026: Scared Stiff — The Exposure Model (Part 4)

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:

  1. Classical Exposure
  2. Cognitive Exposure
  3. 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!


6 thoughts on “026: Scared Stiff — The Exposure Model (Part 4)

  1. 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.

  2. 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

  3. Loved your podcast! But I do have a question – I have suffered from panic attacks for years – the past 2 years I’ve become agoraphobic and don’t want to be far away from my house. So my phobia is now “having panic attacks” – so does that mean I just need to go out and have a bunch of panic attacks in public to get over my fear? The thought seems terrifying. Also I am severely claustrophobic which effects me anytime I feel trapped (elevators, small cars, traffic, tight spaces, etc) Is there a protocol you used to treat patients with this? Just wanted to suggest perhaps a podcast on this subject or maybe the agoraphobia as it does affect many people worldwide.

    • My approach is pretty well described in my book, When Panic Attacks. Have you read it? You can get link to it on my website books page. david

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