Exposure therapy: facing your agoraphobia fears through a weekend hike in the woods

by Sam Courtright

My doctor introduced me to exposure therapy to help me cope with agoraphobia. It has worked for me, but not without uncomfortable moments.
Caption:

My world shrunk to the point that the fear of having a panic attack was a dictating decision in nearly every facet of my life.

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©www.doglikehorse.com / Adobe Stock

A sense of impending doom

I was in high school the first time I felt a sudden unfamiliar tension in my chest. It was followed in rapid succession by shortness of breath, racing thoughts of what could be wrong, and what a retired EMT I once met refers to as a “sense of impending doom.” In the hours that followed, I found myself in an emergency room receiving a dose of lorazepam to help me come down from my first panic attack; triggered by too many energy drinks. So I gave up energy drinks. An easy solution.

We learn from a young age to avoid things that cause pain, so the impulse didn’t seem odd. Over the next few years, this cycle repeated: different triggers, different things, places, or situations to avoid. My world shrunk to the point that the fear of having a panic attack, the fear that they might be physically dangerous, and the fear that I would be beyond the reach of help when they happened, were dictating decisions in nearly every facet of my life. The perspective offered a sobering realization that avoidance was not a fix, it was part of the problem.

Introduction to exposure therapy

My doctor introduced me to the idea of exposure therapy; the forced discomfort of experiencing things the anxious piece of my mind deemed to be dangerous. The act has since helped restore my life to a less limiting state, though progress is always ongoing.

“People with anxiety disorders have an intolerance of uncertainty and distress, so what they need to seek out is not that crowded elevator, not that battery they perceive is contaminated, but the generic sense of uncertainty and distress”

R. Reid Wilson, PhD

Exposure theory – putting words into practice

In the spring of 2017, I found myself in need of an opportunity to flex my therapy-honed mental muscles to face my agoraphobia. Inspired by a long drive up and down the pine flanked corridor of Interstate 35N, I had reserved a campsite in a fit of self-efficacy and an imagined lust for woods. It wasn’t until a short time after I had confirmed our reservation that I noticed a rather balmy overnight low of 30 degrees was forecast for our adventure.

My mind started to get anxious, even before we had begun the trip. How was I going to stay warm in a flimsy tent? But no matter. Our sleeping bags were rated for 30 degrees, and after all, there is no such thing as bad weather, only bad clothing.

The preceding days were a careful balance between the boy scout motto of ‘be prepared’ and the intentional discomfort and refusal to self-soothe that inevitably accompanies exposure therapy. I spent a considerable amount of time reading advice from REI, Reddit, Quora, and countless other camping blogs. I knew we needed to pack light as we would be separated from our car by what had been described as a “challenging” 1-mile hike.

At the same time, we needed enough food and equipment to be comfortable for a night in the woods. We achieved our balance with two loaded down external skeleton backpacks that had been collecting dust in my parents’ garage. By the time we parked and wandered on to the trail, my wife and I each had 20-30 lbs of “essentials” safely secured to our backs.

The hike was uphill: both ways

The trail out to the Backpack Campground was a comfortable mix of woodland, indifferent yet inviting, and the reassuring trails one would expect in a state park. Curated paths suggested that we were indeed about to reconnect with our wild roots, but not without assistance when needed. The trek between parking and camping was the embodiment of a story from before you were born. You know, the one about how entitled kids are these days. It was uphill, both ways.

Our map suggested a descent and re-ascent of roughly three hundred feet from start to finish, which was achieved through a combination of paved path, timber staircases, well-traveled and rain gorged dirt paths, and one seemingly adamant bridge constructed of large wood beams secured by rivets as big as fists. Along our climb, the park manager saw fit to leave convenient benches, each of which seemed to taunt me with a “had enough yet?” as we walked by, then finally, “it’s ok buddy” when we accepted their help. I whistled The Shire Theme (between heavy breathing) to keep spirits high.

Upon reaching our camping site, we assembled our shelter and collected firewood and water from a designated location some hundreds of yards from the entrance to our small tract. We created a small hiking pack, a stripped-down mix of pieces from our more extensive collection of gear and took off to explore the Prairie Restoration to the north, and the flooded banks of the St. Croix River to the east.

