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

– Posted in: Anxiety

tarantula-in-hand-smYou 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.

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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/

19 comments… add one
Christine Forest October 7, 2009, 8:49 pm

Dear Mike,
You have made all these complex information so easy to understand for the reader. Your work and reasearch are wonderful. I will refer my patients suffering from anxiety to your blog to get good info on anxiety. You have created a wonderful resource center.

Dr. Forest

diego January 5, 2010, 12:07 am

Hello Mike,
I have a phobia with spider, and till now i can’t totally remove it. I’m trying to buried my phobia by gaining as much as possible information about spider, read what they are, what they do and etc.
By doing that, at least my fear is decreasing.
.-= diego´s last blog ..Ovarian cancer stages =-.

Diego January 5, 2010, 12:10 am

Hello Mike,
I have a phobia with spider, and till now i can’t totally remove it. I’m trying to buried my phobia by gaining as much as possible information about spider, read what they are, what they do and etc.
By doing that, at least my fear is decreasing.

Thanks for the great article :)
.-= Diego´s last blog ..Ovarian cancer stages =-.

kumpta shankar May 19, 2010, 11:05 am

The greatest exponent of psychology of health was Adi Shankara of 6th cenyury AD born at Aladi village in Kerala.His He was the first who broke duality of mind and advocated the theory of monism or single reality.He contended that what looks dual like matter and mind is an illusion or bramha.He was very popular with english philosophers who wrote scores of commentaries on his life and thinking.Shankara was near atheists and claimed that every mind has right and possibility to reach the STAGE of Brahman.He proved it in life by his incredible accomplishments.He travelled on foot from Kerala to Kailas on Himalayas several times during the short time of a decade.He attained Samadhi at the age of 31.He wrote thousands of verses on his philosopphy and commentaries on VEDAS.He renovated thousand of hindu temples all over India and built Shankara Mutt at various holy places in North and South India.Apart,halted single halted the march of Jainism and buddhism in India.It is said that he attained siddhi powers and performed very many miracles.He returned from nowhere when his mother lay dieing at home in Kerala and performed her last rights alone and cremated her on plantain leaves and stubs,neighbours refusing to provide wood and fire.The remanats of the wood is still seen near the temple.None knows till today where he attained samadhi and his remains are not found till today.Last moment,he took farewell from his desciples and and simply walked away and disappeared.This great saint,sage and savant is considered as an avatar of Shankara,God himself.If one can read his teachings,and practice meditation based on his teachings,one can live with hhgood health and happiness.English writers have written about him in great numbars and one can benefit from his teachings and disciplines prescribed.If one is interested in hearing his footsteps,take a holiday and visit Aladi.It is said that early mornings,the saint goes to nearby river wearing paduka and one can hear the sweet sounds of the footwear from the bed.God bless the world.

anxiety treatments September 1, 2010, 2:18 am

Exposure therapy is like facing the things you are afraid of! They say mind is very powerful that is why if you picture out that you have overcome your fear. You will certainly overcome it.

The more you practice to expose yourself, the faster you will overcome your fear.
.-= anxiety treatments´s last blog ..Tips on Finding the Right Anxiety Treatment =-.

Nancy November 30, 2010, 3:23 am


You make this so easy to understand! It is so well explained and has helpful information too!

Talk Soon!

p.s. I too wrote one here as well anxiety therapy! Check it out!

Anxiety Therapist January 30, 2011, 11:33 am

A great well written and informative article. Exposure therapy does work very well, you just need to remember to take tiny gradual and achieveable steps otherwise it can feel very daunting.

