ERP affects cognition 1 Your negative assumption will

ERP – affects cognition 1) Your negative assumption will not allow you to figure out the truth. 2) The more you avoid something the less you know about it. 3) Facing the fears, will uncover the fallacy of the fear. The fear just melts on its own!

Face the FEARS don’t Fight the FEARS xie ow gd oin g ty g An A ty e i nx up g oin n

R. I. D. E. R ename thought I nsists that you are in charge D efy – do the opposite E njoy – your success

There is another easy option – it is a coasting down easy ride, but…

Troubleshooting – 4 mistakes 1) The exposure task does not include the relevant anxiety provoking cues. 2) The person is engaging in some subtle form of avoidance such as an attempt to self distract(ex. daydreaming) 3) The exposure is not continued long enough (it is better to do fewer exposures of sufficient length than to do many short exposures during which habituation does not occur) 4) The exposure was not done repeatedly enough times.

Behavior Therapy Developing a plan

1) What, exactly am I afraid of? 2) How much am I afraid? 3) What triggers my fears? 4) What do I do to ease my fears?

Forming your fear hierarchy

Rate your fears

Fearometer

Follow your fear patterns

Fine tuning your hierarchy

My Fear Ladder Goal Date Things I’m afraid to do 1 2 3 4 5 6 7 My fear temperature

My Fear Ladder Goal - Be able to talk to people without worrying about how I look or feeling uncomfortable Date June, 11 2009 Things I’m afraid to do: My fear temperature 1 – walk over to rebbe and ask question in בית מדרש 9 2 – ask the store man if he has a certain product 3 3 – Get an עליה in shull where no one knows him 4 4 – asking a בחור something in learning – simple boy 5 5 - asking a בחור something in learning – שטאלצי boy 7 6 – say something at the lunch table with the עולם 6 7 – walk down the aisle when the בית מדרש is full

Situation that causes distress Normal compulsion Watch someone else touch Eckel and look something really dirty change away baby, clean wash room and think about doing it Touch door knob Pick up toys from floor Walk around the house touching things without thinking before touching Goal with specific time constraint Measure on Accomplis Yes – fearometer hed or not how bad rate No - why Watch someone else touch something really dirty, change a baby, clean a wash room and think about doing it – without distancing yourself from it in your mind Use tissue Or wash right way 2 Touch door knob in house and not wash for half hour – 3 x daily Refrain from Pick up toys from floor five picking up. consecutive minutes – no wash for half Wash right away hour – twice daily Think and Walk around the house touching things rethink what did without thinking before touching. I touch Don’t wash for half hour – than only netilas yadayim 3 4 5 Tie younger brothers shoes Wash with soap Wash netilas yadayim – no soap for half hour – even than only minimal 6 Take the garbage outside wash with soap Wash netilas yadayim – no soap 7 Walk around the house touching things without thinking before touching Think and Walk around the house touching things rethink what did without thinking before touching. I touch Don’t wash for half hour – than only netilas yadayim – eat Walk in and out of public rest Wash repeatedly Wash netilas yadayim wait fifteen room with soap for 15 minutes before soaping – minimal soap min – one application 8 Walk in and out of public rest Wash repeatedly Wash netilas yadayim and eat room with soap for 15 something with hands right away min 10 8

Situation that causes distress Normal compulsion Goal with specific time constraint Measur e on fearom eter Ask a stranger a question – change of a dollar / the time Go to a big shul and look people in the face Go to shul where your friends daven and daven near the door Go to tisch standnear the door Ask a stranger a that takes explanation directions Get an aliya in bobov Avoid, Feel negatie thoughts Ask a stranger a question – change of a dollar / the time – 3 x day 2 Look down Imagine their all watching Come late and leave early Go to a big shul and look people in the face for at least five minutes Go to shul where your friends daven and daven near the door come early and leave at the end Go to tisch standnear the door – twenty minutes Ask a stranger a that takes explanation – directions 2 x day 3 Avoid, Feel negatie thoughts Get an aliya in bobov 7 Walking to bima in my beis midrash and daven for 10 min Go to tisch stand in the , middle of the parenchas Avoid Get nervous run out 7 Avoid, Become scared run Avoid Feel negatie thoughts Walking to bima in my beis midrash and daven for 10 min – look around smile Avoid Go to tisch stand in the , middle of Feel negatie thoughts the parenchas – fifteen minutes Turn red and now everyone (work in fives if nec) sees Go to a chasuna where Im a misfit and everyone Go to a chasuna where my chevra are – for five knows it are – for five minutes Go to a chasuna where Im a misfit and everyone Go to a chasuna where my chevra are – dance knows it are – dance and talk – twenty and talk minutes Ask a friend for his opinion avoid Do it 2 x day 4 5 6 8 9 9 10 Accomplis Yes – how hed or not bad rate No - why

