselves out of the fear.
But it doesn't help. So we end up trying to escape those awful feelings of fear (and the agonizing mental battles) by avoiding the things that trigger it, but this just strengthens it.
Exposure Therapy can help retrain our brain to let go of phobias, anxiety attacks, and many other forms of anxiety disorders. With eating disorders, exposure therapy can be beneficial when used in conjunction with other fully personalised support.
The 'f' responses
When your brain gets a signal of danger, it triggers an immediate response, the familiar Fight or Flight response. In our evolution,the advent of the sympathetic nervous system added the options of movement to our previous option of freezing in the face of danger.This is an essential response. When we face danger, we need to react quickly and powerfully.
Humans evolved in a different world than the one we inhabit today. It was a world full of predators,and our main job was to get enough to eat each day without becoming food for somebody else. We required a good emergency alert system to keep us alive. Our responses needed to be immediate and reactive, not taking the extra time to filter through the Prefrontal cortex (the newest part of our brains, that is involved in planning, logic and decision-making.
The Amygdala, a little almond shaped part of your brain, is what is responsible for deciding making these Fight or Flight decisions. It works quickly, without your conscious awareness, because speed is vital in protecting against threats. You only find out what the Amydgala did when you feel its effects in your body (all the familiar panic sensations) and in your behaviour (hide, run, escape).
Whenever we make a decision, there are two possible kinds of errors. One can be called a false positive. This happens when you decide there's a predator, perhaps a sabre toothed tiger, hiding in the tall grass, when there isn't one. When you make a false positive error, you get afraid in the absence of danger, but you get to live.
The second type can be called a false negative. This is where you decide there isn't a sabre toothed tiger hiding in the tall grass when there really is one. When you make this false negative error, you feel fine, but you're going to get eaten.
Your Amygdala doesn't care how many times it scares you unnecessarily. It's there to keep you alive. It can't afford to make any false negative errors.
If you are experiencing anxiety attacks, and phobias that you want to overcome, you need a form of anxiety treatment which will retrain this part of your brain. The most direct and systematic way to do that is Exposure Therapy.
How the Amygdala Works
The Amygdala s always watching, passively, in the background, for some sign of danger. When it perceives one, it presses the "fight or flight" button and adrenaline and cortisol are released into your body, along with glucose into the bloodstream, which all prepare you to run or to fight. Clearly, when the danger is real, this is a good thing. But your Amygdala works like it's still dodging sabre toothed tigers, and will often make the mistake of seeing danger when there's none.
It learns by Association, not reason or logic
When you have run away from whatever the apparent danger is, the Amygdala stands down and goes back to quietly watching. If you ran away from a mugger, clearly that's a good thing. But if you ran away from carbs, or a work meeting that involves food, that's a bad thing. Now your Amygdala will be conditioned to see the carbs or the next work meeting as dangerous, and will make you afraid next time you're faced with either.
The Amygdala learns by association. It will now associate carbs, or that next work meeting, with danger. It doesn't learn by conscious thought. This is why we can't simply talk ourselves out of an anxiety attack or phobia. The fear memory is encoded and stored as a conditioned fear, and can only be relieved by more conditioning, not discussion or reason. That's why we can't be reasoned,or shouted, out of our fear responses.
It only Learns When You're Afraid
The Amygdala only learns when it's fully activated, that is, when it's on high alert because it has spotted something it considers dangerous. It can only forms new associations, new lessons, when you've become afraid. The rest of the time it's on autopilot, passively watching.
Do you see what this means? If you continue to stay away from what you fear, your Amygdala will keep on "believing" the same old errors, without a chance to learn anything new. You will be actively reinforcing that the fear is justified
How Can You "Talk" to Your Amygdala?
Your Amygdala only learns from experience. If you flee the scene every time you have an anxiety attack, your Amygdala learns that you should be leaving to be safe.
How can you get your Amygdala to learn something new? You have to activate it by exposing yourself to a trigger that gets you afraid. If you have a dog phobia, that would be a dog. If you have anxiety anxiety about carbs, you need carbs. And you need to stay there with that fear until it gets a lot lower.
That gives your Amygdala the chance to learn that it that fear was a false positive and it pressed the "fight or flight" button for nothing.That way, it can start to learn that dogs, or carbs, or meetings with food, aren't the threat that it had been conditioned to believe. And, with repetition, it will encode and store a new memory, one that lets you get a handle on your anxiety levels so you can start getting on with your recovery.
Retraining Your Amygdala
That's how Exposure Therapy works. It restrains your Amygdala.
You don't have to do this radically and quickly. What you need to do is to continually arrange to activate your Amygdala by exposing yourself to your 'trigger', to what you fear, and then stay in place, making sure that the fear leaves before you do. You can use a variety of coping strategies to do that, or you can just "float", (Claire Weekes) , and wait for the fear to subside ( and it will subside!).
Either way, Exposure Therapy will enable you to retrain your Amygdala and start rewiring your brain with new learning in ways it can absorb.