Kumpta shankar January 30, 2011, 7:00 pm

There are no better wriyers and psychologists than Dr.Sigmund Freud of Germany and Dr.Ivan Pavlov of Russia.Both were two sides of a coin who wrote volumes on menatl aberrations,icluding anxiety.I would advice concerned read these celebrity doctors and follow their advices.The essence of their writings is as follows.Dr.Freud who wrote psychoanalysis and several other books summarised that all mental aberrations have base in childhood and libido.The suppression of painful experiences in childhood grows with age and turns into monsters and threaten the security and health of the mind.He suggested a theory called Free association of mind.One need to go deep and deeper into ones own psycho and reproduce all the painful experiences and neutralise them.He firmly believed that if one studies ones own experiences year by year and neutralise them,one will find answer to all aberrations and restore the health and confidence in life.He believed anxiety is natural to any child when he is separted by the father from mother who is his or her love object and taken away.This insecurity is the base of all mental illness.One should thus purify ones own mind by uncovering all such painful experiences.One shoulld read his book on Taboos and Totem and also his book on dreams interpretation.One should also devote his studies to Dr.Antony Pavlov who experimented with dogs and wrote books on Conditioned reflex.Inhibitory painful experiences are the major cause for anxiety and depression and excitory stimulas cause feeling of well being.He experimented on dogs proved that main cause of depression was pain experiences during satisfaction of natural instinct like hunger,sex and other natural propensities.He advised that decondioning and rest with relaxation would restore health of the mind.It is advised that those disturbed persons should undergo the same treatment of self analysis and readjustment.Both doctors suggested analysis by self and neutralise the toxic past from the psyche.Drugs too will help the patients to recover faster to healthy life.Dr.Pavlov proved beyond doubt that neurosis can be induced and neutralised by experiments.Dr.Freud was however was more theorician but by treatment succeeded in curing neurosis through analysis of sick minds.Both revolutionised the mental and personality aberrations including anxiety and cured millions.I had earlier suggested a difficult path of Meditaion which Adi Shankara,exponent of monism.

Anna Johnson May 27, 2011, 11:17 pm

I think all this is great!! I have Agoriphobia with panic. I have IBS with Diarrea. I have been on all meds — nothing works.. I’m not trying to cut anybody down, spiders are not my thing either but…… what happens when every time you leave the house your bowel is not right. Like knock a little old lady down trying to get to the bathroom? Almost like food poisoning with craps and sweats from panic? step on the damn spider! sorry… but soiling yourself in the car or in a store not the way i want to live.. I have to have a normal movement before I can leave the house, not normal don’t go.– Thats about 80% of the time. Everytime I leave the house I have my roots, I know every bush, side road you name it just in case. Tired of living this way… fix my gut will hopefully fix my mind of 16 years… thanks for your help if you have any…

Laura September 7, 2011, 8:12 am

whaaaaa..spider..am scared…Im like Ron Weasley..panicking when I see a spider..Grrrrr

Anish October 12, 2011, 4:44 am

Hmm, I think I fear lizards. Exposure therapy might indeed help, sounds tough though.

I like spiders actually. lol. I don’t understand what’s so scary about them. :/

K.s.nayak October 14, 2011, 11:16 pm

My anxiety is inborn.I had no hopes,nor my doctor 70 years back.I am newly addicted to anti-anxiety medication.I tried to withdraw but without success.At 80″doctor advises continuation.It was very diffult life and yet I made it look normal to others.Anxiety is ones enemy but years and how many more,In cannot say.

Kim November 9, 2011, 2:43 am

eehh, i have fears in worms, leeches, snakes, maggots and even caterpillars or anything their kink! and i don’t want to expose myself to those eehhh!! noooo!

john December 11, 2011, 5:59 pm

i am currently doing exposure therapy and finding it very hard. i suffer from social phobia or anxiety. if i had friends practising the exposures would be abit better but trieng to sit alone in a restaurant or walking round in a mall by myself is so scary. i have suffered from this phobia for 15 years. i have decided that if after this therapy if i have made no progess im going to call it quits. :(

Sam J. K. April 9, 2012, 2:12 am

I had exposure therapy for a severe dental phobia and, to my surprise, it was really effective. I was convinced it wouldn’t work but, with a patient therapist who combined it with CBT, I am now at the point where I can have completely normal dentist visits without excessive anxiety. It’s nice to see a good summary, in this post and the previous, of how the process works.

David July 24, 2012, 2:23 am

A really nice follow up article, Mike. You’ve approached the topic with a lot of thought and given a comprehensive picture of what exposure therapy is all about. Excellent stuff! I particularly liked the 9 tips for success.

Keep up the good work,

Danny Gagnon January 25, 2013, 9:25 am

Another excellent article Mike. You discuss the importance and mechanics of exposure very well. I’d like to share my resources on exposure with you and your readers:


asthma tips February 16, 2013, 7:55 pm

Many people contract asthma from dust and mold that settle on those Christmas and Holiday decor you have stashed in corners and closets.

hoa tuoi May 9, 2017, 1:50 am

I particularly liked the 9 tips for success.

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