 This week on the anxious truth, we're going to get a little geeky with it. We're going to talk about how exposure works, why sometimes it only works part of the way and you wind up prone to setback or relapse. We're going to talk about habituation versus inhibitory learning. I promise not to get too technical. We're going to keep it friendly. Let's go. Hello, everybody, welcome back to the anxious truth. This is podcast episode number two to six recording in September of 2022. I am Drew Linsolata, creator and host of the anxious truth. If you are new to the podcast or the YouTube channel and have just stumbled in, the anxious truth is the podcast that covers all things anxiety, anxiety disorders and anxiety recovery. Welcome. I'm happy you're here and I hope you find it helpful if you are a returning listener or YouTube viewer. Welcome back. Always happy that you're here. Thank you for your continued support. Today we are going to talk about the mechanics of exposure, how exposure works sometimes and why sometimes it doesn't work fully and why some people wind up in setbacks and how we can maximize the value of our exposure. Essentially, this was requested by a lot of people when they asked about the difference between habituation and inhibitory learning. So it's going to get a little bit technical and a little bit geeky, but I'm such a nerd about this stuff. I dig this. It's why I'm back in school at the master's level to go through all this stuff, but I'm promising when to keep it a little bit friendly that we're not going to get too technical here. I'm going to keep it within the context of recovery. So before we get to the meat and potatoes of the episode, I just want to remind you that the anxious truth is more than just this podcast episode. There's 200 something other free podcast episodes. There's a bunch of years worth of free social media content. There's my free morning newsletter and podcast called The Anxious Morning. There are three books that I've written about anxiety and anxiety disorders and recovery. There is a free one hour recovery 101 seminar and there is a webinar that I do every month with my friend Joanna Hardis. She's an anxiety and OCD specialist from Cleveland. We do a webinar on the art of distress tolerance. All of those things are at the anxious truth dot com. Go check them all out. If you are already reading my books and you're digging them, maybe heading over to Amazon and review them for me. It really helps me out. And if you are enjoying my work, it is helping you and you would like to help to keep it free of sponsors and advertisers all the ways that you can do that are at the anxious truth dot com slash support. It is never required, but always appreciated. And thank you guys for all the different ways that you support my work. I really appreciate each and every one of you. So let's get into this habituation versus inhibitory learning. So we know about exposure and we know about going toward the things we fear and not avoiding or trying to escape. We're not trying to engineer our life so that we never get triggered. We know that exposure is an effective tool when it comes to anxiety disorders. We're going to start from that premise because we know this to be true. But how does it actually work? I'm going to give you like the TLDR, the too long didn't read. If you want to stop listening now ready, here it is. Old school exposures based on habituating to anxiety are about learning that you're OK as long as anxiety decreases or disappears. Now, that sort of works, but it leads to a fragile state of recovery and frequent relapses and setbacks. Current models of exposure are in many cases a little bit harder and more difficult, they're a little harsher. But they're based on learning that you are OK and can handle it even when or if you get anxious or panic. That leads to more durable and wider states of recovery. So habituation will get you to I'm OK as long as I don't get anxious. Whereas inhibitory learning will when we allow it to happen, we'll get you to I'm no longer worried about being anxious. It doesn't matter. Now, which do you think is better? I can tell you this when you encounter a fully recovered person that does not experience relapses or setbacks, you're talking to somebody that wound up with the second result, not the first. All right, so that's like the reader's digest version of this episode. If you want to hit the eject button, go ahead and do that now. But we're going to get more detailed. So this can get really super technical and geeky, like I said, but I'm not going to get technical and geeky on you here. Now, I could link a bunch of research papers in the show notes for this episode, which will be at the anxious truth dot com slash two to six. But that is probably a bad idea. And here's why. I know that many of you listening wind up in almost almost obsessively researching recovery techniques and methods, reading and reading and trying to make sure that either you have the best way to guarantee that you were doing it right because you need to do it right to try to guarantee that you absolutely will recover or to get immediate relief. It can be way too easy to dig yourself into a ditch and a hole based on obsessively trying to research recovery and get it exactly right. So you can Google on your own if you must, but I'm going to say if you are prone to that kind of habit, please sort of think twice about doing that. All right, so a few important points that we want to get into here. And I'm working from notes today, which is a little bit unusual, but it is a little technical, so I want to make sure that that I hit all the points. So exposure, let's talk about exposure. Exposure is not the thing that you are doing, right? Driving, walking, staying home alone, holding a knife in your hand. That's actually not the exposure. The exposure is to the sensations, thoughts and emotions that you will experience when you do those things, right? So nobody listening to this podcast