John R. Cook, Ph.D.
Registered Psychologist

We learned in Part I of this article that our natural tendency is to want to escape from or avoid people, places, or situations that cause us to feel anxious. This tendency is so strong that we will engage in these behaviours even while knowing they are based on unrealistic fears, and clearly not in our best interest.

Consider the following examples of people with Social Phobia who avoid social or performance situations because of excessive or unreasonable fear about being judged by others. A business man might turn down a promotion at work because the new position requires him to make presentations at regional meetings. A retired woman rarely, if ever, has friends over to her home, and never for meals, because of her fear that she may botch some important part of the preparation. A college student may drop out of her program of studies because it involves receiving verbal feedback on her work from other students.

The problem with avoiding situations or circumstance likes these, that make us feel anxious, is that it makes this avoidant behaviour more likely to reoccur in the future, taking up ever increasing amounts of time, energy and other resources. In addition, we deprive ourselves of the opportunity to learn that our anxiety is simply a false alarm, and that nothing truly dangerous is going to happen. The solution to these false alarms is a cognitive behaviour treatment technique called desensitization that helps us to face our fears.

Desensitization looks different depending on the type of alarm system that you have. People with generalized anxiety sound the alarm with an endless stream of "what if" thoughts about all of the things that could go wrong in their life. Desensitization is done by exposing them to several of their top worries, one worry at a time, by having them imagine these worries as vividly detailed, worst case scenarios.

The alarm for people with panic attacks tends to be signaled by physical symptoms – things such as shortness of breath, accelerated heart rate, stomach distress and muscle tremors. Desensitization for them consists of repeatedly performing exercises designed to bring on the sensation (e.g., holding their breath) until they no longer feel anxious.

People with obsessions and compulsions are desensitized by placing them in situations that regularly trigger their alarms (persistent thoughts, impulses or images), while preventing them from responding with a repetitive, unwanted behaviour. For example, someone with an obsessive fear of contamination may be asked to repeatedly touch the handle of their floor mop, while being prevented from washing their hands. People with PTSD are generally asked to talk in detail about their traumatic experience, while people with social anxiety are exposed to the social situations in which they feel judged.

Fortunately, in most desensitization procedures, it is rarely necessary for the anxiety sufferer to start with their most extreme fear-provoking situation. It is often possible to work up an ordered list or hierarchy of fear-provoking situations, from least fear provoking to most fear provoking. For example, in treating social anxiety, a person may feel relatively comfortable saying "no" to unreasonable requests or speaking with strangers, while they are more anxious speaking in front of groups, or dealing with conflict. This list is called an exposure hierarchy. It allows the person with anxiety to face their fears in a graduated, stepwise fashion where no single step is so great that they feel forced to abandon the effort.

The biggest risk factor in conducting desensitization procedures is that the exposure will be terminated before a significant decrease in anxiety has occurred. If this happens, a further sensitization occurs, resulting in the person becoming more anxious in the future rather than less. It is therefore important to design your exposure experiences to minimize the likelihood of premature withdrawal or interruption.

For further information about treatment and training opportunities in desensitization and other cognitive behaviour techniques, refer to the author's Fear Doctor Seminars website.