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One study done with elevator phobics/claustrophobics had two groups doing a comparable amount of exposure, going up and down for, let’s say, 45 minutes. One group was counseled to tell themselves, after the exposure, to focus on how horrible it was and how they were just lucky they survived. The second group was counseled to focus on how they were able to tolerate a lot of anxiety, and hopefully next time it would be a lot easier. Needless to say, Group B did much better in terms of anxiety reduction. So it wasn’t just the exposure. It was also how they conceptualized it that seemed to matter.
We are also very interested in the role of attention, because it is well-established that people with anxiety not only interpret situations in an unduly threatening way, but often pay a lot of attention to the anxiety. [Parenthetically, I should mention that some people will try to avoid negative thoughts and feelings.] So, we started wondering what people should be doing during these exposures to facilitate maximal benefits. We learned that talking to people about movies or distracting them in other ways was counterproductive. It was actually better to get them to focus on the fear, watch it rise, peak and fall. We realized that so many of the crutches that people employ actually made the exposure less effective. People who carry anti-anxiety medicine, bottles of water, cell phones etc., when they are doing exposures, don’t do as well over time, even if they don’t take the pills. Some of it has to do with one’s attribution of success. If you think you are the one in control or responsible for staying alive, the results seem to be much more robust as opposed to crediting your success to the pills or luck.
Another study of claustrophobic individuals involved putting them in casket-like boxes. One group was told that they would be allowed out in 20 minutes. Another group was told they could speak to the experimenters through an intercom and could push a button if they needed to open the door. The group which was not provided with any escape routes or crutches did much better, needless to say.
Last but not least, I recall one woman I treated who had airplane fears, flew regularly and never seemed to get all that much better. I finally realized that she was surfing turbulence websites and researched the plane and her seat. She vigilantly scanned the faces of the stewardess and listened to the pilot’s intercom to identify any possible threat or tension in their voice or face. As I explained to her, she could fly as many times as she wanted, but it would never get easier if she was going to behave as if she was in a dangerous situation. We realized that we had to add this element of response prevention to all of our exposures. Response prevention is a term that literally means do nothing. It’s almost like Buddhism 101, the notion of feeling the feeling, acknowledging it, and surrendering.
