II. How do these therapies work to lower Anxiety?

• You are scared stiff of crossing a bridge on your own, so you ease your stress by making sure you always have a friend to accompany you； But what happens if you have an important appointment on the other side and your friend cannot accompany you?
• You totally refuse to cross the bridge so you confine all your activities, work and shopping to your side of the bridge. But if there is a fantastic job offer over the bridge, would you still keep refusing to drive on your own?

Behavioural Therapy Basics

This is where behavioural therapies come in. These techniques help guide you to change behaviours and reactions by gradually bringing you into contact with situations and causes of anxiety so you can change the way you respond to them. In behavioural treatments, triggers of fear and panic are tracked and identified, and then different exercises are developed to find new ways to interact and combat them instead of just panicking. This can be done in a number of ways, including:

• Extinguishing: you break the connection between the stressful event and your typical response. For many people with anxiety, it may be avoidance, isolation or panic.
• Generalization: you take the positive response you have learnt to overcome a fear or anxious situation and apply it to other stressful situations in the same way. For example, you learn to change your fear of travel by first dealing with your fear of buses, and eventually move on to taking a train, a flight, or a boat ride.
• Discrimination: you can learn to respond differently to any event or situation that used to cause you anxiety.
• Counter-conditioning: you develop a new response to an event or situation that used to only lead to fear, anxiety, or avoidance.
• Exposure to the anxiety-causing situations as they happen: you take pictures or video of the situation, or through written description of the event, or through virtual reality and computer-aided tools.

Behavioural therapies are results-orientated. When you use these therapies, you can develop a plan to deal with specific fears or sources of panic and reduce the stress which stems from them. Your plan will also set goals for time frames and progress checks to ensure you are on the right track.

Different styles of Behavioural Therapy

There are different styles of behavioural therapy that can be used to reduce anxiety:

• Systematic Desensitization: you learn to induce your own relaxation while you are experiencing a high level of the anxiety-causing situation. Systematic desensitization is widely adopted today to treat phobias. Humour has also been used in systematic desensitization therapy in which the relaxation is replaced with funny responses. Humour has been shown to be just as effective as induced relaxation.
• Behavioural experiments: a one-time “ultimate tests” in which you examine the thought patterns you may have in order to uncover the truth of the worry or avoidance.

Although behavioural therapies can be used on its own to treat a number of anxiety disorders, it is widely combined with other treatments like:

• Cognitive Exercises, or Cognitive Behavioural Therapy (CBT): CBT treats the disruptive thoughts, words and patterns that lead to anxiety and the avoidance or panic responses that come from them.
• Acceptance and commitment therapy (ACT): - a version of CBT which stems from accepting internal experiences (unsettling or fearful thoughts), can lead to avoidance of anxiety-causing situations. Once these thoughts or clues are identified and completely accepted the behavioural interventions can then lead to a longer lasting change.

Behavioural Therapies that may not be appropriate:

Behavioural therapy has been shown to be widely helpful in treating anxiety, but it is sometimes not a suitable treatment for certain people. Behavioural therapies or CBT may not be appropriate for those who wish to resolve concerns over past events or trauma. People with anxiety from traumatic experiences may need to deal with their emotions and relationship problems first either prior to or together with a behavioural therapist before entering the programme.

As behavioural strategies involve tracking stress and a willingness to exercise regular exposure to stress-causing events and practice, not all people are ready to be involved and thus may not be suitable for them to adopt these strategies.