Noticing what is around me: being aware

An occupied mind is less likely to wander, which in my case means my agoraphobia was less likely to breed anxiety. The key lies in awareness. Whether with a physical task or by calling attention to my surroundings and focusing on each detail, the act of mindful participation in the moment seems to help ground me.

The views were pristine and calming, the sun peeked from behind clouds and smiled gently along our path in a way that made my continued whistling of Hobbit tunes seem less comical and more like an apt nonverbal description of our surroundings.

A family of Deer (doe and fawns, no buck) kept a wary eye on us as they jogged lightly through the meadow.

Flashes of bright feathers caught our eyes as Bluebirds darted from tree to tree.

The remnants of an old farm dotted the lush green hills, intentionally left as shelter and a reminder of the way things used to be.

The steady St Croix, the tireless sentry, illustrated the most significant difference between Minnesotans and Wisconsinites, they were over there, and we were over here, and as we all know – our side is better.

We wandered the woods, talking about our life, and veering off in every direction that seemed worthwhile, before finally returning to camp.

Night fell as we lit our fire. After an hour of watching the flames, and whittling away at some walking sticks, we gave it the Smokey Bear treatment and crawled into our sleeping bags. As the part of our outing that provided the least distraction and the most challenging environmental conditions, the hours between sunset and sunrise were ripe with teachable moments and tests of resolve.

I didn’t know exposure therapy would be so literal

10:45 pm: I woke for the first time, disappointed after checking my watch and realizing I had only slept an hour. The pattern of my partner’s breathing indicated that I was the only conscious person in the tent. I assessed my status; wide awake, not too cold yet, not anxious, hoping that some 4:8:8 breathing would lull me back to sleep. I focused on my breath in an attempt to ignore our isolation, and creeping thoughts that this whole trip may have been a horrible mistake.

12:15 am: Awakened again, with no clear culprit. The temperature drop was noticeable, particularly on my face and feet. I used the compression sack from my sleeping bag to add an extra layer of insulation and to decrease the size of the air pocket around my toes and threw on another sweatshirt. I began feeling the telltale signs of discomfort in my chest: a pressure, an urgency. My thoughts were not racing, but they were accelerating to a comfortable trot:

“Is the dropping temperature dangerous or just uncomfortable?

Should I get up and build a fire or better insulate our sleeping bag?

Are my toes numb or are they warming?

I want to bury my face in the sleeping bag for warmth. Will I suffocate? Will my breath create too much humidity inside the bag?

Cold is bad, wet and cold is worse.

What is the temperature? What is the wind chill?

We are still six hours away from the coldest part of the night. I will get up at five to make a fire. I will make a fire in five hours.”

The next day begins after midnight

1:00 am: My sleeping intervals were getting shorter. My partner’s breathing changed, she was awake this time too. I checked to see how she was coping, and she responded flatly with a single word: “cold.” She felt the call of nature and begrudgingly left the tent, successfully relieved herself, then came back to our small bubble of warm(er) air. I wondered how she was processing her experience. Was she silently wishing to be back home in our cozy bed, unburdened by her partner’s need to inflict challenge upon the two of us?  Maybe, just maybe, she was able to find her own silver lining in the suffering. I was too ashamed to ask, and she loved me too much for me to trust her answer. We cuddled closer. I started counting breaths.

Exposure therapy is a tricky beast. On the one hand, it may be sufficient, and downright enjoyable, to immerse in a situation that should cause panic only to be stood up and experience no discomfort at all. However, more potent learning comes from experiencing the worst of one’s symptoms and just riding it out, refusing to leave, refusing to self-soothe. Demonstrating to yourself that these symptoms are extraordinarily uncomfortable, but that the worst case scenarios playing through your head are improbable.

2:00 am: The wind had picked up and was rattling the rain cover of our tent. My toes were colder, I wrapped the compression sack that housed my feet with a down insulated jacket. I had seemingly endless layering options for my torso, I’d have given my kingdom for warmer toes, or for the neurotypical comfort of believing that the cold was the only sensation I was trying to cope with.

“How long would it take for help to arrive in an emergency?

