In this Podcast, David and Fabrice discuss the Exposure Model for treating anxiety. They begin by briefly describing the three different deaths of the ego that are required for recovery from depression, anxiety, or a relationship conflict, respectively. For depression recovery often results from the “Great Death,” A Buddhist concept that involves the discovery that there is no such thing as a “self” that could be worthless, or inferior, or judged by another person. David and Fabrice only touch on this theme and promise an entire future podcast on this fascinating and helpful spiritual notion that can lead to recovery from depression.
For anxiety, the death of the ego is quite different, and involves surrendering to the monster the patient has always feared and avoided using a wide variety of exposure techniques. David traces the origin of Exposure Therapy to teachings in the Buddhist hold scriptures, the Tibetan Book of the Dead, more than 2,000 years ago. David describes the amazing and hilarious phenomenon of “laughing enlightenment,” which often happens when anxious individuals confront their fears.
David describes how he used Flooding, an extreme form of exposure, to get over his own blood phobia, which he’d had since childhood. His fear of blood caused him to drop out of medical school at Stanford for a year on two separate occasions. He finally decided to confront his fear by working for a month in the Emergency Room of Highland Hospital, a major trauma treatment center, in Oakland, California. David explains what happened when a totally bloody man on the verge of death was rushed into the ER after a bomb he was building in his basement blew up.
In the podcast David forgot to mention something fascinating about his experience at Highland. David had had a blood phobia since he was child, and blood phobia is thought to have genetic causes, and perhaps be inherited. And yet, David was totally cured in roughly 15 minutes without any medication at all. The important point is that even if things are biologically caused, they can often be treated with psychological techniques.
Most therapists hate the word, “cure.” David explains why he sometimes uses this term when treating anxious patients, and also explains the difference between a 100% cure and a 200% cure.
David emphasizes the importance of motivation and resistance in the treatment of anxiety, since few patients, if any, will want to use exposure techniques, because it is so terrifying. David and Fabrice will describe the Motivational Model in the next podcast.
David and Fabrice raise questions about the mechanism of recovery during exposure. Why does it work? Is it due to the change in thinking, or is there some other healing mechanism at work?
Fabrice asks about patients who resist exposure and protest that it won’t work. For example, a patient with the fear of heights might say, “Oh, exposure can’t possibly help, because every time I get in a situation where I’m exposed to heights, like when I’m in looking over a railing on the third floor of a building or hiking on a mountain trail, I get terrified. This has happened hundreds of times and it never helped!”
Finally, David describes a humorous but real example of his 8-minute treatment of a therapist with 20 years of failed therapy (several times a week of psychoanalysis) for her elevator phobia.
David and Fabrice end by talking about the enormous amount of information they have to share with listeners, including large numbers of creative exposure techniques that fall into three categories:
- Classical Exposure
- Cognitive Exposure
- Interpersonal Exposure
They promise future podcasts describing these fascinating techniques with more amazing vignettes based on patients Dr. Burns has treated, as well as his treatment of his own many fears and phobias!
Great podcast! I like the concept of 200% recovery from a phobia. I experienced that with my public speaking phobia by joining Toastmasters. I love the thing I once feared.
Thanks, Rob! Always appreciated your comments! david
You said that exposure needs to be voluntary. It doesn’t work if you get confronted by the terrifying object by accident. Now I wonder with some situations if they count as voluntary or involuntary.
Let’s say I have a presentation at university. I have to do that presentation to get my degree. So it is not voluntary. But I could just not go there the day of the presentation. So by going there and doing the presentation one could say that it counts as intentional
yes, that makes sense. And you could also join Toastmasters where you have lots of chances to give talks and get feedback. That would be another good form of exposure. Exposure is not a treatment for anything, just one of maybe twenty or more techniques on a Recovery Circle. david
A great way I learned and is really an effective way to diminish such illusionary thoughts of anxiety.Thanks Dr. Burn for such exposure models to make us understand the true nature of anxiety.
Thanks so much, Souvik! david
I love this! I just used exposure therapy this afternoon. I said I would take a family member to the airport on the opposite side of Houston. I have been petrified of driving on Houston highways and on the massive overpasses.
So today I set out to retrain my thoughts and reactions. My heart was pounding, my hands were shaking, and my brain kept trying to spiral on the highway — but I kept using the techniques I’ve learned in your books. I told myself I was okay with a 10-15% anxiety threshold of fear bc that helps me stay alert in the city and be intentional with my time, but the cost of continuing not to drive on highways and overpasses in my city is just too high of a cost to keep paying. If I wind up fainting, then ok. My family can come get me from the hospital or side of the road, and we will carry on with our day. I choose to not let the fear of fainting keep me from going out!
I appreciate your messages so much!! Thank you for doing what you do!
Very awesome and courageous! Kudos. We will likely read this on a podcast if okay with you! Warmly, david
Hello Dr Burns
Thank you very much for this wonderful and important talk .Realy you are doing great job
I would like to ask if there is any contraindications for exposure technique..Second what are the most suitable type of therapy for highly educated patient(medical consultant) suffering GAD for more than 25 years
Is CBT work for such patient
Thankyou very much in advance
Hello Dr Burns
Thankyou very much for this great and important talk..you are doing great work which is highly appreciated..
I would like to ask about exposure technique is there are any contraindications?
Second question what is the best therapy technique for highly educational patient (medical consultant) suffering GAD for more than 25 years..is CBTwork in such patient.
Thank you so much in advance
Thanks! With regard to contra-indications, I use the TEAM model in sequence. I don’t “throw” techniques at patients based on diagnosis, problem, etc. i offer free weekly training for therapists, since the model is challenging to learn. That prevents foolish use of any of the > 100 techniques in the TEAM model.
With regard to worrying, or any other topic, use the SEARCH function on every page of my website, including the home page, and you’ll find tons of resources on any topic, like worrying, exposure, Hidden Emotion Technique, etc. david
This seems very powerful therapy that I’ve been listening to and is good, Part 4
Thanks so much, Satwinder! Lots more free stuff on my website, feelinggood.com. d
Do you have a list of therapists in California that work on these therapies
Sure you can find a ton of them at http://www.eelinggoodinstitute.com. By city, for example. We check and you were sent the second anxiety class lesson, but did not open it. In addition, it did not go into your spam folder. Sunny Choi is one of many good ones: Sunny Choi
Ive been following your work. I am curious on what your thoughts are with people who have infections that cross the blood brain barrier or nervous system dysregulation that can cause anxiety, for example bartonella, lyme disease, toxic mold exposure, and then develop anxiety/fear after the exposure and how to address this, ive tried exposure thearpy, eft, emdr, ifs, with not much progress.
Thanks. So sorry if you’ve been struggling with anxiety and / or some type of infection. The approach is use I systematic, and is outline pretty well in my book, When Panic Attacks. It is a mass market paperback.
I don’t just “throw techniques” at patients. Also, I have a free anxiety class on my website. It outlines the four types of techniques I use with all anxious patients. Feel free to ask other questions after consulting one of these sources.
All the best, david