Is your anxiety preventing you from facing fears and seeing situations through to the end? Perhaps someone close to you keeps telling you “Let go of your anxiety! Face your fear!” or maybe you even tell that to yourself over and over. Easier said than done, right? Desensitization is a specific, structured intervention used by therapists all over the world that you can do yourself!
Desensitization. Sounds a little scary right? Like you’ll be in tank with your worst fear till you’re not scared anymore? Desensitization is not like that at all. Desensitization is the process of exposing yourself to different stimuli that provoke different levels of anxiety from you. Here are steps for desensitization that you can try at home:
Step 1: Construct an Anxiety Hierarchy
Constructing an anxiety hierarchy isn’t as fancy as it sounds; it is basically breaking down a situation that triggers your anxiety into small goals. First, identify a fear that triggers high anxiety in you. Let’s use riding the subway as an example. Then you will construct a list of 10 to 15 situations surrounding that particular anxiety from 1 to 100. Assign each item on your list a rating of distress from 1 (just a tiny bit of anxiety) to 100 (a full-blown panic attack). This rating is what therapists call SUDS (subjective units of distress).
Write the activities on individual index cards. On the other side of each index card, write your SUDS rating. For example, walking down the stairs of the train station could be a 21 (heart beginning to race, you’re starting to get nervous) while riding the train is a 100 (extreme discomfort, you might have a full out panic attack).
Constructing an anxiety hierarchy will help you identify what items on your list you can start off trying to accomplish.
Here’s an example of what your anxiety hierarchy may look like.
(5) Watching a movie or commercial where a person is riding the subway
(15) Looking at directions of how to take the subway to school
(30) Walking to the train station
(45) Walking down the stairs to the subway
(51) Purchasing the subway token.
(65) Going through the turnstiles.
(70) Standing on the platform.
(76) Watching the train pass by.
(90) Walking into the train and letting the doors close.
(100) Staying in the moving train.
As you create each index card, note the anxious thoughts that accompany the situation. For example, anxious thoughts that might occur while walking to the train station could be, “People can tell I am anxious. They must think I’m weird” or “I want nothing more right now than to turn around and go back home.”
Step 2: Clear The Way! Practice Progressive Muscle Relaxation
People with anxiety are often so used to being tense throughout the day that they don’t even recognize how tense they are! Practicing Progressive Muscle Relaxation will help you learn to distinguish between when your muscles feel relaxed and when they feel tense. Progressive Muscle Relaxation is a great way to reduce your general anxiety so you can clear the way for your brain to dedicate all its focus to the items on your anxiety hierarchy.
First, inhale deeply through your nose from your diaphragm. You can tell if you’re doing it correctly if your stomach expands when you inhale. A red flag is if your chest puffs up! While you inhale, tense a particular a particular muscle in your body (like your shoulders, fists, calves, toes or jaw). Hold in your breath for as long as it feels a tiny bit challenging but overall comfortable (5-10 seconds is a good start). When you exhale slowly through your mouth, release the tension and notice how differently your muscles feel now that they are relaxed.
Set aside 10-20 minutes a day to practice Progressive Muscle Relaxation with all the muscles in your body, from head to toe before you start the next step, using your imagination. You can also practice Progressive Muscle Relaxation discreetly when you’re commuting to work or school, while you’re getting dressed or taking a shower.
NOTE: It’s a great idea to practice progressive muscle relaxation at the beginning and conclusion of the time you’ve set aside to practice your anxiety hierarchy in your imagination (Step 3) and in real life (Step 4). It is important that you feel relaxed and have a clear mind so that your stress from work, school, relationships, and other parts of your life doesn’t add to the anxiety you’ll be experiencing as you start challenging yourself with items in your hierarchy.
