Anxiety disorders can be difficult to understand and treat because they seem to operate in a paradoxical manner--sometimes the more aware the person is of the anxiety, and fighting it, the more intractable it seems to grow. The reasons for this are clear, however, when anxiety is viewed in terms of reinforcement theory.
Anxiety involves mental and physiological autonomic nervous system arousal in reaction to a feared stimulus. The person soon learns that by avoiding the stimulus, he or she is released from the anxiety. This is negative reinforcement for avoidance. The person will continue to avoid the stimulus, and continue to be reinforced (by the relief from anxiety) for that avoidance.
Unfortunately, reaction to anxiety-provoking stimuli tends to generalize. Soon, other similar stimuli are avoided. Even thoughts, memories, or indirect reminders may be avoided. The person's life becomes constricted and restricted by everything that must be avoided in order to stay anxiety-free--and eventually that doesn't work either, and the person may feel anxious at even the remote possibility of encountering the stimuli.
Treatment in one way or another interrupts the cycle by removing the reinforcer. In other words, the person must not avoid the anxiety-provoking stimulus any longer. this does not have to be done all at once--in fact, systematic desensitization, probably the most widely used technique, involves incrementally introducing exposure to thoughts of the feared stimulus and waiting until there is no more anxiety before moving on to the next small step. Other techniques such as flooding or implosion, which involve prolonged exposure to the stimulus, should be done only with care and caution and in absolute safety, with plenty of time to "decompress" and process the experience. But all techniques boil down to facing the feared stimulus rather than avoiding it.
The physiological state of extreme anxiety cannot be maintained for long periods of time. As the person faces some form of the stimulus in a controlled setting and lives through the anxiety in safety and without harm, the autonomic nervous system essentially shrugs its shoulders and says, "oh, what's the point in getting so upset."
Relaxation skills are essential in dealing with an anxiety disorder. Some cautions are in order. Actual exposure to the anxiety-provoking stimulus should be done only in a safe and controlled setting. the person should not leave the anxious situation without using relaxation to bring the anxiety down to acceptable levels. If the person leaves while still feeling anxious, then the avoiding behavior has been reinforced again and the problem becomes worse. The person shouldn't give up if they seem to backslide, however; but move back to an earlier step.