Hierarchy Facing a Fear of Flying • Step 1: Look at photos of planes • Step 2: Watch a video of a plane in flight. • Step 3: Watch real planes take off. • Step 4: Book a plane ticket. • Step 5: Pack for your flight. • Step 6: Drive to the airport. • Step 7: Check in for your flight. • Step 8: Wait for boarding. • Step 9: Get on the plane. • Step 10: Take the flight.

Flooding Takes it all at once - Take your worst fear: -Remove all behaviors that calm your fear: - remove all circumstances that reduce the need for avoidance: - put yourself in that situation for a prolonged span of time. :

Dangers in the flooding the approach 1) This can make the patient very uncomfortable, causing him to give up before reaching habituation, and proving to him that this method will not work, and he will never be willing to try it again. 2) It is extremely difficult to getting someone to try this, unless they are very motivated, strongminded and have a lot of trust in the one who is directing them 3) Can cause the person to panic and reinforces fears.

Precautionary measures At least – the person has to have a very clear understanding as what to expect!! - Preferably the exposure should be done in your presence - Never use force or exaggerated hope.

Gradual Exposure Will accomplish the same goal as flooding, just it will take it one step at a time.

-Start at the bottom of the hierarchy, namely the fears ratings 1 thru 5 -Get the person to be willing to face the easiest ones first, and understand the goal of eventually reaching the tough ones. - Continue exposure until you are able to bring down the level of those fears and begin with the fears on the next level - When the rating goes down on those fears we will go to the next level.

The procedure for exposure 1) 2) 3) 4) 5) Expose Retreat Recover Repeat Continue going through the above cycle

Expose Put yourself in a phobic situation that will cause your anxiety to reach level 4 on the anxiety scale. This means to the level where your anxiety begins to feel a little unmanageable. This does not mean uncomfortable, you are expecting willing and wanting to be uncomfortable – but still manageable.

Retreat After reaching level 4 – which is the point that begins to feel unmanageable, Remove yourself temporarily by leaving the situation until you feel better and then return. (Remember retreat is not the same as escaping or avoiding the situation, it is saying “I will get to the top of this - But I want to do it one step at a time”.

Recover After you temporarily pulled back from the phobic situation, wait until your anxiety recedes to no more than level one or two on the anxiety scale. (you may find that the relaxation techniques will help you get back to normal feeling)

Repeat After recovering, re-enter your phobic situation and continue to progress into it up to the point where your anxiety once again reaches level four on the anxiety scale. Very often by the 2 nd or 3 rd time you will be able to stay in this situation for a longer period of time and the anxiety level will not go up as high. However even if it is still tough just keep repeating the steps to the point that you can handle it.

Continue going through the above cycle Continue the cycle according to your ability to hold out. The limit for how far you may go in any practice sessions should be determined by the point where your anxiety reaches level four on the anxiety scale.

Keeping score of progress My successes Date: Goal Things I was afraid to do 1. 2. 3. 4. 5. 6. 7. Fear at start Current fear

Understanding the additional benefits 1) It puts the fear in perspective, exactly how bad is it. It removes a lot of the confusion surrounding the anxiety. 2) Makes them literate of their feelings, puts them somewhat in control. Very often, they start laughing as they describe it since they see for themselves how ridiculous it sounds. 3) Lets them appreciate when the fear is not so high.

Understanding the additional benefits 4) It also makes the goals clear, so that we cont’ know what were working on. 5) It sets up a path and shows how progress can be measured a little at a time as opposed to all or nothing. 6) It makes noticing and measuring the process much easier and more efficient. 7) When overcoming the easy ones (1 -4), you become confident that this is working and it gives strength to move on.

Celebrate your successes