PSYCHOTHERAPY FOR ANXIETY – EXPOSURE AND RESPONSE PREVENTION

Imagine you are lost in the jungle and suddenly come face to face with a tiger. What would be your response? Naturally, you would panic. While you panic, let’s check out what happens inside your mind and body. The brain senses danger and activates the body’s fight and flight response. Rational thinking shuts down (this is no time for mind games!). The heart beats fast, you sweat profusely, your body starts to shake, you feel short of breath and there is a sudden lump in your throat.

This is exactly what happens to a person living with anxiety disorders. Trivial triggers like getting into an elevator, making a public appearance, going for a job interview or facing an examination makes their brain see red. Their brain is wired to sense the same level of danger in these situations as it would in a life-threatening situation. Obviously, the person experiences a panic attack when faced with such triggering situations. With time the brain learns what it must do to avoid such attacks. The best bet is to avoid such situations altogether. Therefore, they flee from crowded places, take the stairs in place of an elevator (even to the fifteenth floor!) or avoid making presentations at the office, even at the cost of a promotion. In a nutshell, whenever the person is exposed to an anxiety provoking situation, their natural response is to flee.

What then, is the solution in such cases? Psychotherapy for anxiety disorders utilizes this very principle. The therapist painstakingly finds out each situation or thought that triggers anxiety in the client after taking a detailed case history. The next step in psychotherapy for anxiety is to make a list of these situations and grade them based on the level of distress they cause to the client. Once that is done, therapy starts. The situation or thought causing the least distress is selected first. The client is then deliberately exposed to that trigger and made to withstand the anxiety that ensues. His/her normal response, to quit the scene is therefore prevented. The anxiety levels rise to a maximum, maintain a brief plateau and then automatically come down. In addition, the client is taught relaxation techniques that help withstand the anxiety with ease. Initially, the client is exposed to triggers in presence of the therapist. As he/she masters the technique, the client is encouraged to do the same on his own. As the psychotherapy for anxiety progresses, the client is exposed to more distressing triggers. The idea is to rewire the brain circuits so that the anxiety provoking stimuli no longer result in a catastrophic cascade of fight or flight response.


This article is a simplified overview of the most commonly practiced psychotherapy for anxiety, exposure and response prevention (ERP in short). The actual process is quite time consuming and needs full commitment on part of both the client and therapist. There are quite a few sessions, strategically timed, and the client is advised to attend the sessions on time for best results. For more insights into psychotherapy or pharmacotherapy for anxiety, feel free to post a query.

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