is using exposure to learn how to drive again or to walk to the park or nobody's doing listening to the podcast to learn how to stay home alone or to hold a knife. We're actually learning and you've heard me say this so many times, probably sick of it by now, we're learning how to relate in a different way to the way we feel when we do those things. This is really important, right? Keep this in mind as we go through this podcast episode. The exposure is the anxiety, the symptoms, the thoughts, the sensations, all of those things, the emotions. That's the exposure. We only use driving, staying home alone, holding a knife to trigger those things. So keep that in mind. Exposure is about coming into contact. Good exposure, right? Where we're going to try to leverage the mechanism mechanism of inhibitory learning, good exposure is about coming into contact with those sensations, those scary thoughts, the emotions, the feelings, the symptoms. We're trying to come into contact with those things while also resisting the urge to perform safety rituals or compulsions that you are hopeful. We'll take away the bad feelings and the fear that because you hate that, right? So what are some examples of that? Examples of that would be going home when you panic at work. If you're out trying to practice driving, turning the car around when you get anxious while you're driving and going home, like exiting the exposure, only doing certain things with a safe person using safety devices like mince or snacks or essential oils or ice packs or always having to have water with you in case you get anxious. Another one would be automatically calling somebody, a partner or a friend or somebody to have them talk you through if you get anxious. And the last one is I mean, I'm involved in this one instantly turning on a podcast episode when you get anxious. If you start to feel yourself panic, if you immediately run for your favorite episode of the anxious truth or your anxiety toolkit or the panic pod or all the hard things, whichever podcast you like, if you immediately run to a podcast episode, that's a safety and escape behavior, right? Do you do any of those things? So let's talk about those things speak to the idea that when I do difficult things, I'm trying to make my anxiety decrease. I need to make it lessen, which speaks to habituation, right? Habituation is a natural process. Humans and animals habituate. So the idea of habituation is that you start to get used to it, right? When we looked at exposure based on habituation, getting used to something so that your reaction to it decreases. We kind of had that right, but we were really missing some important parts of the puzzle. And when we looked at some of that, when I say we, the royal we, everybody in the behavioral sciences and clinical circles, not me and you, but when we look at this stuff over time, we started to see that, hey, CBT is really super effective, like old school CBT. That was just, you know, exposure, get used to it, get used to it. And then it goes away when we looked at the success rates there, they were way better than other forms of therapy. True, but then the relapse rate was pretty high, right? So the relapse and setback rate was pretty high with that. And what the situation we find ourselves in now is that a lot of people, because they try to get a basic understanding of exposure, like, OK, I get it, I just have to do the things. So if you think that exposure is just doing the things, then you are really kind of accidentally relying on habituation. You expect that if I do it, then anxiety will lessen over time because I'll get used to it. And yes, that again, that happens. Habituation is part of this for sure all the time. But that's kind of an old school way where exposure was done in an incremental way, sounds familiar, right? Lots of repetition, sounds familiar, but in a more simplistic way, simply trying to get someone acclimated or habituated to anxiety. So if you are hoping that you can just keep pushing through your exposures and engineering them so that they are as easy as you can make them. And remember our list of safety behaviors, then you are purely banking on habituation to get you to a recovered state. What's the problem with that? This often leads to partial recovery or good enough recovery. The acceptable bubble you hear me talk about. This is where you can do most of what you need to do and manage life on a daily basis. You're not completely restricted anymore, but you're usually doing that with a big set of conditions and restrictions. So I'll give you a couple examples. I can do the school pick up now. But if I'm having a really bad day, my partner does it. How about this one? I can stay home alone now. As long as I know that there's someone around that I can call in case I get anxious or how about this one? I'm pretty good at handling my intrusive thoughts now, but I still can't watch any movies that have babies in them or I spiral. Right. So that's sort of good enough recovery, partial recovery, acceptable bubble recovery and that kind of recovery has a limit. And when you cross that limit, you often experience anxiety and fear again, which you then think you can't handle because you're not used to it in the those context across your limit lines. Right. So a partially recovered person does some things with conditions, but refuses to do other things because of how they may feel if they do them. A partially recovered person that just got used to it by powering through over and over and over or learned how to make it stop or lessen. We'll tell you that they are OK in the supermarket, but still can't go to the movies and are afraid to try. So fear extinction, which is like an old term that we used to use, you're trying to make your fear go extinct based on habituation tends to be very specific. Like habituation is OK, but it essentially teaches us that we are OK as long as we can be sure that anxiety won't be there or won't last very long. And we see this