Is there such a thing as "bad" exposure?

[Neurotic Nick]

Hi guys, as most of you i do exposure by going outside. I endure the anxiety, jelly legs and all the other fun stuff until subsides and it usually works. As long as i stay positive and accepting that is.

But sometimes i get a "big one" - an attack that is strong i literally have to stagger home and that leaves my unable to speak till i get there. Now for me i know that after one of those i need to recover as it is so draining so i usually have to start back at square one for a while.

But my question is: if i stay outside in such a state can an attack of that magnitude subside? It sure feels like it can't but part of me wonders... And i keep reading "don't overdo exposure" but when exactly are you overdoing it? Might seem a stupid question but i genuinely can't tell...

[PanchoGoz]

By overdoing it (like doing it too much) you'll just tire yourself out, which will make you think less logically and feel weaker. And if you're doing a too hard a step or working in an unreasonable timeframe you might feel it doesn't work or you feel like you aren't good enough so be careful not to do that. But seeing through an attack is not bad for you at all - it proves the futility of it! They always subside, attacks never ever last for ever as your adraneline just runs out.
Perhaps your exposure is not routine enough. Are you making charts and doing one step at a time, or are you just going on feeling? Sometimes you need to stick to a plan with the most difficult thing last, that way you tackle your goals and become comfortable, if not, bored with each, one at a time.

[debs71]

Yes, I believe strongly that it can subside, it is just that when you question whether it can, the cycle perpetuates from your own mind TELLING you you can't do it, and that it won't ever subside. It's a self-fulfilling prophecy and a vicious cycle, and the key is in breaking it.

The only way to do that, in my experience, is to keep exposing yourself to what you fear, time and time again, because it eventually loses its power, hard as that is to believe, I know.

I became agrophobic during my breakdown 10 years ago. This stemmed from me having had a massive panic attack whilst out shopping, where I had to leave my basket of food on the shop floor and run home. I just could not face going out again, primarily because I was scared of the same thing happening again. I spent weeks at home, but then said to myself that if I keep avoiding going out, that is how the rest of my life will be, and do I want that?

I eventually forced myself out, but I did so sweating, shaking and with my heart thumping through my chest. I made it halfway there, then turned back, and was angry with myself. The next time I tried again, and that time I made it to the same shop, but again did so totally anxious, but I stayed regardless and completed the trip.

I felt so happy that I had, although I did so deeply anxious, but the thing is that it is that WIN that gives your mind the confidence and belief that you can do it again, and then again, until it becomes almost easy again.

It is terrifying, I know, but it is certainly not impossible to get through and - OVER TIME - for those feelings to subside. I personally don't believe in 'over-exposure'. I do think that exposure needs a pace to it, and everyone is different, but it also needs consistency, as doing it once and having a bad time of it, and then not doing it again for ages and ages just doesn't help. As hard and as bad as it is, it has to be regularly attempted to hopefully reach a breakthrough.

[Neurotic Nick]

Thanks guys! I do actually practice regularly as i have a dog and it needs to be walked three times a day. In my last good phase i would simply increase the distance a bit every day and that worked well. But then a few weeks ago i had a bad experience (i was sent to some odd form of group therapy where i was the only agoraphobic and i was mocked! :mad:) and i lost my nerve a bit i guess. Also i was tiring out myself probably by getting all frustrated again.

I will try your suggestion Pancho because i guess i do go on feeling and now that i think about that is a perfect way for my exposure to "shrink". I.e. Not going as far as usual because i have a bad day and reducing that distance over time as bad days usually come in groups ;)

Did you overcome your agoraphobia debs? Or at least are you able to go to the shop now? I still have to have my mum do the shopping and at 36 that is a bit embarrassing... But i practice that as well but its harder as right now i cant manage it without a support person.

[MyNameIsTerry]

Take a look at this thread where I posted a diagram which shows how panic works in exposure. My CBT therapist gave me something very similiar and explained how panic peaks and then reduces more consistently. She also said it can re-spike but to a lesser level and I have found this to be true e.g. going into the supermarket creates the big initial spike, after a while I'm ok but then when it comes to the tills the lesser re-spike occurs. Thats how I felt when I started getting back out.

http://www.nomorepanic.co.uk/showthread.php?t=160784

Exposure needs a hierarchy if using the ERP method of steps. Anxiety is all micro goals and setting things too large means setting up for failure, putting more pressure on yourself and then punishing yourself when it doesn't go right. Have you used a ranking method e.g. 1-100 against a list? Also, if something fails like this, its not really a failure but a lesson learnt, so go back a step and work back up or insert another micro goal inbetween to give you a stepping stone. Its more of a worry when you start retreating back thourgh goals you have achieved.

