Anxiety generalizes very easily. If you were repeatedly punished for playing with dirt as a child, dirt can evoke strong anxiety in you as an adult. If you were bitten by a dog, the sight of a dog years later may make you feel anxious. Anxiety can come to be associated with almost any experience. What is particularly destructive about this is that you soon find yourself caught in a vicious circle: a certain situation makes you anxious, you try to avoid the situation and the anxiety it produces in you, and as you do this, you build up secondary anxiety—you get anxious that you'll get anxious. So anxiety compounds, feeding on itself, fueling itself.
Counter-conditioning therapists have found that, to varying degrees, we are all capable of inhibiting anxiety. A behavior therapist tries to teach you how to do this, eventually so that you can use relaxation techniques on your own.
The following are the main phases of desensitization therapy—assertiveness training and sex therapy are similar, gradual, and reassuring processes:
1. You are taught how to achieve a state of relatively complete physical relaxation. Many therapists will tape relaxation instructions so that you can practice daily at home for twenty to thirty minutes. Some therapists will instruct you to tense your arms, hold the tension for ten seconds or so, then relax and feel the resulting sense of relaxation, the sense of relief from tension and strain. Or, some therapists use suggestion, asking you to imagine that your arms are becoming heavier and heavier, encouraging you to relax deeply. Each of your major muscle groups is relaxed in turn until you feel fully relaxed. This first phase of therapy usually takes from two to six sessions.
2. Next a hierarchy is constructed by the therapist for each individual client, ranking situations or stimuli from most to least anxiety-producing. A person who fears to leave the sense of security of home already is aware of such a hierarchy: low anxiety may be felt on the front steps, greater anxiety when going out to the mailbox, more anxiety in walking around the block, and extreme anxiety when facing a trip or a move to another residence.
3. The last phase is the actual process of desensitization. You are asked to relax deeply with eyes closed, usually in a recliner in the therapist's office. You are asked to imagine a scene taken from the low-anxiety end of your hierarchy. The therapist tries to describe the scene as realistically and vividly as possible. If you begin to feel anxious, you can raise an index finger, and then the therapist will shift away from the imagined scene and will turn back to relaxation instructions. When you are again relaxed, the process continues until, in time, you are able to imagine a scene high on the hierarchy, but still sustain deep relaxation.
Once this process of desensitization can be accomplished in the office, you begin anew, but now with actual situations—first with those low on your hierarchy and then working your way toward situations that used to cause you high anxiety. Frequently, behavior therapists will accompany their clients outside the office, helping them to remain relaxed—e.g., while riding elevators, in crowds, even sometimes on airline flights if fear of flying is the problem.
BEHAVIOR MODIFICATION
The central idea behind behavior modification is that undesirable habits of behavior will gradually be eliminated if, consistently, they are not rewarded or even are punished. Conversely, desirable habits are encouraged when they consistently are reinforced or rewarded.
Therapists who use behavior modification techniques may recommend both punishments and rewards to clients. If you are a chronic smoker or overeater, for example, you may be given a small device with which to shock yourself moderately each time you reach for a cigarette or a second helping. Or, you may be asked to deposit $100 with the therapist, and a certain amount will be donated to your most disliked political group each time you go astray.