Rich Silvestri

Embrace Exposure

Confronting feared scenarios, which psychologists call exposure, is a cornerstone of the treatment of anxiety. 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. Furthermore, people who are anxious or uncomfortable in a situation they fear will often use avoidance techniques (such as distractions, excessive checking, or seeking reassurance), which prevent them from gaining any benefit from the exposure.

The tools for creating a successful exposure experience are:

  1. Develop an exposure hierarchy. This is a list of anxiety-provoking situations that are ranked in terms of degree of discomfort. This should include exposures that are practical to do and that pose varying degrees of difficulty.

  2. When starting, exposures work best when they are predictable and under your control. Once you have a fair degree of practice, you can build in more unpredictable exposures.

  3. The goal of exposure is to learn that you can be comfortable 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 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 achieve treatment gains. If the exposure is something brief (such as touching a contaminated surface), repeat the brief exposure often to help 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 that you need to continue practicing, as opposed to a sign that things are not going well. With repeated practice your anxiety will decrease.

  7. Do not use avoidance strategies. These may include things like distractions, reassurance seeking, repeated checking, and so on. 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 exposure so that you can overcome intrusive thoughts and debilitating compulsions. Reach out to a qualified provider today to gain mastery over your anxiety.