when a partially recovered person may experience one or two episodes of intense anxiety and then winds up in a setback or a relapse. Now, as a side note, a little bit of geekiness that I'll throw in here. We kind of know now that we never actually unlearn our fear, right? That's not a thing. I know we used to talk about that. And I mean, I know there are literally people who are sort of building a brand on unlearn anxiety, but you don't actually unlearn that fear response. So that response is kind of coded permanently in your brain once we learn it. And we have experiences that are associated with that response. And this kind of helps to explain how sometimes setback and relapse are so easy for people to fall into, to some extent, right? We're not unlearning our fear. What we are actually doing when we recover is that we are learning new ways to relate to it and new ways to handle it and new ways to get through it. And those new pathways get encoded into your brain alongside of the old pathways. So you will still kind of have that fear for the rest of your life. But that's OK, because now you have stronger pathways that you can travel down in your brain is gross over simplification, just for visualization purposes. When when it comes up, I can pick that pathway as opposed to the old one. But the old one is still there. We never actually unlearn it, if you will, or erase it. So if we're aiming at fear extinction or making your anxiety go away, relying solely on habituation, getting used to it, just repeating it enough so that you get used to it makes for a bit of a fragile state full of conditions and prerequisites for being OK. See the problem there? So now let's go into inhibitory learning. Enter inhibitory learning. So inhibitory learning isn't so much concerned with making anxiety go away as it is concerned with teaching us that we can tolerate and navigate through anxiety when it happens. And at this point, you've got to be sick of hearing me say words like tolerate and navigate. You've heard me say them thousands of times, but now you're starting to understand the reason. So let's bring it back to some of the things you hear me talk about on this podcast and you seem you write about all the time. When you hear me talk about changing your reaction to anxiety and fear or giving up the fight or surrendering, all those words that I use all the time. We are we are in inhibitory learning territory there. When you hear me tell somebody to mix up their exposures and have varied experiences, because that's most effective, we're banking on the mechanism of inhibitory learning, right? It works better. And again, this is a lot of research on this. It works better when we have a varied range of experiences to work from. When I tell you to be incremental and keep adding difficulty to your exposures over time, we need them to be difficult. We're leveraging the power of how inhibitory learning works in your brain. And when this is a big one when it's a big one to me, to be honest with you, when I plead with you, when I'm practically begging you to take the lessons that reality hands you and I did an entire podcast episode in this one. I'll link it in the show notes because I remember which one it is. When I beg you to please take the lessons that the universe hands you after an exposure that nothing happened except that you were afraid and had thoughts and sensations, I am pointing you in the direction of inhibitory learning. When you refuse to take that lesson. Yeah, but I had I was anxious. I was afraid, but I panicked. You're you're saying I can only be OK if I don't panic or I can only be OK if it decreases, you're relying on the fact that you might get used to it. That's the habituation model. I'm simplifying, but when I tell you, no, you it doesn't matter. You just have to take the lesson that said you were afraid, but nothing bad actually happened. I'm trying to get you to move closer to the way your brain works in terms of inhibitory learning. So it's important for me, I think, to say that in inhibitory learning, it's not so much a technique like this isn't a technique. It's not a method. Inhibitory learning is a method. It's more of a model that we came up with to describe how brains achieve like a wider and more durable state of recovery. I'm relating it back to recovery from an anxiety disorder, but so be careful. Like, don't go to a therapist and say, do you do inhibitory learning here? I mean, a good therapist who specializes in anxiety sort of should understand what you're saying, but they would correct you like inhibitory learning is not a therapy. It's this is not a therapy type. It's not a method. It's not a technique. It's really a model that we use to describe what's going on in our brains. When we learn in a deeper and more effective way that we're OK and we can get better that way, all right, there's a different way to get better. And our brains are we can do it. We just have to make sure that we do things that use the power of our brains to be able to do those things. So this is not so much about guaranteeing that your fear goes extinct, which would be the old way, but rather it's about knowing that even if you do wind up afraid, you're still OK and you can move through and pass that. This is why if I have a rare panic, self panic attacks now, but they're very rare for me, if I have one, it comes, it goes, it's over. I'm literally not thinking about that panic attack an hour later. I just don't care. So, you know, this ties into some of the other things that we've talked about. I just wrote about this in the anxious morning newsletter last week. How can I not care? Well, the mechanism of inhibitory learning, if you gear your exposure to take advantage of the fact that your brain can do it that way, we'll teach you that you don't have to care. So this is not like you can just snap your fingers and decide to not care about your anxiety. You can stop trying to do that because it's not going to work. But when we leverage