I was heading to class when I came across a flyer for participation in a study on Panic Disorder. It was my Junior year of undergraduate school, and while the extra credit opportunity was appealing, I was even more interested in finally addressing the years-long panic symptoms that had been plaguing me off and on since the 5th grade. It felt serendipitous as I had just climbed what felt like 10 sets of stairs to get from the parking garage to the Psychology building and I was experiencing that familiar feeling. Heart racing, shortness of breath, impending doom and what I believed to be an almost certain outcome of death as a result of increased cardiovascular activity. I called the number, registered, and was on my way to my first introduction to Exposure and Response Prevention therapy, and 5 points extra credit.
Exposure and Response Prevention (ERP) involves intentional, gradual exposures to feared stimuli without engaging in avoidance or compulsive behaviors. ERP works, in part, through a process called Habituation. Put simply, exposing a specific feared stimuli to your brain over time will eventually reduce the fear response to that stimuli. But what if what we are fearing is…fear itself? Or in my case, panic.
Panic disorder is an anxiety disorder in which one experiences sudden, often unexpected panic attacks. Which often then leads to a fear of experiencing panic attacks. Fear begets fear, panic begets panic. A difficult cycle to break!
When I arrived at the Psychology Lab I was eager, but terrified. Admittedly, I knew very little about ERP, much less interoceptive exposures. However, my drive for extra credit kept me committed. Yay for extrinsic motivation!
Prior to ever engaging in my first exposure, I was assigned to participate in on-demand learning about what exactly is happening in the process of a panic attack. I learned quickly that while my “reptilian” brain was perceiving threats, the “worst” thing that could happen is that I could pass out! What a relief, I felt so much better! Sort of. Logically, it’s something that was obvious to me, but the education wasn’t quite enough for me to feel confident in my survival the next time one of my unexpected panic attacks hit. And to be fair, passing out is not the best consolation prize.
This is where interoceptive exposures came in. Interoceptive exposures involve exposure to feared, albeit harmless, physiological stimuli. For me, that included physical symptoms associated with panic. Shortness of breath, rapid heart rate, dizziness, feeling hot, etc.
Always a dedicated student, I stared excitedly at my therapeutic homework. Until I realized what was being asked of me. Each day I was assigned to participate in a variety of activities and log my completion on a tracker. The list included: spin around in a swivel chair until dizzy, intentionally hyperventilate, do three sets of 10 jumping jacks, jump in place for two minutes, and my personal least favorite, practice breathing through a coffee straw.
I worked diligently on my homework, which included participating in the assigned activities and rating my level of distress after each activity. Over time, my distress decreased with each activity. In other words, my brain habituated to the stimuli and no longer registered my internal sensations as a threat. This, combined with the psychoeducation I received learning about the physiological process of a panic attack gave me the tools I needed to manage my fear.
I am happy to report that through ERP, I no longer suffer from panic disorder, have learned a great deal about myself and can wholly relate to those on the brave journey of recovery from debilitating anxiety and OCD. And while some things about my college experience are a distant memory, the experience of breathing through a coffee straw is one that I will not soon forget.
ERP is a powerful tool for lasting change. At Cascade Academy, we utilize modalities such as ERP, Inference-Based Cognitive Behavioral Therapy, Acceptance and Commitment Therapy, Radically Open Dialectical Behavioral Therapy and more to expand the lives of those we work with. I know firsthand just how life changing these modalities can be and I am fortunate to have learned that I am capable of doing really hard things.