I know what you mean about your mum Nick, I would feel the same, but on here no one will judge you for that...its people without anxiety disorders that may as they won't understand how everyday things they take for granted can be very hard to those with anxiety disorders. When I was at my worst with GAD & OCD, I could barely take a shower, have a shave or brush my teeth without panic let alone go outside. My relapse was much worse than my initial onset. Don't be embarressed on here, we all understand.

[debs71]

Did you overcome your agoraphobia debs? Or at least are you able to go to the shop now? I still have to have my mum do the shopping and at 36 that is a bit embarrassing... But i practice that as well but its harder as right now i cant manage it without a support person.

Hi Nick!

Well yep, I have overcome it on the whole, but I do find that when my anxiety creeps up again, I become averse to going outside again. I think that I assume in my brain/worry that I will have another panic attack when I am out in a public area. I am able to force myself out, but I do so sweating. Funny thing is, once I am at the shops or wherever, and occupied, I feel ok more or less. I think it is just the thought of going out, and the 'what if?' images that run through my head.

Please don't be embarrassed about your Mum with you. I used to do that too, as it just helped to have someone with me, just in case. Being on your own is scary sometimes, as it is awful when nobody familiar is there to reassure you if you feel rough.

Don't pressure yourself. It sounds to me like you are doing great, as you are not staying in altogether. You are attempting it, and again and again, and that is key. It is great that you can walk your dog too, as it gives you a great incentive to get out, plus you have your dog for company, something I am sooooo envious about as I would LOVE to have a dog, sob!! (I live with my parents at the mo, so can't right now:weep:)

You are doing really well....onwards and upwards! :yesyes:

[Neurotic Nick]

Wow guys thanks you for going so in depth with this. It really helps me to get to the nuts and bolts of exposure. I'm really jazzed about doing some planning for my exposure - in other parts of my life i've always found that putting in some effort into planning for a goal and breaking it up into smaller steps makes it so much easier.

Thanks for all those links Terry, (and yeah i know where you've been, when i had my breakdown last year taking a shower took a lot of effort as did everything else) i love getting into the mechanics of these things, one of the things that helped me out a lot the last few months were the cbt4panic books because they broke everything down so clearly.
One thing that still bugs me, and i hope i don't seem like i'm just being difficult but it's something that keeps tripping me up: backsliding.

Now maybe this is because of a lack of planning but let me try to explain, let's say i'm trying to get round the block. The block consists of street A, B and C. I start halfway down A and then progressively work my way up to C. At first A keeps getting easier and easier the more i progress down the block and that of course feels great. But let's i have a heavy workload some week (i work from home) or something upsetting happens and i get a little burnt out. Suddenly when i walk down A its very hard. It seems even harder than the first time. This is the point it usually all goes south.

Now at that point what do i do? Writing this i realize that i usually start retreating as you put it Terry. Perhaps i should just keep at the level i'm at till things subside a little (let's say i'm at B so i keep it there?) I guess there are no easy answers to this... :P I do know that when i start to backslide it can get very bad, currently i seem to be back at square one again (maybe 1,5..) and of course i feel like i'm letting all my support people down. I know i shouldn't but it's hard as some people around me are putting in a great deal of effort on my behalf.

Anyhoo it's great to hear you got so far debs, it's always very reassuring knowing that someone has made it out! :) Yes the dog is great, not only does it force me out but she's also my little ambassador to people i meet, she's loves everyone! And of course as i spend so much time at home she's also great company as it's such a funny and happy creature. I hope you are able t get one soon! Till then here's a picture of my little hellraiser ;)

[debs71]

OOHHH.....she is so cute.

Jealous.com... lol.:D

[MyNameIsTerry]

Hi Nick!

Well yep, I have overcome it on the whole, but I do find that when my anxiety creeps up again, I become averse to going outside again. I think that I assume in my brain/worry that I will have another panic attack when I am out in a public area. I am able to force myself out, but I do so sweating. Funny thing is, once I am at the shops or wherever, and occupied, I feel ok more or less. I think it is just the thought of going out, and the 'what if?' images that run through my head.



I had the same issue Debs, things I had already beaten would start to feel like they were coming back as a challenge but in a more minor way, like your brain questioning whether it needs to become an issue again. I found that just keeping going and not letting it stop you helps here and then the next day you get up and feel different and its not there anymore. I have various forms of OCD with my GAD and when I'm having a flare up of the GAD I see some of those OCD issues return or intensify if not completely gone but as long as I keep going, once the GAD decreases its back to normal again and all that changes back.

Its like anticipatory anxiety with the shops by the sounds of it, like maybe you have conquered it but are questioning "What if" it starts again whilst I am in there. I get this too when I'm having a bad day with the GAD, had a rough nights sleep or if I'm not feeling well physically. It changes back to normal though once I feel better.