the inhibitory learning model and our exposure work and our recovery work, we learn that it's OK to not care anymore. Right. So it's really important. That's why I say we're learning this way newer ways that even if we do wind up anxious and afraid, we're OK to move through it in that moment and then past it going forward on the long term. So then let's bring it back to sort of recovery and what that means. Because if we don't have, we have no way to actually apply this in what we do, the things we actually do to try and get better than we're good as it. So I can give you some hints here and I'm going to wrap it up in a couple of minutes here. I don't want to get too long on this one. I literally could go for hours on this stuff. It's it's it's goofy. I don't know why I'm so into this, but I always have been. So that explains, I guess, why I'm behind this microphone. Anyway, what are the hallmarks of exposure and recovery work that kind of tap into the power of that inhibitory learning process? Right. So your exposures should be focused on tolerating and navigating through anxiety, not making it decrease. That is huge because if you are approaching your recovery so that, OK, Drew says I have to do scary things. I'm going to do scary things, but I'm going to really try to make them as less scary as possible because I don't I'm trying to make the anxiety not happen or happen at a low level. You're missing the point. You actually want the exposure to teach you how to tolerate that anxiety and move through it. Yes, even full blown panic. So some of this, if you're going to try to gear your recovery work toward this model, some of that involves an openness to say, if you insist that panic is too much and you can't do it that way, then that's OK. I'm not going to try to convince you otherwise, but you can't have it both ways. You can't draw a line in the sand and say, I cannot tolerate certain levels of anxiety and also want to do this. You can't have both. So you've got to have that openness to accept that this might actually be true and that what I'm saying might actually work for you and that you actually can do things you think you can. And you have to focus your exposures on the act of tolerating and moving through anxiety, not trying to make it not happen. So if you're going to go drive on the highway today and you're going to try and find ways to do that without being anxious, you're missing the point. You want the anxiety. You want that to happen and you want to practice moving through it. That's important. The other thing that you need in your exposure and and recovery work is an openness to experience all anxiety during exposures rather than trying to minimize it, which is what I was just talking about. So we're looking for exposures that have varied experiences. Now, the cool thing is like you can't just recover. You're also living your life. So often life will hand us a lot of varied experiences. You can't very few people have the luxury of just sitting on the sofa and just doing an exposure or two a day and then going back and sitting on the sofa until it's time to do more exposures. You're going to be challenged all the time, except the challenges that life hands you, even if they are small, take them, even the small ones. That's fine and use them to have varied experiences. I don't care if you drive every day. Now, I did it by driving every day, but I also started doing other things. Like what I did my and it's funny because when I wrote the anxious truth, I talked about how recovery will accelerate. But recovery accelerates when you can take the lessons from one exposure and bring them to the other. And that's when you need those varied experiences. So mix up your exposures. Remember what I said in the beginning of this episode, the exposure is the anxiety and the panic, not the task. So drive, walk, stay home alone, go shopping. Go to a pizza place and sit down and have a slice of pizza. Whatever it takes, mix them up as best you can. Right. So we're still talking about using like fear ladder and moving up. You don't go from housebound to a world cruise in two days. But within that fear ladder, just mix things up that are in sort of that same difficulty level. It really helps. Important, super important. We've talked about this, the RP part of ERP exposure and response prevention, which all exposure ultimately is ERP, whether you're dealing with OCD or not, resisting the escape, avoidance and safety rituals. Very important. You can't you can't try to hang on to your mints, your water, your phone, your partner, your safe person, your oils, your ice pack, and also do this. Now, if you are going to hang on to those things to get started, I've said this before, go for it. I would rather you see you get started and then start to leave those things behind than to never start. Just know that at some point you're going to have to leave the safety, the escape rituals, the safety rituals and those safety devices. You're going to have to leave the crutches. You're going to leave behind. Keep that in mind. You're going to have to at some point. Next thing, difficulty. We need exposures to be difficult. They are supposed to be difficult. That's the whole point of the exposure. Like one of the things that we know from from the research and a lot of the stuff around inhibitory learning model is difficulty is important. And in fact, a lot of the if you look at some of the literature in the OCD community, they'll acknowledge that like, yeah, we need it to be harder now so that your life can be easier later. Keep that in mind. But we need your exposures to be challenging. If they're not challenging, then they're not exposures, right? So I say this all the time, if you are bored now, taking a walk to the park with your kids, that's not an exposure anymore. So it's good. Go ahead and take the walk to the park to kids. It's life. I hope it's good and you're enjoying it. It's a good thing for you guys, but you can't keep calling it