Exposure Therapy: Eliminating Anxiety Disorder’s Fear, Part 2

You have a fear of spiders, or of flying, or of crowds. Are you just sitting there suffering? It’s time to try Exposure Therapy!

Exposure therapy is a type of Behavioral Therapy used to help the patient confront a feared situation, object, thought, or memory and dispel its power to produce fear and anxiety. It involves reliving a traumatic experience in a controlled, therapeutic environment.

The Anxiety Disorders can paralyze the sufferer with ever-mounting avoidance behaviors. While successful for the moment, avoidance just sets aside the fear and anxiety triggered by a situation. They are sure to come back, stronger than ever.

Exposure therapy has been shown to be effective with many of the Anxiety Disorders, including Social Phobia (SAD), Generalized Anxiety Disorder (GAD), panic attacks and Panic Disorder, Agoraphobia, Adult Separation Anxiety Disorder (ASAD), Post Traumatic Stress Disorder (PTSD), and specific phobias.

This is the second of a two-part series of articles on Exposure Therapy. It focuses on tips to make your Exposure Therapy successful. Today’s installment has these headings:

• Exposure Therapy: Better in real life or in imagination?
• Tips for successful Exposure Therapy experiences

Yesterday’s Part 1 describes Exposure Therapy and what goes into a typical Exposure Therapy plan:

• Exposure Therapy is based on habituation
• Exposure Therapy counteracts Anxiety Disorders’ avoidance
• Exposure Therapy is a part of Cognitive Behavioral Therapy
• Characteristics of a typical Exposure Therapy plan

Exposure Therapy: Better in real life or in imagination?

Exposure Therapy in the thoughts or imagination is more difficult

Exposure Therapy may be done in vivo (in real life) or in the thoughts or imagination. In vivo exposure is more effective than exposure using the imagination. While anxiety or other discomfort may get worse in the first few minutes of in vivo exposure, it is important to continue the experience until the discomfort has diminished.

Examples of exposure in vivo are resuming driving after being in a traumatizing accident, or returning to a now-safe location where an assault once occurred.

Exposure in imagination or in thoughts involves the person recounting traumatic memories in their mind until they lose their sting. While treating exposure in imagination is sometimes unavoidable, it is harder for you and the therapist to create an exposure plan, and more difficult for both of you to evaluate your progress. Your therapist will teach you a number of techniques for coping with the stress and fear that accompany exposing yourself to traumatic thoughts.

Your therapist will have you use several tools to guide you through the steps of your exposure plan. Some of these include keeping a journal, guided reading, or making recordings. For example, you may confront fearful thoughts by saying them aloud repeatedly, writing, reading and rewriting a biography of the events or recording them on a tape and playing them over and over until they are no longer distressing.

Tips for successful Exposure Therapy experiences

Your commitment to your Exposure Therapy is key to its success!

The skill and experience of your therapist is very important to developing and evaluating an Exposure Therapy plan. However, your efforts are even more important for its success. You will be the one executing the steps in your plan, both in your therapy sessions, and more essentially, outside them.

You will be on your own 167 hours of the week outside your one-hour therapist’s appointment! It will be your responsibility to initiate and complete your exposure exercises, and in some cases, to determine when to move on to the next step.

Here are some tips for making your Exposure Therapy exercises successful and confidence-building:

• Keep your final goal firmly in mind at all times. Picture yourself being successful in overcoming the feared object or situation and living your life free of their power.
• Always have in mind your exposure plan’s steps toward success. Each should be small enough that success is easy, and close enough to the next that you can move on as you are able. Your plan may be explicit, in the form of increasingly challenging tasks, or implicit, in the form of a set of principles for escalating the exposure.
• One step at a time: Follow your plan and don’t suddenly jump into the deep end. It’s tempting in the glow of success to want to skip steps in your plan, but you are only inviting failure if you do.
• At every stage, your self-exposure should be completely voluntary, and should offer an easy way to terminate it. By choosing not to escape, and practicing a better response, you are weakening your learned avoidance behaviors and learning new ways to think about the situation.
• Stay in the situation and try not to leave or quit if you suddenly feel anxious. Use the techniques your therapist has taught you such as rational thinking, focusing, controlled breathing, and relaxation. If you have to end the exposure, try to do it again as soon as possible. However, it may be that the step was too big for you, and you need to repeat the previous step again to gain confidence.
• Repeat the successful exposure experience before moving on to the next step, since doing something only once can be interpreted as a fluke! The more often you do something challenging, the more you will feel comfortable in the situation.
• Regular practice is very important. Try to do your exposure exercises as much as you can, rather than letting long periods of time come between repetitions. Just like learning the guitar, regular practice is more effective than occasional practice.
• Ups and downs are a part of life. Some days will be good days when your exposure task will be easy, and there will be other days when it is almost impossible. Try not to beat yourself up on the bad days with negative self-talk. Rather, accept it for what it is — a not-so-good day! If you have a series of bad days, it might be wise to repeat the previous step until you gain more self-confidence.
• Be aware of avoidance: It’s what got you into your problem in the first place! By not doing something that you fear, you are only making it harder for yourself, and allowing your avoidance to grow and keep your fears alive and healthy. Remember, it is you who are in control of your anxiety, and it is you who can decrease and manage it, as well.