---------- Post added at 08:13 ---------- Previous post was at 08:07 ----------


Wow guys thanks you for going so in depth with this. It really helps me to get to the nuts and bolts of exposure. I'm really jazzed about doing some planning for my exposure - in other parts of my life i've always found that putting in some effort into planning for a goal and breaking it up into smaller steps makes it so much easier.

Thanks for all those links Terry, (and yeah i know where you've been, when i had my breakdown last year taking a shower took a lot of effort as did everything else) i love getting into the mechanics of these things, one of the things that helped me out a lot the last few months were the cbt4panic books because they broke everything down so clearly.
One thing that still bugs me, and i hope i don't seem like i'm just being difficult but it's something that keeps tripping me up: backsliding.

Now maybe this is because of a lack of planning but let me try to explain, let's say i'm trying to get round the block. The block consists of street A, B and C. I start halfway down A and then progressively work my way up to C. At first A keeps getting easier and easier the more i progress down the block and that of course feels great. But let's i have a heavy workload some week (i work from home) or something upsetting happens and i get a little burnt out. Suddenly when i walk down A its very hard. It seems even harder than the first time. This is the point it usually all goes south.

Now at that point what do i do? Writing this i realize that i usually start retreating as you put it Terry. Perhaps i should just keep at the level i'm at till things subside a little (let's say i'm at B so i keep it there?) I guess there are no easy answers to this... :P I do know that when i start to backslide it can get very bad, currently i seem to be back at square one again (maybe 1,5..) and of course i feel like i'm letting all my support people down. I know i shouldn't but it's hard as some people around me are putting in a great deal of effort on my behalf.

Anyhoo it's great to hear you got so far debs, it's always very reassuring knowing that someone has made it out! :) Yes the dog is great, not only does it force me out but she's also my little ambassador to people i meet, she's loves everyone! And of course as i spend so much time at home she's also great company as it's such a funny and happy creature. I hope you are able t get one soon! Till then here's a picture of my little hellraiser ;)

Very cute Dog, Nick. They are great for helping us out and I find mine seems to know my moods and spends more time with me if I'm suffering. They can be great to walk with too as they are so care-free and I think whilst at first we are very anxious, they help us to break routines and walk down places we would normally not.

Here is another thread Nick that is a .pdf for therapists when trying to tackle the pitfalls of exposure therapy. Maybe there are some answers in here for you in terms of the best strategy to manage the backsliding issue as its proper book/manual sized and it covers all the ways exposure therapy can fail and how to prevent/tackle it:

http://www.nomorepanic.co.uk/showthread.php?t=159265

I know for me, it was always a matter or getting it over with and keep going until it felt easier but my agoraphobia was mild as it was GAD inspired so I don't know how this would work for others. Another option would be to drop back to the last goal you conquered before the one you are struggling with and work back up again but remembering not to add in all the guilt & frustration for having to do so.

[jefferina]

I came on here hoping to read about exposure and glad I seen this. I really am not doing it right at all. I'm not planning things and I'm not consistently doing things either. My main problem is being around people especially people I no... So I've been trying to see people but to be honest I think I've been thinking about it more than doing it... When I start to right a plan of action I start getting confused and have no idea where to start, who to see, when to see them etc.... I get that confused that I just give up and that's probably anxiety taking over.... It's like I need a push to do it I just can't seem to take the steps I need to take. Like frozen with fear can't take that step and it's annoying because it is what I need to do aaaahhhh so annoying :doh:

[PanchoGoz]

CBT4Panic has lots of worksheets you might find helpful and it explains everything thouroughly. If you follow the link in my signiture you get it for free for NMP members.

[Neurotic Nick]

Thanks for that link Terry, i had actually already found it hunting down some other posts of yours the first time ;)

Well i went to see my gp yesterday and he's great, he's even offered to go out with me once a week and he's a busy man so that was very positive. On the other hand talking to him and doing some thinking we both came to the conclusion that this recent backslide was probably triggered by some very dark and suicidal thoughts i had and that is probably my meds "going bad" on me. I had actually just increased the dose about a month and while that seemed to help at first it's possible it also triggered some nasty stuff. At any rate they're not doing me any good at the moment.

So now i'm just gonna slowly lower the dose and just "survive" for a bit until my treatment stabilizes. Im also currently sans therapist and waiting for a new one so its all a little shaky. My agoraphobia was crazy today, panicked just walking around my building! But i also drove to the gasstation with a friend and that went very well as she is just the best support so i got a nice little reminder that it's not unbeatable!

Im not having the best of times but i am gonna hang in there, thank god i can still manage to draw and paint a few hours a day so i dont have to feel im completely at rock bottom.