Step 3. Use Your Imagination
Set aside some time in a place where you’re not likely to be disturbed. After you’ve practiced progressive muscle relaxation, imagine a scene representing the weakest SUDS level item on your anxiety hierarchy from Step 1. Is your heart racing? Are your muscles tense? Are your short of breath or sweating? Notice the sensations and thoughts you are experiencing. Then you have to imagine the scene repeatedly by thinking through the anxious thoughts you mapped out in Step 1. At first, each time you imagine the situation will produce more and more anxiety. Your anxiety will increase! But it will eventually decrease with repetition.
It is important you do not practice coping skills while you are imagining the situation; trying to cope positively with the situation defeats the purpose of desensitization. When we are anxious, the amygdala, a part of the brain, floods the body with cortisol and adrenaline. The more you do the thing that makes you anxious, the less your amygdala will be able to keep up producing the cortisol and adrenaline that the physical symptoms of anxiety. When you imagine yourself in the situation over and over again, you are essentially teaching your amygdala that the situation is not as big of a threat as it thought it was.
Everything on the list will be challenging, but start off with something that you rated with a low level of discomfort. Give yourself time to accomplish the task because it’s not going to be easy! Even if you complete your task with half the anxiety that you would usually experience, that is a great accomplishment. Once an item on your list is about half as anxiety provoking as it was in the beginning, it is time to challenge yourself with another item.
After you can imagine that step of your anxiety hierarchy while exhibiting a level of anxiety that feels manageable to you, imagine the next higher anxiety-producing step, and so on. You should spend between 10 and 20 minutes on each step of your anxiety hierarchy, depending on the SUDS level you assigned to it. The higher the SUDS level, the more time you should spend on it. Thus, the anxiety cues are gradually decreased until you can imagine the most frightening step with a manageable amount of anxiety.
Step 5: Start Challenging Yourself, One Step at a Time
You’ve constructed the Anxiety Hierarchy. You’ve used your imagination to desensitize yourself to the situations on your hierarchy. Now, it’s time to get into those situations in real life. Self-compassion and patience are now more important than ever. Remember, practice progressive muscle relaxation before you bring and start with the situation on your hierarchy with the lowest SUDS level.
Let’s keep using the example of feeling anxiety about riding the subway. Next time you’re on your way to the grocery store, walk by a train station. Stop for a few seconds in front the train station. Make note of what you’re experiencing: racing heart beat, shortness of breath, worrisome “Oh no, oh no, oh no” thoughts. Accept it. Breathe. And continue your walk to the grocery store. Go back to the train station on your way home and repeat.
Stop by the train station multiple times throughout the week until you feel your anxiety level has decreased. It’s okay if your anxiety is not totally gone, just a decrease is a great accomplishment. Now it’s time for you to start walking down the stairs of the train station. You don’t have to go inside or buy a ticket; just walk down the stairs. Repeat practicing self-awareness, breathing, and acceptance.
Continue this process with the rest of your items in the anxiety hierarchy.
Step 6: Practice Desensitization Maintenance
You’re going to need to keep practicing desensitization throughout your life. Going back to avoiding the things that make you anxious can undo all the hard work you did to desensitize yourself. Keep maintaining contact with the things that make you anxious. For example, if you’re afraid of using the subway but now you own a car that you drive frequently, watch videos online of trains and/or opt for using the subway instead of your car once in awhile. Keep exposing yourself to the anxiety stimuli you identified in your anxiety hierarchy.
This process is going to take time, self-compassion, and dedication. These steps are possible to do on your own, but it helps a lot to have a therapist to guide you and support you along your journey. If you’re having a tough time creating your anxiety hierarchy, practicing progressive muscle relaxation, tolerating the anxiety that comes up when you imagine the items on the anxiety hierarchy, or challenging yourself by facing the items in real life, consider making an appointment for individual therapy with a therapist at The Center for Growth or join our Depression & Anxiety Support Group to meet and connect with other folks struggling with anxiety. We have offices in Philadelphia PA, Mechanicsville VA, Ocean City NJ, Santa Fe NM.