Exposure Exercises for Dealing with Panic Disorder

06 September, 2020
Did it ever occur to you that deliberately generating the symptoms of a panic attack could help prevent them? Continue reading to find out how exposure exercises can help people deal with anxiety.

A panic disorder is one of the conditions that most limits someone’s life. This is because their daily routine ends up engulfed in major concerns about when the next attack will occur. Thus, they tend to restrict their daily activities. Drugs can help. However, psychotherapy and exposure exercises are what truly make a difference.

People experience a panic attack as intense sudden terror accompanied by various physical and cognitive manifestations. The intense discomfort experienced during the first one makes the person feel afraid of being afraid. Thus, they begin to be alert and vigilant, fearing a new crisis.

What they fear is the appearance of any unpleasant sensations. However, paradoxically, fear itself can make one magnify and oversize any normal bodily sensation. The excess attention they pay to it, along with a series of maladaptive thoughts, leads to a new panic episode.

“The worst part about anxiety attacks, is that you’re aware it’s irrational and sometimes unexplainable, but knowing that gives no aid what so ever. In most cases, it deepens the anxiety as you realise “if I know it’s irrational, why can’t I stop it… Oh god I can’t stop it” you begin to believe you are no longer in control of your mind. That. That is fear.”

-Ami Desu-

A distressed person.

Interoceptive exposure

People end up considering certain innocuous physical manifestations as both dangerous and alarming. They take palpitations as a sign of a heart attack and interpret shortness of breath as imminent suffocation. Also, they consider dizziness a preamble to fainting. During a panic attack, the individual feels they’re going crazy, losing control, or even dying.

In order to avoid such unpleasant situations, they begin to follow a series of avoidance strategies. They try not to do activities or go to places they associate with a panic attack. In addition, they carry out safety behaviors, such as always carrying a bottle of water or sitting near the exits in any public transportation or public place.

All this avoidance perpetuates the interpretation of danger and deprives the person of verifying the harmlessness of their sensations. Therefore, the main element of treatment is exposure to these bodily sensations. It’s also about provoking these physical manifestations through different exercises. All so the person gets used to them and stops being afraid of them.

Exposure exercises for panic disorder

Some of the most common preventive practices against a panic attack are:

  • Hyperventilation often causes dizziness, numbness, and a feeling of derealization. For this, the person should breathe in and out 30 times per minute.
  • Breathe through a straw for two minutes so it leads to nausea and shortness of breath, as well as rapid heartbeat and palpitations.
  • Quickly shake your head from side to side for 30 seconds to cause dizziness and blurred vision. You can also accomplish this by rolling over or by lifting heavy objects.
  • Make sudden posture changes, such as getting up suddenly. This will create hypotension and it’ll act as a barrier against overactivation.
  • Force breathing is a good exercise to emulate the feeling of tightness and chest pain. To do it, the individual must breathe deeply and keep the thoracic muscles tense. Then, take a deep breath again after releasing as little air as possible. They must repeat this sequence several times.
  • It may be enough to wear a high collar or a tight tie to create the sensation of choking and throat tightness. Also, it may be helpful to press down on the back of the tongue with an item such as a toothbrush handle or a wooden tongue depressor.
  • Staying in a very hot environment dressed in warm clothing can be enough to cause overwhelming feelings that are similar to those of a panic attack.
A therapist and her patient.

Other helpful exposure exercises

In addition to getting used to bodily sensations, imagination exposure exercises can also be positive. In other words, those in which the person is visualized experiencing the bodily sensations of panic and facing them, without fleeing or avoiding them.

Likewise, a person must gradually go to those triggering places and situations they’ve been avoiding. Clearly, exposure can be aversive and unpleasant. However, it’s proven to be the most effective intervention with long-lasting results. In fact, these are superior to those obtained with drugs.

  • Moreno-Fernández, I. M., Gómez-Espejo, V., Olmedilla-Caballero, B., Ramos-Pastrana, L. M., Ortega-Toro, E., & Olmedilla-Zafra, A. (1991). Eficacia terapéutica de los psicofármacos y de la exposición en el tratamiento de la agorafobia/trastorno de pánico. Una revisión. Clinical and Health2(3), 243-256.
  • Frangella, L., & Gramajo, M. (s. f.). Manual psicoeducativo para el consultante. Trastorno de pánico. Recuperado 18 de junio de 2020, de https://www.fundacionforo.com/pdfs/panico.pdf