Facing Your Fear to Relieve Anxiety

As the old saying goes: “If a horse throws you, get back on the horse right away!” In a nutshell, these words of wisdom highlight the essential step in overcoming fears–you have to get back on the horse! The technical term for confronting fears as opposed to avoiding them is called “Exposure.” Recently scientists have discovered that exposure actually changes the brain in a very positive way. There are several types of Exposure that are effective for specific fears. There is even a type of Exposure for out of the blue panic attacks called Interoceptive Exposure. Habituation is the process of facing a fear enough to lower the activation in the Midbrain and Amygdala described above.

How Exposure Works
When you initially face a feared situation anxiety often rises quickly (your body is preparing you to Fight or Flee). When anxiety rises it becomes uncomfortable and there is a strong urge to leave or avoid the situation or do something to dampen down or subtly avoid the anxiety. But what happens if you resist the urge to leave and instead fully enter into the situation and you do so many times or for long durations? The answer is that you learn over time if the situation is really threatening, or not. If it really is not threatening, your fear response goes away! In this case you have Habituated to your fear, meaning the situation does not activate your Amygdala to trigger a fear response anymore because there is no danger. You have re-conditioned your Amygdala!

However, most people with Anxiety Disorders have a long history of succumbing to fear and avoiding the situation. Avoidance can happen even if you know there is nothing to be afraid of because your Amygdala has been conditioned to activate your fear response! Remember though, the more you avoid the more you give your Amygdala the message that there really is something to be afraid of. You are conditioning it to remind you to be afraid, to trigger a fear response. The relief you feel for avoiding the discomfort of anxiety, comes at a steep price: You have actually rewarded your Amygdala for making a false assessment!

Another way of looking at this process is by describing it as a “Fear and Avoidance Cycle”. Not only does Avoidance keep your anxiety going, but it also makes all those anxious thoughts and beliefs about the situation more active (you will see later that there is a special way of dealing with anxious thinking called Cognitive Restructuring). Before describing the Fear and Avoidance Cycle, a little more information on Habituation and Avoidance will be helpful.

So what happens to the brain when you successfully confront your fears?
A few words on the brain and how anxiety is processed in the brain, what areas of the brain are involved when you are anxious, and how the brain communicates with its different parts will help you to bet ter understand your anxiety and how to overcome it. The brain consists of 3 parts: the Brain Stem, the Midbrain, and the Neo-Cortex.

Here is a brief description of each:

The Brain Stem
This is the oldest part of the brain. It is responsible for basic attention and wakefulness. It is common to all reptiles, so it is often called the “reptilian brain.” It causes your heart to beat and your automatic breathing.

The Midbrain
This part of your brain is called the “animal brain” or “emotional brain.” It is instinctive and reactive, and does not involve a lot of conscious thought.
In the fear response, a small part of the midbrain, called the Amygdala, is very active. This part of your brain alerts you to danger on an “all or nothing” principle. It is turned on or off as it identifies whether something is a threat or not. In the case of Anxiety Disorders the Amygdala falsely recognizes non-threatening triggers (like certain situations and sensations) as threatening. You teach or condition the Amygdala to warn you if something is dangerous by how you interact with the situation. If you consistently leave a situation that is not really dangerous when you feel anxiety, over time the Amygdala will “learn” to warn you even more strongly every time the situation presents itself.

When there really is danger, the primitive warning from the Amygdala has survival value. It can activate other parts of the brain, such as the Brain Stem, to speed up heart rate and breathing as part of the Fight or Flight Response. Once something has been conditioned in the Amygdala to trigger a fear response, it will warn you of danger every time you enter the situation. In doing so, the Amygdala can override common sense. Then higher order thinking, like reasoning and logic, do not work!

The Neo-Cortex
This is the largest part of your brain and the most evolved in humans. It uses reason and logic to solve problems. You can use it to help more accurately identify when something only seems threatening versus when something is truly dangerous. Ordinarily the Neo-Cortex sends messages back to the Amygdala to stop the fear response when it is not needed, but in Anxiety Disorders these “brakes” do not work: the fear response generated by the Amygdala takes over and you respond accordingly, usually by avoiding.

Getting Balance Back
To evaluate threats properly, all the parts of the brain need to work well together. The pathways between the Midbrain (the Amygdala) and the Neo-Cortex can become better linked through using the self help Cognitive Behavioral Skills taught by Cure Your Panic. The result is better communication between the different parts of the brain and overall anxiety reduction for you!
Scientists have discovered when people face their fears rather than avoid, using Cognitive Behavioral Skills, there are detectable brain changes in the pathway between the Neo-Cortex and the Midbrain. The main effect of these changes is a dramatic decrease in the activity of the Midbrain: it quiets down and approaches what a non-anxiety disordered brain looks like!