Exposure Therapy 2.0

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There is a treatment method in dealing with anxiety and phobias called exposure therapy. Let me give you a personal example of how it works. First, a little background.

When I was 13 and at Scout camp I was playing with my campmates near one of those tin-roofed open-walled shelters with several picnic tables underneath it. Electricity ran to the shelter to power the lights underneath, and it entered the shelter through a junction box high in one of the corners of the shelter. It began to rain fairly hard though the sun was still shining, so we had the weird experience of running underneath the shelter to avoid rain in bright sunshine. The clouds eventually crossed over the sun, and within seconds of that there was a tremendous clap of thunder and a flash of light underneath the shelter. The thunder was so loud it was disorienting, and when I came back to reality I saw one of my counselors fall straight backward from the edge of the cement slab underneath the shelter into the mud just outside of it. There was pandemonium everywhere else, and it took me a couple of seconds to realize that lightning had just struck the junction box underneath the shelter, directly in front of me not ten feet from where I was standing. It went out in several streams, and it hit four people total, the counselor I’ve already mentioned and three campers. One of them got a perforated eardrum from the experience and was deaf in one ear for weeks afterward. Another got hit with enough juice to fuse the zipper in his pants together (I’ll give you a minute to recover from that one). All four went to the hospital overnight for observation; the counselor that was hit only experienced lack of muscle control and a brief spell of unconsciousness and was back at the camp the next morning and the three boys were pretty much done with camp. All four survived the day, fortunately, but my previous love of thunderstorms was a casualty. From that moment forward I became terrified of thunder and lightning, and understandably so. I was closer to the junction box than the three boys that were hit. That could just as easily have been me that was hit that day.

Fast forward many years to a time in my life when I was dealing with anxiety far worse than I am today. I entered an outpatient program at the local psychiatric hospital geared to deal with anxiety and phobias, and it’s there that I learned about exposure therapy. With regard to my fear of lightning, we started with a written exercise: what’s the worst thing that could happen? I wrote the very grim paper and then was asked to rate my anxiety from 0-100, with 0 being no anxiety at all and 100 being the worst anxiety imaginable. Then I was asked to perform deep breathing exercises until my anxiety was half of what it was when writing the paper. After that, I was asked to write a paper detailing what it would be like for me to be out in a thunderstorm – no worst case scenario this time, but just express everything I was experiencing, using all five senses if possible, followed by the same 0-100 measurement and deep breathing exercise until my anxiety was half of what it was. The next step was watching a video of a thunderstorm, with a writing exercise explaining what I experienced watching the video and the same measurement and deep breathing exercise. The final step was a little creative, since it was a time of year when thunderstorms were pretty rare (this was in Illinois, not in Texas, which is known for some spectacular thunderstorms), and it was my own suggestion. I proposed that I take a day off from the program at the hospital and go face as close to my fear as I could. The Museum of Science and Industry has a gigantic Tesla coil that fires overhead at regular intervals. It’s loud, it’s pure raw electricity, and it’s only maybe 20 feet above the seats that are beneath it. My goal was to go sit under the Tesla coil and measure my anxiety both when I sat down and when the coil fired, and to do deep breathing exercises until my anxiety was half of what it was at its worst. I went downtown with a friend who was able to accompany me and we sat underneath the coil for nearly an hour, and by the end of my stay there I was so desensitized to the lightning going off overhead that I was experiencing no anxiety at all. (I took the photo at the top of the article myself, while sitting directly underneath the Tesla coil.)

The process of exposure therapy is to have you experience your fear in a safe setting and to gradually experience it with more and more actual sensory input until your fear has subsided to the point that you’re not experiencing as much anxiety in situations that would previously have you frozen with fear.

Nowadays I can even go stand outside in a thunderstorm, though if it’s particularly close and violent I tend to want to head back inside, but that’s just as much my desire to avoid being soaked to the skin as it is to get out of the way of a potential lightning strike. I enjoy them, in fact. The exposure therapy worked exceptionally well and has stuck for almost six years now with no relapses at all.

So I told you all that to tell you that today I learned about a new tool being used in exposure therapy, in a similar method as the video that I watched, a technology that existed in 2011 when I went through the program but was prohibitively expensive for the hospital to own.

Virtual reality exposure therapy.

In a sense, everything I did was a form of virtual reality, even the culmination of my therapy underneath the Tesla coil. None of them were the actual experience of being caught outside in a thunderstorm, and so the experience had to be simulated to the best of the hospital’s ability using the tools that they had. (Fortunately my phobia about lightning was common enough that they had a tape – still using VCRs at this point, kids – featuring a thunderstorm. If it were a different phobia, and I presented with several, they used different methods to expose me to the thing I feared. The therapies for the rest of my phobias all culminated in that one day trip to downtown Chicago and I’m better off with all of them today, thank goodness.) With the technology of virtual reality becoming more common and accessible, there are programs that can simulate situations of fear far better than watching a video, for instance. You’re immersed in the experience much more so than I was, and you have a controller to help get you out of the situation if need be.

Virtual reality is not a replacement for the process that I went through. It’s far more immersive than writing a paper about “what’s the worst that could happen?” and needs to be built up to, just like I was built up to the videotape. Odds are good that VR would be a further step from simply watching a video of what scares you since it is so immersive. In addition, exposure therapy – whether virtual reality or not – should only be done under the watchful eye of an individual trained in administering exposure therapy, so if you have fears of your own that you wish to conquer, I would recommend searching out an outpatient anxiety program near you. It helped me immensely with several phobias and I feel it could likely help you with yours.

The good thing is that exposure therapy can be used for other anxieties besides phobias, something that I tend to forget is a large portion of what we’re trying to establish in my own therapy right now. A lot of my anxieties can be ported over easily. My fear of crowds, my fear of driving, my fear of everyday socialization – all of them are being treated with a form of exposure therapy to try and convince my brain that these situations are not something to be feared, but rather a part of everyday living that I’ll need to embrace before I can get back out in the job market.

I don’t know if I’ll ever get to – or need to – experience therapeutic virtual reality. But it’s nice to know that the option is there should the need arise.

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