Exposure for Kids

This section is for kids if you working on this by yourself or with an adult

Illustrations by Lindsey Nowak

If you are just beginning to face your fears, bravo! Way to go. What you are beginning to do is exactly how to get free of this frustrating phobia. If you are using my book (Dr. Russ) then you will have read about how your brain works and why you have to face your fears. Maybe you have someone helping you who has explained how this works. That is great. However, if you don’t know how and why you need to face your fear, I highly recommend you read my book or do this with someone who can help you go through it. Think of it like this, if you plan to ride your bike to visit a friend whose house you haven’t been to before, and if you have good directions you can get right there, no problem. But if you just start riding without knowing directions you could get extremely lost. This process isn’t incredibly hard (I didn’t say easy) with a good map and explanation. But without that, you will find it is much harder than it needs to be. The steps we have created on this website are a very good map. Start at step one and do NOT jump ahead. Practice the first step and do that over and over until you KNOW you can handle it. Then move to the next step. Don’t rush.

Exposure just means facing what scares you. Feeling anxious happens anyway, right? You will just be organizing and scheduling it if you follow this program. If you follow our steps and practice each step until you are much less bothered, then it will be less distressing than you are used to feeling day to day. Some exposures will be harder than others, but after talking to hundreds of people, we have done a good job of putting them in a sensible order. The first step is one or two words that often trigger some anxiety. It is not the word, of course, but what the word makes you think about. Remember, it is stuff that you think about all the time. Well, you probably try not to think about it but it pops into your head, doesn’t it? You got this.

This section for Clinicians

This page and those under this heading are designed for children 6 to 13. You can try them on kids a bit younger if you are very experienced with that age group. Older teens may find some of this helpful as well because, for example, some of the paragraphs assume a student in a classroom. Some of the exposures are virtually identical to what we would do with adults. But several of the exposures will be customized for kids and young teens. On both the adult and kid exposures we strive to make them as generalizable as possible but you may need to adjust for your patients. For example, if your patient is homeschooled a typical classroom example may not fit. However, you could customize it for a religious service or sporting event.

Every kind of anxiety has an object, situation, or feeling that triggers distress. Emetophobia is no different. Exposure is the process of voluntarily leaning into that trigger. It is not for the faint of heart! The therapeutic art of exposure is designing a gradual hierarchy of triggers from less challenging to more challenging. Even if you are attempting to randomize the difficulty of the exposure, in a clinical setting we all know it has to be structured in a manner that your patient will agree to do. In the case of emetophobia, virtually no clients would agree to random degrees of challenge for the exposures. In fact, we highly recommend that you follow a classic lower challenge to a higher challenge hierarchy and do not surprise your patients. Once your patient is far up the hierarchy you may introduce some random exposures. With children, we recommend you start quite slowly. Better too easy than too anxiety-provoking. Kids with emetophobia nearly universally present as extremely reactive and anxious when triggered and to keep them in the process the exposures must NOT be too provoking. The following pages follow the hierarchy we recommend and have found to be tried and true. Of course, you may find creative ways to introduce triggers and we would love to hear about it. If generalizable, with your permission, we might add them to the public resources we are presenting on this site.

If you are taking a client through these steps you will like need to make adjustments. The steps might be too easy or too hard. The following suggestions are ways to adjust the challenge of the steps.

  • Adjust the volume – generally silent or low is easier
  • Break something into smaller parts. For example, if ‘throw up’ is too challenging as a word, start with only ‘throw’.
  • Adjust distance or size – generally smaller or farther away is less challenging
  • Adjust the speed – when watching videos, faster is usually less challenging
  • Blur or removing the color can make images less challenging
  • Adjust how you introduce an exposure – give your client as much choice as you can. For example, ask, “Do you want to see the word or hear the word first?”
  • Adjust focus – draw attention to details in an image as part of the exposure.

For younger clients or clients who don’t really like using numbers here is a graphic you can print and use to track SUDs.

First Step: Words