Exposure therapy for severe anxiety and panic disorder in Scottsdale-

Severe anxiety and panic disorder treatment is hard to come by when dealing with extremely difficult cases. As a psychiatrist in Scottsdale who focuses on severe cases of anxiety and panic disorder, I utilize a behavioral approach to treatment called exposure therapy. Often times medications are utilized as a tool to enable my patient to participate fully in the exposure therapy because in severe cases, patients often cannot even participate in the exposure’s without some relief of symptoms. I specialize in treatment of these cases in Scottsdale.

Steps below outline the approach to exposure therapy which unfortunately unless followed very specifically leads to poor results and an actual worsening of symptoms.
Exposure therapy is a behavioral therapy that relies on the process of conditioning and counter-conditioning. The specific process to counter-condition a feared response, such as leaving the house or experiencing anxiety in general, is called desensitization. Essentially we induce very small levels of anxiety in a consistent, regimented way on a daily basis in order to expose someone to piece of anxiety they can succeed at handling. The way we get these exposures to manageable levels is through the use of a structured hierarchy of exposures in conjunction with short-term benzodiazepine use if their panic or anxiety is severe. A following case of someone who is house-bound or struggles to leave the house is common in treatment.

Week 1-Leaving the house to a simple, short task which induces a goal level of anxiety in the range of a 3-4 out of 10 (10 being severe anxiety). A common starting point is a short trip to a grocery store to walk in, pay for one item and walk out. The goal is to create a situation in which anxiety is induced but a predictable amount of anxiety is induced. If one cannot leave the house, or even minute tasks are overwhelming than I utilize benzodiazepine medication to minimize the anxiety to a target of the 3-4 out of 10.
Once this target goal is achieved, it is critical that the person now completes the exact same task multiple times per day or at the very least, once a day until the anxiety is extinguished and they can complete the task with minimal anxiety. In this example that would include one visiting the store, picking up one item and then leaving; all with almost no anxiety. Whether this takes 2 visits or 10 visits one must be vigilant in the consistency. This extinguished fear creates success, positive experience and realization that anxiety can be dissipated.

Week-2-If the week 1 activity is successful extinguished in terms of anxiety, than we set a new goal which is slightly more anxiety provoking. Again-the goal is a 4/5 out of 10. This week may include a longer trip to the same store with goal of standing in the checkout line with more items. Again the process of counter conditioning will include the person repeating the exact same activity at the same place until the anxiety is dissipated over numerous exposures to that store and that level of exposure.
The process continues from here, raising ever-so-slightly each week, the exposure but always with the goal of it being a 4 or 5 out of 10 on the scale of anxiety. Keep in mind, what is a 4/10 in week 1 will be much more “simple” than a 4 out of 10 on later weeks. With progression, the process of desensitization occurs and what once was considered an overwhelming task, becomes very manageable because one essentially completes many successful positive exposures where they overcome their manageable pieces of anxiety. This also leads to confidence being built and the process works amazingly fast.

The benzodiazepine used initially is phased out over weeks to months depending on the case and ultimately one is treated and off of medications. Unfortunately less experienced therapists and treatment providers in the Scottsdale area will denounce medication use when in reality there is a large group of sufferers who will never be able to complete exposures consistently enough with no aid and ultimately will never get better. On the other hand, it is unfortunate that for treatment of anxiety and Panic, many physicians will use medications to try to eliminate anxiety as a “fix.” The danger with this is only a mask of the symptoms and no repair of the core problem. When I utilize a medication it is only to reduce but never to eliminate anxiety as exposure therapy, desensitization and ultimately counter-conditioning cannot occur with no perception of the anxiety.

It is also almost always necessary to integrate psychotherapy to explore the long-standing, usually child-hood derived deep-seated sources of repressed emotion that almost always accompanies severe anxiety and panic disorder. Often times these repressed childhood memories are filled with painful emotion that was buried deeply in the unconscious mind. Emotions buried but never dealt with drive the symptoms of anxiety and panic disorder, both physically and mentally. These psychological drives are exacerbated in people with a genetic predisposition and neuro-circuitry that is prone to producing anxiety.

Michael Yasinski MD