Confronting feared scenarios (e.g., exposure) is a corner stone of anxiety treatment. However, for exposure to be effective it has to be done in a systemic way. Clients often tell me that they have already been “exposed to their fears” and that it didn’t help. They’re right. In everyday life, exposure to feared situations tends to be unpredictable, brief, and infrequent. Further, people who are anxious or uncomfortable in a feared situation will often use avoidance techniques (e.g., distraction, excessive checking, reassurance seeking), which prevent them from gaining any benefit from the exposure.
Tools for creating a successful exposure experience are below:
1. Develop an exposure hierarchy. This is a list of anxiety-provoking situations that are ranked in terms of perceived discomfort. You should have items that are practical to do and have varying degrees of difficulty.
2. When starting, exposures work best when they are predictable and under your control. Once you have obtained adequate practice, you can purposefully build in more unpredictable exposures.
3. The goal of exposure is to learn that you can gain comfort in the anxiety provoking situation.
4. Exposure works best when the practice is prolonged. For example, if you are nervous about heights, standing on a low level bridge until your anxiety goes goes down is more effective than standing on a high bridge for a few minutes and then leaving before your anxiety has decreased. If you leave a situation before your anxiety has had a chance to go down you will not obtain treatment gains. If the exposure is something brief (e.g., touching a contaminated surface), repeat the brief exposure often to assist with helping your anxiety go down.
5. Schedule practice exposures close together. Daily practice works better than once a week.
6. Expect to feel uncomfortable. The goal of exposure work is to feel manageable levels of discomfort. If you feel anxious that’s a sign you need to continue practicing, as opposed to a sign that things are not going well. With repeated practices your anxiety will decrease.
7. Do not use avoidance strategies. Avoidance may include distraction, reassurance seeking, checking, etc. Avoidance undermines the exposure and will prevent gains from being made.
Confronting feared scenarios is hard work. A skilled provider can teach you tools for managing the discomfort associated with exposures so that you can overcome your intrusive thoughts and debilitating compulsions. Reach out to a qualified provider today to gain mastery over your anxiety.