When not to use DBT skills: Conference highlights on treating anxiety disorders (with Melanie Harned, Ph.D. and Katheryn Korslund, Ph.D.).

This last week I was able to attend a wonderful conference on exposure-based treatments. Exposure therapy is basically this: If you are confronted with objects, sensations, or memories that you are afraid of over and over again eventually your fear of them goes down. Exposure is used to treat anxiety disorders such as panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, and post-traumatic stress disorder. According to the conference presenters, 60-85% of anxiety-disordered clients who receive exposure therapy show clinically significant improvement.

One example of exposure treatment is for people who have panic attacks. Panic attacks generally include a range of symptoms such as a racing heart, shortness of breath, fear about going crazy or dying, numbness and tingling, feeling flushed, and intense physical sensations. In essence, when people have panic attacks they are often afraid of having more panic attacks. For instance, when a person runs a short distance, they may get out of breath (naturally!). Not so naturally, however, they may become flooded with anxiety that this is yet another panic attack coming on. Therefore they go out of their way to avoid anything that includes a racing heart, shortness of breath, or physical sensations associated with exercise. Perhaps this includes feeling their heart beat or feeling their breath. Therefore they may avoid any activity (or any emotion!) that involves physical sensations.

Exposure treatment for panic disorder involves facing and experiencing physical sensations. This is known as interoceptive exposure. For instance, clients are asked to participate in activities that create the feeling of not getting enough air in the lungs. Classic examples may include running up a staircase, breathing through one nostril through a straw, spinning around in a chair, or hyperventilating on purpose. (Hey, when I was in graduate school, we had to do all the above with our classmates!).

The important thing that makes exposure treatment work is that the person has to be alive, awake, attentive- and not under the influence of drugs, medications, or alcohol- to make it work. NO CHEATING!!! This is actually a time NOT to use DBT distracting skills. The point is that a person’s brain has to experience the situation differently when the person is exposed to the feared stimulus. Anxiety will go up- initially- and then it will go down. Otherwise the brain never learns! The new learning is experienced, and this makes all the difference in the world. No amount of rational cognitive problem solving is going to convince your brain otherwise.

This conference gave me new food for thought, allowed me to visit old material that I haven’t seen in a while, and was an excellent and thorough overview of exposure treatment for trauma (including when not to use it!). I will keep chewing on this food for thought- and definitely keep you posted.