If we were to leave camp now how long would it take to get to help? How long would it take to pack up camp?

Why would you drag your wife through this? We could leave camp.

Can the rangers drive out this far? Could we find our way back in the dark? Is it more dangerous to stay put or leave in the night?

This is anxiety. You are feeling anxiety. I am feeling anxiety.

You knew it would be cold. This is what it feels like to camp in the cold. You have no telltale signs of frostbite. Eat something to increase your body heat. You can make a fire in three hours.”

Learning to cope with my condition had bred a particular distrust for my own sensations and motivations. Was I actually that cold? Was this just a new symptom of panic? Did I really need to calculate the survival math of a mid-night evacuation plan? Were these just clever tricks my mind was playing to coax me away from perceived distress? Justifying avoidance is what led me down the path I have worked so hard to recover from, so for the moment my thoughts and sensations were suspect.

3:15 am: The urge to pee that I had been ignoring since midnight had become a problem. I was reluctant to leave the tent and lose the body heat I had built up in our shared sleeping bag. But in reality, the bag was nowhere near being that airtight. I left the tent to relieve myself and made the mistake of aiming my flashlight down a trail into the woods. The eerie high-intensity light against the trees could have been taken from the negatives of any number of horror movies that my partner and I had watched in the years since we met.

In fact, it was difficult for me to keep from counting the number of ways in which a deranged murderer, supernatural entity, mythical beast, or satanic cult could have seized this opportunity to (insert grizzly plot point here). I survived and was momentarily grateful for the increase in temperature upon returning to the tent. Contrast therapy is bliss.

3:45 am: So close. So cold. The wind had increased to the point where I worried we would lose the rain fly. There was no continuity to the moving air, only severe gusts separated by unsettling calm.

“Made it through the halfway point. This is discomfort not danger. There is no need to better secure the rain fly. You can start the fire early. Start the fire in one hour.”

5:40 am: I slept through my self-imposed fire starting time! I was beside myself with joy at the thought of igniting a roaring fire for us to warm by. Practicality be damned, I would make it the largest fire our pit could accommodate.

Awake and alive – I didn’t die from exposure therapy

Upon exiting the tent, we were treated to one of the most colorful sunrises I have seen in my life. The sky was striped with hues of pink, blue, orange, and purple above the hill to the east of our campsite. And though I don’t believe it to be the case, I was tempted by the idea that we were being rewarded for the difficult night we had endured. We ventured out to better circulate blood to our frozen feet and to gather wood for the fire.

I violated the park’s quiet hours (which end at 8:00 am) to break the logs down to a burnable size, emboldened by a sense of entitlement from having survived the night before. We did not leave. I had only been anxious, hadn’t suffered a panic attack. I was awake and alive.

Fully alive – facing my fellow campers

On the second trip back to the community woodpile I exchanged greetings and personal Midwestern observations from the previous night with our fellow woods-people who, like me, were seeking to warm their bones by their own roaring fires.

“It sure was cold,” we all agreed.

“Quite cold” some ventured, “and that wind,” we added agreeably.

It seemed we all had experienced similar challenges in the night, except for one fellow, let’s call him “Bear.” Bear had, like me, excitedly booked a campsite for the previous evening without looking at the forecast. Upon realizing his misstep he, like me, had opted to endure and go camping anyway. The detail in which Bear’s story differs from mine, and those of our fellow campers, is rather than insulating himself from the elements with a tent, he opted for the more immersive experience of camping in a hammock. A decision he stood by until roughly 3:00 am when he relented, after being tipped by a rather nasty gust, onto the forest floor. I felt so sorry for him, his night was probably worse than mine.

Back at our tent, we contemplated our next move. We picked at some of our rations, knowing that regardless of how we chose to spend our morning, our car, hopefully, was across the valley, just on the other side of a “challenging” hike. We enjoyed our fire for a couple more hours, then packed up our gear and embarked on our journey home. This time with the aid of some finely whittled walking sticks. This time the woods and river greeted us like friends. A light breeze patted our backs as we ascended our last hill, and a welcoming glint of the sun reflected off a windshield in the distance.

We had made it. I had made it.


Article by Sam Courtright

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