Loading practices
Loading practices
Areas › Worry and anxiety › Facing it a step at a time
What you learned did not vanish. It went out of reach for a while, usually because something else was going on in your life. Pick up a rung or two below where you stopped and you will generally find yourself back at your old level in a fraction of the original time. Knowing that beforehand is what stops a rough fortnight turning into a decision to give up.
Facing a fear in steps works, and it works best with someone guiding the ladder. Read this as an explanation of how it works, and take the steps themselves to a therapist.
Do not lose heart or despair (Quran 3:139). The address is to people whose attempt has just gone badly, not to people who are doing well.
آل عمران
وَلَا تَهِنُواْ وَلَا تَحۡزَنُواْ وَأَنتُمُ ٱلۡأَعۡلَوۡنَ إِن كُنتُم مُّؤۡمِنِينَ
Do not lose heart or despair- if you are true believers you have the upper hand
Qur’an 3:139read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
A meta-analysis found that a drug promoting fear extinction enhanced the effects of exposure therapy, which is evidence that exposure works through new learning rather than by wearing fear away, and learning is the kind of thing that can be held and recovered. Worth adding that when all the trials of that drug were pooled at the level of individual patients, its advantage turned out smaller and more conditional than the early results suggested. Neither piece of work set out to measure how quickly people recover from a setback.
Norberg MM, Krystal JH, Tolin DF. (2008). A meta-analysis of D-cycloserine and the facilitation of fear extinction and exposure therapy.. Biological psychiatry doi
Mataix-Cols D, Fernández de la Cruz L, Monzani B, Rosenfield D, Andersson E, Pérez-Vigil A, Frumento P, de Kleine RA, Difede J, Dunlop BW, Farrell LJ, Geller D, Gerardi M, Guastella AJ, Hofmann SG, Hendriks GJ, Kushner MG, Lee FS, Lenze EJ, Levinson CA, McConnell H, Otto MW, Plag J, Pollack MH, Ressler KJ, Rodebaugh TL, Rothbaum BO, Scheeringa MS, Siewert-Siegmund A, Smits JAJ, Storch EA, Ströhle A, Tart CD, Tolin DF, van Minnen A, Waters AM, Weems CF, Wilhelm S, Wyka K, Davis M, Rück C, the DCS Anxiety Consortium, Altemus M, Anderson P, Cukor J, Finck C, Geffken GR, Golfels F, Goodman WK, Gutner C, Heyman I, Jovanovic T, Lewin AB, McNamara JP, Murphy TK, Norrholm S, Thuras P. (2017). D-Cycloserine Augmentation of Exposure-Based Cognitive Behavior Therapy for Anxiety, Obsessive-Compulsive, and Posttraumatic Stress Disorders: A Systematic Review and Meta-analysis of Individual Participant Data.. JAMA psychiatry doi
Strength of evidence: one line of research. A single study, or a theoretical account.
The learning is still there even when your performance drops, so you are starting from a foundation and not from nothing.
Years of avoiding people leave real gaps, not only fear. How to start small talk, how to join a group already talking, how to get out of a conversation. Those can be taught, and being taught them is not an insult.
Nobody puts a child who cannot swim into the shallow end and calls it teaching. Before anyone goes near the thing they dread, they need something to do with their body and their head when the fear arrives.
Let the person facing it choose the first step, and let them choose an easy one. A rung somebody picked gets climbed. A rung assigned to them gets argued about.