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Areas › Worry and anxiety › Facing it a step at a time
At the height of fear the only skills within reach are the overlearned ones. Something demonstrated once in a quiet room will not turn up in a school corridor with your heart going. Run it in the calm, run it with someone watching, run it when you are slightly bored by it, and then it will be there when it is actually needed.
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.
recite as much as is easy for you (Quran 73:20). What is asked for is a practice kept at a size a person can actually sustain and repeat.
المزمل
۞إِنَّ رَبَّكَ يَعۡلَمُ أَنَّكَ تَقُومُ أَدۡنَىٰ مِن ثُلُثَيِ ٱلَّيۡلِ وَنِصۡفَهُۥ وَثُلُثَهُۥ وَطَآئِفَةࣱ مِّنَ ٱلَّذِينَ مَعَكَۚ وَٱللَّهُ يُقَدِّرُ ٱلَّيۡلَ وَٱلنَّهَارَۚ عَلِمَ أَن لَّن تُحۡصُوهُ فَتَابَ عَلَيۡكُمۡۖ فَٱقۡرَءُواْ مَا تَيَسَّرَ مِنَ ٱلۡقُرۡءَانِۚ عَلِمَ أَن سَيَكُونُ مِنكُم مَّرۡضَىٰ وَءَاخَرُونَ يَضۡرِبُونَ فِي ٱلۡأَرۡضِ يَبۡتَغُونَ مِن فَضۡلِ ٱللَّهِ وَءَاخَرُونَ يُقَٰتِلُونَ فِي سَبِيلِ ٱللَّهِۖ فَٱقۡرَءُواْ مَا تَيَسَّرَ مِنۡهُۚ وَأَقِيمُواْ ٱلصَّلَوٰةَ وَءَاتُواْ ٱلزَّكَوٰةَ وَأَقۡرِضُواْ ٱللَّهَ قَرۡضًا حَسَنࣰ اۚ وَمَا تُقَدِّمُواْ لِأَنفُسِكُم مِّنۡ خَيۡرࣲ تَجِدُوهُ عِندَ ٱللَّهِ هُوَ خَيۡرࣰ ا وَأَعۡظَمَ أَجۡرࣰ اۚ وَٱسۡتَغۡفِرُواْ ٱللَّهَۖ إِنَّ ٱللَّهَ غَفُورࣱ رَّحِيمُۢ
[Prophet], your Lord is well aware that you sometimes spend nearly two-thirds of the night at prayer––sometimes half, sometimes a third––as do some of your followers. God determines the division of night and day. He knows that you will not be able to keep a measure of it and He has relented towards all of you, so recite as much of the Quran as is easy for you. He knows that some of you will be sick, some of you travelling through the land seeking God’s bounty, some of you fighting in God’s way: recite as much as is easy for you, keep up the prayer, pay the prescribed alms, and make God a good loan. Whatever good you store up for yourselves will be improved and increased for you. Ask God for His forgiveness, He is most forgiving, most merciful
Qur’an 73:20read it in the library
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
In a randomised trial for panic disorder with agoraphobia, exposure that the therapist guided on the spot produced more pervasive and lasting effects than exposure simply prescribed as homework. Guided practice beat handing someone the instructions, which is the same point at the level of a whole treatment. It was one trial in one condition, so it argues for practising together rather than telling you how many repetitions a given skill needs.
Gloster AT, Wittchen HU, Einsle F, Lang T, Helbig-Lang S, Fydrich T, Fehm L, Hamm AO, Richter J, Alpers GW, Gerlach AL, Ströhle A, Kircher T, Deckert J, Zwanzger P, Höfler M, Arolt V. (2011). Psychological treatment for panic disorder with agoraphobia: a randomized controlled trial to examine the role of therapist-guided exposure in situ in CBT.. Journal of consulting and clinical psychology doi
Strength of evidence: one line of research. A single study, or a theoretical account.
Under high arousal you can only use what has already become automatic.
Stay with a step until it stops being interesting. Not until you have survived it once, but until it is ordinary, and then move up.
If you are helping someone with their sleep and eating, ask rather than instruct. The moment you sound like their mother you have lost the part of you that was useful.
A ladder worth climbing has six things: real steps, built with you rather than for you, in your own words, a first rung that is genuinely easy, your hand on the pace throughout, and practice often enough to add up.