Panic Disorder Treatment Desensitization for Panic Disorder How to use your imagination to overcome your fears By Katharina Star, PhD Katharina Star, PhD Facebook LinkedIn Katharina Star, PhD, is an expert on anxiety and panic disorder. Dr. Star is a professional counselor, and she is trained in creative art therapies and mindfulness. Learn about our editorial process Updated on December 04, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Hero Images / Getty Images Many people with panic disorder suffer from certain fears or phobias that seem to trigger their anxiety. Those who have panic disorder with agoraphobia are struggling with a fear of situations in which escape would be difficult or embarrassing. It is these intense feelings of apprehension that often lead to panic attacks. Personal worry and concern about triggers can result in many maladaptive behaviors, such as avoiding any situation that may initiate a panic attack. Fears and phobias grow stronger the more that we avoid them. In order to overcome them, it does seem natural that we would need to face them. However, coming to terms with our fears head-on may feel unbearable, if not impossible, to do. Imaginal exposure (self-control desensitization) is a technique that allows a person to gradually confront panic triggers by tackling them first in their imagination. What Is Imaginal Desensitization? The triggers or events that cause you to have panic attacks are situations that you are considered “sensitized” to, meaning that you have grown to associate these situations with fear and anxiety. For example, a fear of flying may cause a person to have high levels of anxiety, even when simply thinking about traveling in a plane. For whatever reason, the person has come to associate flying with strong emotional feelings of worry and fear. Over time, we avoid the situations that we have become sensitized to. In this example, the person would no longer fly even if it meant missing out on vacations or special events. The more we avoid our anxiety, the more our fear grows and eventually a phobia may develop. In order to overcome a particular fear, you need to become “desensitized” to it, meaning that you learn to no longer associate extreme anxiety with the event or situation. The process of getting past extreme fear often begins by engaging in the feared situation while feeling completely secure and relaxed. Imaginal desensitization allows you to do this by using your imagination and relaxation techniques to break your connection of panic with certain triggers. How to Desensitization Works The first step of imaginal desensitization is to get into a completely calm and relaxed state of mind. This can be achieved through many relaxation techniques, including breathing exercises, progressive muscle relaxation, yoga, meditation, journal writing, or a combination of these strategies. Once you are feeling completely relaxed, the next step is to gradually imagine yourself in a panic-inducing situation. It is important to try to remain calm and comfortable as you visualize yourself in feared situations. If at any time you begin to feel afraid or highly anxious, envision yourself moving away from the apprehensive situation and into a more calming and serene place. By regularly practicing imaginal desensitization, you will begin to break the link between a particular event and your personal feelings of fear and anxiety. To further strengthen your desensitization, you may eventually confront your actual fears in person. It is important to face your fears through imagery first, as this will cause the least amount of anxiety and will allow you to effectively break the connection you have between panic and the particular situation. Your imagination may also be where many of these associations were initially created, so it is beneficial to confront them where they began. Using Desensitization on Your Own Start by making a list of varying degrees of your fear. Keep your list to between 10 to 20 situations that form a hierarchy from the least anxiety-provoking circumstances around your fear to what causes you the most panic. For example, here is what this list would look like for a person who has a fear of flying: Watching airplanes fly in the sky.Driving to the airport with a loved one.Seeing planes take off and land at the airport with a loved one.Going inside of the airport and through security with a loved one.Repeating numbers 2, 3, and 4 on your own.Boarding a plane with a trusted companion.Taking a short flight with a trusted companion by your side and available to talk to you the entire time. This list can continue until you reach extreme feared situations, such as taking a long flight alone or flying through turbulence. Before you move on to visualizing these events, you first need to practice and have a good understanding of relaxation techniques. Determine which of these strategies work best for you and make a commitment to practicing them on a regular basis. Once you have built up your relaxation skills, it is time to use them in the process of imaginal desensitization. Set aside about 10 minutes a day to relax and another 10 to imagine your phobias. To begin, get as comfortable as you can, possibly by lying down, turning your phone off, and removing any heavy jewelry or uncomfortable clothing. Bring yourself into a relaxed state and then imagine yourself being in the very first scenario of your hierarchy. Take note of every detail around yourself. Notice the sounds, colors, and smells. Try to imagine as many details as possible. As you feel your anxiety rise, bring your mind’s focus back to the peaceful relaxed state. Over time, you may progress up your list, mentally going through different situations. Through the practice of desensitization, you may be able to overcome some of your worst fears. You may still feel anxious when faced with certain situations. However, your nervousness can be greatly minimized. Remember to take it slow and always first practice through visualization before attempting it real-life situations. The Best Online Therapy Programs We've tried, tested and written unbiased reviews of the best online therapy programs including Talkspace, Betterhelp, and Regain. 8 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Cleveland Clinic. Agoraphobia. Reviewed May 8, 2015. National Alliance on Mental Illness. Anxiety Disorders. Reviewed December 2017. Kaczkurkin AN, Foa EB. Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues Clin Neurosci. 2015;17(3):337-46. Vanden bogaerde A, De raedt R. The moderational role of anxiety sensitivity in flight phobia. J Anxiety Disord. 2011;25(3):422-6. doi:10.1016/j.janxdis.2010.11.005 Hayes-skelton SA, Roemer L, Orsillo SM, Borkovec TD. A contemporary view of applied relaxation for generalized anxiety disorder. 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