One of the most common questions my anxiety patients ask me is about using relaxation exercises and distraction techniques to help manage anxiety. They (rightly) point out that one of the central goals of exposure-based treatment for anxiety involves confronting situations they are afraid of, feeling the anxiety that results, and learning that the anxiety is temporary and not a sign of actual danger. What role, then, can relaxation and distraction play? Wouldn’t that contradict the entire point of learning to accept anxiety as a normal part of life?
As an example to better illustrate this point, imagine a person with a strong fear of flying. Many people with such a fear are concerned about something bad happening to the plane, while others are worried about having a negative personal reaction (such as a panic attack) and being unable to get help. Behavioral and cognitive treatment for this fear would involve identifying the anxiety thoughts (such as “the second the plane takes off, I know I’ll have a panic attack” or “turbulence means that the plane is in trouble and might crash”), confronting the feared situation (by viewing photos and watching movies of planes and airports, and eventually taking a brief flight), and learning to accept the thoughts and feelings which result without reacting to them. The goal of all of this is to learn to experience an airplane as a safe place, as opposed to activating the brain’s “threat detector.”
What I have always told people in these situations is that techniques such as distracting from unpleasant situations and relaxation (such as deep breathing) can be helpful up to a point. As a general rule, I never tell people to not use coping strategies which are safe and work for them, and if distraction falls into that category, so be it. The problem comes in when distraction is depended upon as the only way to manage difficult thoughts, or when people expect relaxation to make all of their unpleasant feelings go away. Returning to the plane example, using some deep breathing during turbulence, or focusing on music to distract from the noises of takeoff may help someone to handle being on the flight. This will in turn enable them to gain the benefits of exposure to a feared situation. If, however, they are looking to separate themselves from the entire experience, they are probably less likely to benefit from confronting the fear. Once the distraction wears thin, or they become too dependent on the relaxation exercise, they may find themselves looking for new ways to avoid or escape from the feelings. Additionally, the goal is not to gain control of anxious thoughts and feelings, but rather to learn to manage them, to coexist with them until they eventually pass.
Overall, distraction and relaxation exercises can be good tools, especially for challenging things that occur less often (for instance, takeoff is often very anxiety-provoking, but takes place only once per flight). The important thing is to be sure they are not the only thing in your toolbox.