Still Unsure about Exposure Therapy? Six Reasons to Try this Approach

It is estimated that somewhere around a third of people with anxiety disorders are unwilling to try exposure therapy. From their point of view, it seems too risky. Why would you do something that you are terrified about? It likely seems that doing an exposure would make the very thing they fear much more likely to happen. For others who tried it, if they went too fast or the exposures were too strong, they may have had a bad experience with it. However, there are very compelling reasons to consider this treatment.

First of all, people with anxiety disorders are anxious all the time anyway. Even if you are really good at avoiding potential triggering situations, it is just lurking in the background. Think of it this way, your own nervous system if persistently presenting exposures to you. There is wisdom here. Your mind and body keep bringing it up and there is a built-in urge or demand that you do something about it. Why not accept the message being given to you and learn how to do that process effectively? It’s not going to stop until you work it out by the way. The exposure treatment process will organize the process, create a series of steps starting with lower challenge experiences and increasing as you master each step, and allow you to plan when it happens. You choosing when to cause the distress is already a significant change in how you respond

Consider changing your assumption that there is something terribly wrong with you, that you need some sort of cure, and the faster the better. A more useful frame of reference is that you need to learn something new and you will have to practice it over and over until you have mastered it. If I am out of shape but I want to run a 5K what makes more sense? Thinking I am helpless, I won’t be able to handle it, and need a miracle, or that I will have to gradually get in shape by practicing, pushing through my resistance, and learning something new? Of course, there are biological elements to anxiety. However, the amazing thing about our brains is that they change. You have to put in the work. It won’t be easy but it isn’t more dangerous than getting in shape.

What has the anxiety cost you? Be brutally honest. How much time, money, planning, and energy do you spend on it? What experiences have you lost? What has it cost you in relationships? How do you feel about yourself and your outlook on like as a result? An anxiety disorder is a tyrant. In the moment, you will feel it is worth listening to the distress because often it seems like life and death. Recently, I went to the emergency room. I didn’t care how much it cost. I was worried about my health (I’m okay by the way). I get how scared you feel. However, step back and take a hard look. At what point do you feel that you will be ready to do whatever you have to do to get some freedom back? Exposure is hard, don’t let anyone tell you differently. But what is worse?

The research is exceptionally clear. Exposure and response prevention is very effective. Of course, nothing always works. Someone may also need a medical intervention and other kinds of help as well. But for most everyone with an anxiety disorder, this is the tried and true way to go. Here is a link to one article using it with OCD. It is easy to find research on this if you want to investigate it further.

Exposure therapy works in a variety of ways. Just repeating something over and over causes something called habituation. You just get used to it. Either you feel less anxious or you feel much more confident that you can stand it. It can also cause cognitive changes about how you view the threat. If you do something over and over and what you fear doesn’t happen or you realize you are capable of dealing with it, it becomes less catastrophic. On a neurological level you are pairing a different response to the triggering event. Your brain ‘rewires’ (literally) a different response to the problem. Go here if you want to see that in action. Neurological changes operate on the use or lose it principle. That is why you have to repeat a new response to a trigger over and over. Here is a very informative video about that process. If you have ever wondered why anxiety disorders tend to strengthen, it is for the same reason. If you keep responding the same way, you keep reinforcing the fear. If you don’t change that, you won’t get over it.

Whatever you imagine might take place during the exposure process it can be done in a very reasonable and manageable manner. Whenever I hear of bad therapeutic experiences it is because the therapist suggests too strong of an exposure, too soon. The art is breaking down the steps that someone is willing to do and the level of distress is moderate and tolerable, especially at the start. For most people, it isn’t that much harder, if at all, than day-to-day life with an anxiety disorder. Find an experienced clinician who will listen to what you need and adjust the treatment to suit you. You will need to be pushed a bit because, really, who wants to do exposures, but you should have the freedom to slow or speed up the process.

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