Written by Talia Kaplan
Consider the following three people:
Joseph is a 35 year old married man whose father died from stomach cancer 5 years earlier. Recently, Joseph has begun to worry that he too may develop cancer. He has gone to several medical doctors and has had numerous scans, all indicating that he is healthy. Joseph continues to worry despite his doctor’s, his wife’s and his family’s reassurances. Any time Joseph feels nauseous or pain in his stomach he begins googling the symptoms to see if it is possibly stomach cancer. Joseph severely has limited the type of food he eats, stopped exercising, and stopped working due to his fear of stomach cancer. Recently, he has noticed that he is worrying about a hernia and other types of medical problems. When he went to see his general practitioner, he was referred to a therapist.
Nancy is a 60 year old divorced mother of three children who has a fear of flying on planes. Her three children live all across the United States, but Nancy has never been to visit her children due to her fear. She has never met her grandchild, and has become depressed as a result of her strained relationship with her children. Nancy’s daughter will be getting married in 2 months and she would like to be able to attend the wedding.
Michael is a 25 year old single male who obsessively worries about the remote possibility that he might kill someone, despite the fact that he has no desire to do so and zero history of violent behavior. Michael works as a barista in a coffee shop, but recently had to take a leave of absence because he kept thinking that he may have accidentally put detergent in a person’s coffee which might kill them. Michael would therefore re-do each cup of coffee he made three times before handing the cup to the customer. Michael’s supervisor noticed what he is doing and has threatened to fire Michael as a result of his inefficiency.
The three people listed above experience debilitating levels of anxiety. Their anxiety has moved beyond regular daily stress. It has moved beyond the frustration of frequently experiencing anxiety in difficult situations. For the people in these vignettes, anxiety has become the thing to fear, and a significantly inhibitory factor in their lives. The first person, Joseph, experiences hypochondriasis (health anxiety); Nancy has a specific phobia of airplanes; while Michael has OCD. While it is expected for all people to worry at times, anxiety can prevent people from living their life in the way they would want to. In cases like these intensive outpatient treatment involving exposure therapy, can help people make rapid gains in treatment over a short period of time.
Exposure therapy works on the premise of behavioral learning models. By avoiding the feared stimulus, people’s anxieties tend to get worse because their fears take over their life decisions. Exposure therapy re-teaches people that they can fully engage in life. Sometimes the feared outcome takes place, and sometimes it doesn’t, but their fear does not dictate whether it will happen. In intensive exposure-based treatment, the therapist and patient first work to ensure understanding of the core fear. For example, for some people the fear of flying in an airplane is that the plane may fall out of the sky, for others it may be that the airplane may hit turbulence and the passenger may experience nausea. Second, the therapist and patient collaborate to develop a hierarchy of feared situations. This hierarchy serves as a map for treatment progress. Patient and therapist then spend a series of half- or full-days together to move in a linear fashion to tackle areas of avoidance for each patient. An example of a first stage in a hierarchy for Michael might be thinking about a person spilling hot coffee on themselves and thereby slightly burning their hand because of a hot cup of coffee that he gave them. The therapist and patient work methodically to help the person re-engage fully in their lives despite feared situations. In many cases of intensive treatment, patients have seen significant improvement in their ability to live the life they want to be living within a week.
One important aspect of doing this type of short-term intensive treatment is attending to bodily sensations. For a patient like Joseph, bodily sensations are often interpreted as dangerous or scary. Through the use of mindfulness techniques, therapists work to teach patients how to re-interpret the daily aches and pains of daily life. Research suggests that intensive treatments can be used to help a person meet a short term goal that they have been struggling with for years. It can help a person reconnect and rebuild interpersonal relationships, allow a person to keep their job, and help people feel more satisfied with their lives.