How to make exposures work FOR you, not against you

Often people think they have tried exposure, but it hasn’t worked for them. Usually they try taking a step that is too intense and for too short a time. This creates so much distress that they don’t try again. The anxiety persists.

Ineffective ways to do exposure

For example, if you have an intense fear of elevators and force yourself to go all the way up to the 40th floor, only to have a panic attack on the way up (and have to walk all the way down!), you’ll probably never want to get near an elevator again.

Or if you fear social situations and then go to the huge office party with hundreds of guests, you might end up leaving after a few minutes because you feel so anxious.

Another common reason that situations remain hard is our approach to the situation. We often give ourselves mixed messages. We go into the situation, but also do some sort of “quick fix” to minimize our anxiety. In clinical terms, we call these safety behaviours.

For example, think of the message you would be giving yourself in the following situation:  

You push yourself to go to a local new mom’s meet-up. But once there, you don’t make eye contact with the other moms, avoid talking when possible, carefully rehearse what you are going to say over and over, and sit off to the side or by the door. Even if everything goes well, you may think it only went well when you did all that extra effort to make it feel bearable. You will probably not be any less anxious next time.

If you regularly push yourself into scary situations, but discover that over time things are not getting easier, Resisting the Quick Fix Tool will also be an important tool for you to learn more about.

Tips for making exposures work FOR you, not against you.

Feel a moderate level of anxiety for long enough for it to slowly decrease on its own. This might mean sitting with your anxiety for 20 or 30 minutes, without doing anything to make it go away. Or doing something over and over (and over!) until it doesn’t feel scary anymore. Not a lot of fun, but highly effective.

Don’t jump in the deep end – take it slow.

Going back to our elevator example, your first step could be standing in an unmoving elevator with the door open, or just going up one floor with a friend and walking down the stairs. And then do it over and over again, until it feels pretty boring. For social anxiety, you could first try smiling and saying hi to a few people. Or starting up a conversation with a colleague in the lunch room. Or having a goal of walking home from prenatal yoga with someone new.

Keep doing it.

Although you feel anxious, keep doing the exposure activity and slowly build up your tolerance. If it feels fairly uncomfortable, but not overwhelming, that’s what you are aiming for. The goal is NOT to feel comfortable (that’s where you have been living, and it isn’t working). The goal is to feel UNcomfortable, and do it anyway. That way you build up your confidence, and more things will begin to seem possible.

Challenge yourself a little.

Exposure is like exercise. If you try to lift weights that are too heavy, you could injure yourself and then not try weight training again for a year. You also won’t get fitter if you lift weights that require barely any effort. To get stronger, you need to take on something moderately challenging and do it repeatedly. It’s the same principle with exposures. In order to feel less scared over time, you need to do an exposure exercise that causes a manageable amount of anxiety, and practise it over and over and over. When it starts to feel much easier, you are ready to take on a more challenging exposure exercise.

For example:

If Ellen, who is afraid of watching childbirth shows on television, forces herself to watch a few minutes of an episode containing a serious childbirth emergency just once, and then never again, this is unlikely to reduce her anxiety. It would be more helpful for her to record a similar but less distressing birth story program, and watch it over and over again over a period of several days. When this program becomes boring, rather than distressing, she is ready to take on a more challenging program. 

Jennifer is afraid of being around knives, especially if she is at home alone with the baby. If she uses a knife just once, for just a few minutes, and then locks it up again and continues to avoid it, she is unlikely to become less fearful. It would be more helpful for her to stay in the kitchen, picking up knives and putting them down, at first while her husband is at home with the baby. As this becomes easier, she can progress to more difficult tasks, such as using knives while her daughter is napping in her room.

If Salima, who is avoiding leaving the baby with anyone else, forces herself to leave the baby with her sister to run to the store for 10 minutes once a week, this is unlikely to reduce her anxiety. It would be more helpful for her to leave the baby with her sister or a trusted neighbour a few times every day, even if it is only a few minutes each time. When this is no longer frightening, she is ready to take on a more challenging exposure exercise, like going a little farther from home, or being out of the house longer and longer periods.

Work at your own pace.

Perhaps confronting your feared situations with a trusted companion at first before attempting them to face them on your own. It can be helpful to enlist close family members or a good friend to help you. They may be able to help you figure out what kinds of things you are avoiding, and how you could tackle them in a gradual way. In particular, ask them to keep in mind the gradual nature of this process, and encourage you to take only the next step, not try to force you to leap to the most difficult things to do.

For step-by-step instructions for doing real-life exposures and more examples, click here.