Staying current with research literature and best treatment practices in the field of anxiety disorder treatment can be difficult. Sometimes even knowing the current language of treatment is a barrier to clinicians. Recently, one of the therapists I work with for case consultation went to a workshop in her area where the presenter taught desensitization for anxiety. The problem with old therapeutic concepts is that there is a reason we no longer use them: they stand in the way of therapists providing the most current and effective treatment. Desensitization is a perfect example of this problem.
Early in my work as a therapist, I thought of desensitization as the goal to treatment. I remember a young man I worked with had hair down his back because he had agoraphobia and was afraid of sitting in a barber chair for a haircut. Fast forward through 8 frustrating weeks of treatment, and when he and I said goodbye, he still had that long hair. Looking back, I can see the problem was we focused all our attention on exposure to the barber chair, and not enough on building his tolerance of the yucky feelings of anxiety as well as his ability to tolerate uncertainty and embarrassment.
The reverse can be true as well; we may focus so much on desensitization and be happy that a client was desensitized that we were surprised when a new symptom appeared. So a young woman who had worked hard to desensitize to fear of vomiting (emetophobia) and then developed a fear of feeling trapped by being pregnant (she was married and she and her husband longed for a child) had to go back to therapy and back to a new hierarchy.
Anxiety can come and go through our lives. That isn’t a life sentence; it’s recognition that it’s important to be able to tolerate the feelings of anxiety and to recognize them in different situations and with different topics. The goal is to live a rich, full life without limitations due to anxiety. We help our clients understand that by cheering them on when they do hard things even with anxiety – one woman with fear of flying said to me, “I had the thought, ‘I don’t want to go.’ And I realized it was another anxiety trick, so I walked onto the airplane and buckled my belt anyway. Anxiety isn’t going to stop me from flying.” The skills of tolerating anxious feelings and uncertainty in multiple situations allowed her to be her own best therapist, the true goal of CBT.
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