Don’t miss yesterday’s Part 1 of the series!

Yesterday’s Part 1 describes Exposure Therapy and what goes into a typical Exposure Therapy plan. If you missed it, be sure to read it now to better understand what Exposure Therapy can do for you! The topics of discussion in Part 1 are:

• Exposure Therapy is based on habituation
• Exposure Therapy counteracts Anxiety Disorders’ avoidance
• Exposure Therapy is a part of Cognitive Behavioral Therapy
• Characteristics of a typical Exposure Therapy plan

What do you think?

As with many of life’s experiences, you only get out of Exposure Therapy what you put into it. You have to have the desire to end the constriction and suffering that your avoidance causes. You must endure the discomfort of exposure to that which causes that suffering, and do it repeatedly and on an ever-more-challenging basis.

But you are not suddenly thrown to the lions: The exposure plan will present the feared situation to you in small steps that are designed for success. Your therapist will prepare you by helping you learn coping strategies that will defend you, not only in the series of exposures, but against other fear-triggering experiences you will have throughout life.

I have been through Exposure Therapy for my Agoraphobia, and I can say without hesitation that it works magnificently. Where I was once confined to the house, I now go where I want with a minimum of anxiety and fear — if any at all.

• Do you have situations that you avoid? Do you think Exposure Therapy might be able to help you?
• Do you think you could do Exposure Therapy on you own, without the help of a therapist?

©2009 Michael L Nichols. All rights reserved.

Resources used in this post:
Andrews, G.; Crino, R.; Hunt, C.; Lampe, L.; Page, A. (1994). The Treatment of Anxiety Disorders. Cambridge, England: Cambridge University Press. (Quoted) Retrieved October 1, 2008 from Shyness & Social Anxiety Treatment Australia Web site: http://www.socialanxietyassist.com.au/treatment/exposure.shtml
Anxiety Treatment Center. (2006). Exposure and Response Prevention Therapy. Retrieved October 1, 2008 from Anxiety Treatment Center Web site: http://www.anxietytreatmentexperts.com/cbt_exposure_therapy.asp
Atherton, J.S. (2005). Learning and Teaching: Cognitive Dissonance and Learning. Retrieved October 3, 2008 from Learning and Teaching Web site: http://www.learningandteaching.info/learning/dissonance.htm
ChangingMinds. (2002). Cognitive Dissonance. Retrieved October 3, 2008 from ChangingMinds Web site: http://changingminds.org/explanations/theories/cognitive_dissonance.htm
HealthyPlace. (2008). Exposure Therapy for Anxiety Disorders, Panic Attacks. Retrieved October 1, 2008 from HealthyPlace Web site: http://www.healthyplace.com/Communities/Anxiety/treatment/exposure_therapy.asp
Hoffman, Hunter. (2008). VR Therapy for Spider Phobia. Retrieved October 1, 2008 from HITLab Web site: http://www.hitl.washington.edu/projects/exposure/
Katz-Wise, Sabrina; Poore, Ralph. (2006, November 10). Exposure therapy. Retrieved October 1, 2008 from RevolutionHealth Web site: http://www.revolutionhealth.com/articles/exposure-therapy/aa131258
Madison, N. (2008). What is Exposure Therapy? Retrieved October 1, 2008 from WiseGeek Web site: http://www.wisegeek.com/what-is-exposure-therapy.htm
Mindsite. (2008, March 12). Exposure Therapy. Retrieved October 1, 2008 from MindSite Web site: http://www.mindsite.com/article/229/exposure_therapy
PTSD Facts for Health. (2008). Exposure Therapy. Retrieved October 1, 2008 from PTSD Facts for Health Web site: http://ptsd.factsforhealth.org/exposure.html
Rapee,R.M., (1998), Overcoming Shyness and Social Phobia. Cambridge, MA: Lifestyle Press.
Terri. (2007, February 24). Exposure Therapy for Treating PTSD. Retrieved October 1, 2008 from A Soldier’s Mind Web site: http://soldiersmind.com/2007/02/24/exposure-therapy-for-treating-ptsd/

Related Posts:

• Exposure Therapy: Eliminating Anxiety Disorder’s Fear, Part 1
• Radical Approach to Therapy for Anxiety Disorder
• Pills Are Not Enough: Effective Treatment of Anxiety Disorders With Psychotherapy
• Anxiety’s Bad Memories Can Be Minimized, Scientists Find
• 10 Reasons Why We Lie to Our Therapists

Filed In Category: Anxiety

Tagged as: Adult Separation Anxiety Disorder, Agoraphobia, Anxiety, Anxiety Disorder, Exposure Therapy, GAD - General Anxiety Disorder, Panic Attacks, Panic Disorder, PTSD - Post Traumatic Stress Disorder, SAD - Social Phobia, Specific Phobias