an exposure. So exposures are things that are difficult. We need them to be challenging, tip throwing through life, trying to not be anxious and doing things here and there. When you're feeling like that's not exposure. So that's just tip telling through life. And then the last thing that I'm going to throw in here is when I wrote the anxious truth, I talked about changing your reactions. And the third reaction is the reaction after. And in that book, I wrote about the story that you tell yourself and everybody else after the challenge is over. The last thing I'm going to talk about is that it's an openness to accept the outcome of the exposure based on the feared disaster not happening rather than how you felt. Like this is where you hear me say again and again, and it sounds cruel and it sounds cold and it sounds all of those things. But when I tell you that I don't care how it felt, I only care what happened. That's where I am like begging you to see that I know that it was hard and I know that you were terrified and I know that you thought you were going to die. And I know that it felt like you were going to go insane. But you are now here an hour or a day or a week later telling me that story because none of those things happened. So it's so important to be open to the lesson that the exposure teaches us, which is that surprise, the thing that you are terrified will happen, doesn't happen. That's so important. Now, if you're listening to me, you may say, but the bad thing is the anxiety. I get that. And for some people, it's not that the anxiety signals a danger because for most of the community, it's well, I'm terrified to panic because when I panic, I think I'm going to die or I think I'm going to go insane or I'm going to pass out or I'm going to have a psychotic break. For other people, it's just, no, I don't think that I'm just afraid of the panic itself because the panic itself tells me that I'm failing. I'm weak. I'm broken. I'm less than I can't do this. This shouldn't be happening. But even if that's the way you fear it and you don't fear death or, or passing out or heart attack, in the end, the panic came and left. And again, nothing bad happened that does not show that you are broken or weak or less than at all. So you're going to have to begin to accept that lesson that like, Oh, look, I did that again. I tolerated it again. Instead of saying it was wrong for happening. No, I did a great job getting through it. So it's so important to be open to the lesson that the experience teaches you, other than just recounting the experience as a nightmare and something that you never want to happen again. That is so important. And it's why we say all the time we don't care how it felt. We only care what happened. We only care what happened. So that kind of gives you, you know, 25 minutes on the difference between habituation and inhibitory learning and a rough idea of how that fits into exposure work. And I hope near the end here, how you can start to gear your exposure or recovery work to take advantage of the inhibitory learning model and not just try to get used to anxiety or make it go away. The key takeaway here is, am I doing these hard things to try to make it go away? Or am I doing these hard things to learn that I can do hard things and it doesn't matter if I get anxious. That's really where you want to be. That's where I really want you to be. I want you there. I know that you're trying to make it go away. We all want it to go away. But I say all the time, go away is a happy secondary effect. It's a secondary outcome. It's a happy secondary outcome of learning that you're okay, even if you do panic. So please, if you take anything out of this episode, take that, you should not be approaching recovery as a way to, to feel better and make it stop. You should be approaching recovery as a way to learn that it's okay, even if you do get anxious and panic, because when you get there and know that you can handle it, no matter where you are or what the situation is, then it starts to go away and it goes away in a more durable way. It goes away across context. You don't have to worry about like, well, I can go to restaurants, but I haven't gone to the movies yet. So I got to do six months worth of movie exposure to be able to go. No, you know that I'm okay if I panic in a restaurant. So I'm okay if I panic in the movies. It's, there's magic in there. There really is. So that is my 26, 27 minutes on habituation and inhibitory learning and the mechanics of exposure. Hopefully it has been helpful. I've been looking forward to doing this episode to be completely honest with you. And it was going to be super geeky at first, but I'm pretty proud of the fact that I didn't get too deep into the technical woods here. And I hope that I've been able to present it in a way that's understandable and relatable more than anything else, more than anything else. So that's it. We are done. This is episode 226 in the book. You know, it's over because music that is afterglow by Ben Drake. That is a song you hear at the beginning and end of every one of these podcast episodes. If you'd like to hear the whole song or know more about Ben and his music, you can visit his website at ben drake music.com. If you are listening to this podcast on Spotify or iTunes or some platform that lets you rate and review the podcast, leave a five star rating and maybe write a quick review if you dig it because it helps other people find the podcast. If you're watching on YouTube, subscribe to my channel, like the video, leave a comment. I circle back every few days to interact on YouTube. So if you want to ask a question, I promise I'm going to see it. And I think that's it. Thanks for coming by. I appreciate your support. Go find all of my other resources and goodies at the anxious truth.com. I will be back again next week with another podcast episode. I don't know what I'm going to talk about, but I will be here. And remember until then, this is the way.