Exposures work for anxiety problems

When practiced appropriately, exposure techniques are among the most effective treatments for anxiety.

This is because avoidance is what maintains our anxiety. Exposing ourselves to that fear in a controlled way allows us to recognize that our worries are unlikely to be true and allows our mind and body to get used to what scares us.

Exposures can be so effective that phobias that people have had for years can be solved in a single treatment session. Exposures can be done gradually (slowly moving up a hierarchy of scary situations) or by flooding (putting yourself in the scariest possible situation to get rid of the anxiety all at once).

For example, let’s say the fear was a phobia of elevators. Gradual exposures might start by simply being in the presence of an elevator before moving up the fear hierarchy to finally being inside an elevator. On the other hand, flooding strategies may get the person to immediately be in an elevator alone and go up and down floors.

Challenges of completing exposures properly

There are two reasons why exposures, though very effective, can be hard to complete.  

The first reason is that exposures literally require us to face our fears. It’s hard to put ourselves in uncomfortable positions, especially when we have an irrationally strong fear of something.

For example, people with social anxiety may be asked to smile and say hello to a stranger or to do something embarrassing in public to face their worries about people judging them.

Moreover, in exposures, we are asked to stay with the feeling of anxiety for as long as possible. This means that subtle avoidance behaviours are resisted, and we stay uncomfortable until the anxiety subsides.

The second challenge comes from the internal battle to decide whether to change in the first place.

The fact of the matter is that our anxiety isn’t necessarily all bad. Our anxiety behaviours may keep us safe, reduce anxiety (at least in the short-term), and reduces the chances that anything could go wrong. Because in life, there is no guarantee. There is a reason that changing our anxiety is hard – there are pros and cons with deciding to change.

Below I discuss a few strategies to support successfully using exposures to fight your anxiety.

Strategy #1: Sticking with the exposure until anxiety reduces

Exposures are not necessarily going to reduce your anxiety in the first minute or necessarily the first time you complete an exposure.

Our brain and body need time for them to recognize that our fear response is not well-calibrated to the threat of the situation. It may seem like the anxiety will never reduce, but our parasympathetic nervous system will kick in – you just have to stick with it!

Try to accept that you will feel anxiety and notice the sensations rather than reject them. Anxiety, although it feels dangerous and scary, is a natural response to fear. It will not harm you and it is not life-threatening. Remembering this when engaging in exposures can be helpful to bring you through difficult times!

Strategy #2: Avoid safety behaviours when completing exposure

Sometimes safety behaviours (things we do to subtly reduce anxiety) can happen during exposures, which can sabotage the great work we are doing.

An example could be a person doing an exposure by their social anxiety by saying hello to a random stranger, but looking at the ground or immediately leaving the scene the moment they say hello. In this case, the person is doing excellent working attempting to face their fears, but they are still feeding into anxiety thoughts (e.g., “don’t look at their face, they probably are angry at you” and “leave now before they talk to you and realize you’re boring).

Therefore, it’s important to face our anxiety with our heads held up high!

Strategy #3: Reflect on exposures afterwards to support learning and coping

It can sometimes be helpful to formally jot down your experience of the exposure to assess your anxiety levels over time.

You may note how anxious you were going into the situation, what the anxieties levels were like during the exposure, and how you felt by the end of it. It can also be helpful to jot down whether your anxious predictions were true and how you managed to cope with the situation.

For example, somebody dealing with a spider phobia may write something on the lines of “I was extremely scared going into the exposure (100%). My anxiety was very high going in (90%) and seeing the spider was frightening and I was shaking. I stayed with my anxiety and observed the spider. After a few minutes, my anxiety levels started to lower (70%) and by the end, I thought it was kind of cute (0%)! I learned that spiders are not that scary, and I was able to deal with my anxiety quite well by focusing my breathing”.

These reflections can help in consolidating our learning after doing an exposure.

Strategy #4: Determine whether it’s worth making a change through a cost-benefit analysis

In order to move towards the path of reducing our anxiety with our best foot forward, we must resolve any ambivalence of making a change.

This can be done through a cost-benefit analysis (CBA). CBA, which as the name suggests, allows us to determine the pros and cons of making a change to see whether the juice is worth the squeeze.

For instance, we can look at potential pros and cons of a person deciding to defeat their social anxiety of looking embarrassing in public by doing silly things in front of other people (e.g., loudly exclaiming how hungry he is in front of a bunch of random strangers).

On the one hand, pros of making this change could be feeling less anxious and on-edge in public situations; feeling more comfortable on a day to day; and perhaps knowing that people are less judgmental than they think.

On the other hand, sticking with the status quo would mean that they don’t have to face embarrassment, they may avoid people potentially laughing at them and thinking they are strange.

Once you’ve created this list, what you decide is ultimately up to you! For some people, it’s just not worth it at this time to change; for others, it may empower them to face their fears. There is no right or wrong answers here.

Concluding thoughts

I hope this post was helpful in learning a bit more about ways to increase the likelihood that we start and stick with exposures to fight our anxiety!

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Best wishes,

P