What is exposure therapy?
Exposure therapy is central to the work I do. Why? Because it is effective. Not only is there a significant amount of research that demonstrates it is the most effective treatment for numerous concerns, I’ve also seen first hand the changes exposure therapy has made on people’s lives! Things clients have told me:
“I want to keep doing the exposures, I really see a difference”
“I’ve been in therapy before and we just talked and I didn’t get better. I’ve never made this much progress.”
Here I’ll go through the important pieces of exposure therapy and why they matter.
What is exposure therapy used for?
Exposure therapy is used to treat:
Generalized anxiety
Social anxiety
OCD
Trauma
Body dysmorphic disorder
You may hear it be called exposure therapy, exposure and response prevention (shortened to ERP or EXRP) or prolonged exposure. They all have the same essential pieces, but are slightly different in their approach and what they treat.
Is exposure therapy harder than other therapies?
Exposure therapy is hard work. I like to compare it to seeing a personal trainer. You don’t go to a personal trainer to just hang out, right? At least not if you want results - to be stronger, to run faster, to have more energy. You go to have someone coach you on the best ways to achieve your fitness goals for your body and needs. You leave the session sweating and tired, and most likely proud of yourself for kicking ass.
Clients don’t usually leave my sessions sweating, or ready to run a marathon. But they do leave proud of the work they’ve done and often less afraid and more confident than when therapy started. Sure, venting is a lot easier than exposing yourself to things that make you anxious, but it doesn’t always lead to a change. And if you’re struggling with anxiety, I can imagine you’re tired and ready for some relief.
Naming the core fear
At the beginning of treatment we often spend time digging into the anxiety. How does anxiety show up for you? What does it feel like? What triggers it? Then we’ll look at what the core fear is behind much of the anxiety. A lot of people, with support, can dig deep to notice what deep fear is driving the anxiety. For some it is a phobia. Others, it is a fear of death, or being alone. Not being perfect. Harming someone. That they’re not the person they think they are. These core fears are just some of the ones I hear, but each person has their core fear that fuels their personal anxiety. And once we can identify that, we can name, and address it.
What anxiety tells you to avoid
Anxiety leads to avoidance. It’s in our nature to avoid anxiety and therefore avoid the things that make us anxious because anxiety is uncomfortable.
The problem with avoidance is that it makes your life smaller.
Together we’ll identify a list of things you avoid in order to feel less anxious. This might include things like social gatherings, public speaking, foods that might cause you to choke, sharp objects when your children are in the room, conflict, or tasks that seem too difficult. This will help us start to build the road map for our exposures.
Compulsions
Not only does it tell you to avoid things, it often leads you to repeat certain behaviors to feel less anxious. These are called compulsions. They are behaviors you do in order to feel less anxious. At times they may feel optional, and other times it may feel like they are automatic and out of your control. The compulsions give us another major piece of the map to building the exposures and knowing the areas we’ll want to target.
Some common compulsions:
Double checking you did something (stove, lock, straightener, emails)
Checking to see if you harmed someone (making sure you didn’t hit someone with your car, replaying a conversation)
Rumination
Repeating an action until it feels “just right”
Checking how you look in the mirror or checking a specific body part in the mirror
Seeking reassurance from others, or reassuring yourself
Pacing yourself
When you go to the pool do you jump in to get the shock over with? Do you dip in a toe and gradually work up to the rest of your body?
One thing exposure therapy is NOT - I don’t push anyone into the deep end. We start by ranking how anxious various situations might make you, or how anxious you might feel to not do a compulsion. This gives us the final piece of the map to building our exposure journey. These rankings, also known as SUDS (subjective units of distress), are a 1-10 scale that let me know where you’re at. So I can get a sense of how anxiety provoking a situation is. If it’s lower anxiety, let’s start with it. If it’s a 8 out of 10, well we will get to that once we’ve tackled some lower ones first. Most importantly, we go at a pace that feels okay for you and that is also leading to positive change in your life.
Using values to remember your “why”
At the end of the day, the “why” is the most important. Why are you doing exposure therapy? What would you stand to gain if your anxiety no longer called the shots? What would your life look like if you didn’t feel so overwhelmed by anxiety?
Anxiety has a sneaky way of attacking the people, places, and things that matter most to people. So when people try exposure therapy and find that relief, it can often bring them closer to people they care about, expand their world, and allow them to really focus on what matters to them.
