When we fear something, we often avoid it. This is a useful tactic when there are good reasons to be afraid, for example, if we came across a bear in the woods! But sometimes we avoid things that are not a serious threat. When we avoid things, we might feel less anxious in the short term, but we will often feel more anxious in the long term. Avoidance stops us from learning that there is nothing to fear.
Exposure therapy is a technique designed to help overcome avoidance and face fears head on. The idea behind exposure therapy is simple: by spending time with the things we fear most, we learn that our fears are overblown. Over time, this helps us to feel less anxious.
Exposure therapy is often used alongside other techniques as a central component of cognitive-behavioural therapy (CBT). However, it can also be delivered as a stand-alone intervention.
What happens during exposure therapy?
There are two key stages to exposure therapy. First, you will work with your therapist to create a list of anxiety provoking objects or situations. You will order this list from least anxiety provoking item to the most anxiety provoking item. Grading your anxieties in this way is a crucial part of exposure therapy.
In the second stage, you will confront each item on your list, beginning with the least anxiety provoking item first. You will find that if you stay with each of your fears, your anxiety levels will start to reduce. And by repeatedly confronting each of your fears, your anxiety levels will decrease over time. Once this has happened, you can tackle the next item on your list and follow the same procedure.
Your therapist will offer you support and encouragement throughout the course of therapy. Your therapist may also ask you to keep a diary record of your exposure experiences. This is useful when discussing your progress during each session.
It is important when facing your fears that you avoid distractions or other things that could reduce your anxiety in the short term (e.g. using your mobile phone, taking medication). By facing your fears undistracted, you are able to learn that your fears are unfounded.
A real world example
Anil has been diagnosed with panic disorder. He is unable to get the bus to work, as he worries that if he does, he will have a panic attack in front of dozens of morning commuters. It was suggested by Anil’s therapist that exposure therapy could be an effective way of helping him to overcome these fears.
Anil and his therapist worked together to create a list of anxiety provoking situations. Anil rated each item out of 10, based on how anxious it makes him feel:
1) Walk to the bus stop at a quiet time of day (4/10)
2) Walk to the bus stop at a busy time of day (5/10)
3) Travel one stop on the bus at a quiet time of day (6/10)
4) Travel three stops on the bus at a quiet time of day (7/10)
5) Travel for three stops on the bus at a busy time of day (8/10)
6) Travel to work on the bus (10/10)
Anil began to tackle this list by first walking to the bus stop at a quiet time of the day. He found that if he waited at the stop for a while, his anxiety levels began to drop. He then visited the bus stop the next day, and the day after that, each time waiting until his anxiety decreased before leaving. After the fifth visit, Anil felt much less anxious about walking to the bus stop, so his therapy suggested that he tackled the next item on his list. He then repeated this process until he felt comfortable catching the bus to work.
Although Anil was keen to take some medication on the bus with him, to help if he felt anxious, his therapist advised against it. Taking medication would stop Anil from learning that he is safe on the bus without the medication.
What can exposure therapy help with?
Exposure therapy when delivered alone, or as part of CBT, has been shown to be effective in reducing symptoms of a range of anxiety issues, including panic disorder, generalised anxiety disorder, obsessive-compulsive disorder and post-traumatic stress disorder . Because of this evidence, exposure therapy is recommended by the National Institute for Clinical Excellence as a treatment for these anxiety conditions.
Exposure therapy is less useful for conditions where anxiety is not present, such as some cases of depression. In these cases, other techniques such as cognitive restructuring or behavioural activation may be more appropriate.
To find out more about exposure therapy or CBT, please click here and speak to one of the therapists at Cognitive Practice.