The Role of Habituation in the Treatment of Anxiety Disorders

The Role of Habituation in the Treatment of Anxiety Disorders

Written by Hillary Gorin, PhD, LCP

Treatment for an anxiety disorder generally involves two components:

1. Taking small steps towards facing a fear, psychologically and/ or behaviorally.
2. Taking the same small steps over and over again until you can take another step.

​In theory, if you keep taking small steps, eventually, you get to the final step and overcome your fear. Why would you need to repeatedly take the same step over and over again to get used to it? Well, simply stated, that is the only way we learn that we can do something difficult as human beings. If we do not think we can do something difficult, we need to go do that thing over and over again until we feel like we are actually capable of doing it and have collected enough instances of success to be confident in our abilities. Treating an anxiety disorder, in this sense, is similar to training as an athlete. How many baskets does an NBA player have to make to feel confident? Many. 

Exposure therapy, a therapy that entails facing and overcoming fears that are interfering with your happiness and success in life, is therefore effective because it entails repeatedly taking small steps towards overcoming your fears. Your therapist will explain a part of this process as habituation, or getting used to or desensitized to unhelpful or unrealistic anxiety (as cited in Abramowitz et al., 2019, p. 17). Habituation involves anxiety reduction/ getting used to anxiety both within and between sessions. In other words, during sessions, you will work on sitting with anxiety but in between sessions you will repeat the exercises for successful habituation.  

Why can’t you just complete the work in one session per week? Because habituation or desensitizing is a process that takes several repetitions and a large amount of time (Abramowitz et al., 2019). You would never go to the gym and expect results after only one gym session. Similarly, modifying your brain will take repetition. As mentioned in the previous blog in this series (see The Role of Avoidance Learning in the Development of Anxiety-Based Disorders, OCD, and PTSD), fear is promoted through operant conditioning, or the encouraging or discouraging of behavior by using reinforcement or reward. Therefore, unconditioning a fear requires habituation or many repeated exposures to the conditioned stimulus (the now feared situation that you did not fear before) presented without the unconditioned stimulus (feared outcome taking place) until fear starts to diminish. For example, if someone is afraid of riding a bike because they fell off of it previously, successfully riding the bike many times will eventually lead to habituation, or getting used to riding the bike again and confident you can continue doing so. 

With respect to neurobiology, during habituation (and eventually elimination of a fear), an area of the brain called the medial prefrontal cortex or the mPFC blocks output in what is called the amygdala, the part of the brain that regulates fear (Kwapis & Wood, 2014). The mPFC is responsible for decision making (Euston et al., 2012). More specifically, during exposure work, neurons, or cells in a portion of the medial prefrontal cortex called the infralimbic cortex (as cited in Kwapis & Wood, 2014) undergo changes that reduce activation in the amygdala (as cited in Kwapis & Wood, 2014). In other words, cells in our brain help us get used to being exposed to a fear (that originally activates the amygdala) and eventually our rational brain realizes that we no longer need to be afraid because a situation is not inherently dangerous. 

Psychologically, one additional component of habituation is learning that our anxiety will not last forever, as we start to learn that the feared stimuli is not actually dangerous. It has been theorized that fear extinction, or complete elimination of a fear, first requires habituation. In other words, getting used to the fear and seeing that it is not as dangerous or intolerable as once believed, allows you to form new associations and to stop avoiding the originally feared situation, object, thoughts, etc. Due to habituation, exposure therapy remains a highly effective intervention for treating anxiety disorders. 
 
If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References

Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. H. (2019). Exposure therapy for anxiety: Principles and practice (2nd Ed.). The Guilford Press.
Euston, D. R., Gruber, A. J., & McNaughton, B. L. (2012). The role of medial prefrontal cortex in memory and decision making. Neuron, 76(6), 1057-1070. 
Foa, E. B., Steketee, G. S., & Rothbaum, B. O. (1989). Behavioral/cognitive conceptualizations of posttraumatic stress disorder. Behavior Therapy, 20, 155–176. https://doi.org/10.1016/S0005-7894(89)80067-X
Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books.
Krypotos, A-M., Effting, M., Kindt, M., & Beckers, T. (2015). Avoidance learning: A review of theoretical models and recent developments. Frontiers of Behavioral Neuroscience, 9(189), 1-16. https://doi.org/10.3389/fnbeh.2015.00189   
Kwapis, J. L., & Wood, M. A. (2014). Epigenetic mechanisms of fear conditioning: Implications for treating post-traumatic stress disorder. Trends in Neuroscience, 37(12), 706-720. 
Resick, P. A., Monson, C. M., & Chard, K. M. (2014). Cognitive processing therapy: Veteran/military version: Therapist’s manual. Department of Veterans Affairs.