Anxiety and Phobias

Rethinking exposure: from relief to expansion

The treatment of anxiety disorders from this perspective involves a thorough revision of the concept of "exposure".

In traditional models, exposure is based on the principle of habituation: if a person is afraid of elevators, he or she is repeatedly exposed to them until his or her anxiety level, subjectively measured, decreases.

Success is defined by the reduction of fear. However, ACT relies on the inhibitory learning model.

The goal is not for fear to go down (although it often does), but for the person to learn a new association: "I can be in an elevator feeling afraid and be safe at the same time."

It is a matter of expanding the behavioral repertoire in the presence of the aversive emotion.Let's imagine someone with a fear of driving on highways. From ACT, we wouldn't ask him to drive to relax behind the wheel.

We would ask him to drive to expand his life, taking anxiety as a co-pilot.

The instruction would be, "Notice how your hands are sweating on the steering wheel, notice the thought that says 'you're going to lose control,' and notice that, despite all that internal noise, your arms are still steering the car correctly toward your destination."

We seek to break the causal relationship between "I feel fear" and "I must escape." By decoupling the emotion from the flight behavior, the person gains freedom.

Anxiety ceases to be a "stop" signal and becomes simply a "caution" signal, allowing life to go on.

Approach to social anxiety and panic from acceptance

In the case of panic and social anxiety, suffering is perpetuated by catastrophic interpretation of symptoms and merging with external judgment.

A person with panic disorder does not just feel tachycardia; he or she merges with the thought "I'm going to have a heart attack."

A person with social anxiety doesn't just feel shame; he or she merges with the thought "everyone notices that I am incompetent."

The intervention focuses on radical acceptance of physical sensations and defusion of narratives.

For example, if someone is afraid to attend a wedding because they think they will blush and make a fool of themselves, the therapy does not seek techniques to avoid blushing or relax.

On the contrary, the client is encouraged to attend the wedding willing to blush. The willingness to "bring the blushing to the party" as a guest is worked on.

By eliminating the struggle against the physical symptom ("I have to stop blushing"), the feedback loop that increases anxiety is eliminated.

The person reconnects with their