Exposure – And how it’s used to treat Anxiety (5 steps)

In this post, I’ll talk a little bit about what Exposure Therapy is – and how it’s used to treat different kinds of anxiety.  In short, “exposure” refers to exposing oneself to triggering situations gradually in order to desensitize oneself to the stimulus, or the situation that causes the anxious response.

We all have experience anxiety at times. Whether it be related to an upcoming test, a presentation at work, a visit to the dentist, or meeting new people, a certain amount of nerves are normal.  For some, though, anxiety surrounding specific situations can be so severe that it causes a major impact on life and can often mean doing almost anything to avoid (or to escape) said triggering situations.  The relief associated with separating oneself from the stimulating situation, reinforces the anxiety associated with it and can make it worse over time. In some cases, triggers can cause full blown anxiety attacks. This kind of anxiety usually has some kind of a link to a past event.  For example, if someone has strong anxiety associated with going to the Dentist’s office, it can usually be traced back to an unpleasant experience at the Dentist. It’s not always the case that anxiety is linked to traumatic events from the past.  Other times, it’s due to fears about possible outcomes (worst-case-scenarios), lack of experience with a certain situation, stories heard from other people or the media, or distorted thinking patterns.  Regardless of the reason for the anxiety, when it’s causing a significant impact on an individual’s career, academics, social functioning, finances, overall well-being, or any other major area of life, there’s reason for concern – and reason to seek help.

Through the effective use of Cognitive Behavioral Therapy (CBT) and exposure activities, anxiety is very treatable. One of the most reliable (evidence-based) methods for treating anxiety, is Exposure Therapy. Exposure therapy can be a little scary sounding.  This is because in order for it to work, one literally has to expose themselves to the situation that causes anxiety in order to overcome the anxiety.  The good news is that most of the fears associated with the anxiety-provoking stimuli, are out of proportion to the actual level of danger they present.  As one prepares for exposure in therapy, thoughts one has that are leading to the anxiety are challenged. Over time, and through use of learned coping skills and gradual exposure, anxiety decreases. Exposure Therapy can be very effective when done properly!

Although different therapists have slightly different approaches for how exposure therapy is implemented, the steps below should give you a general idea of how it is put into action.  To illustrate how it works, I’ll associate each step with an example.

1- Identifying triggers: Explore what kinds of things trigger anxiety.

Example: Someone who gets very anxious in crowded public places, might be triggered when in a busy restaurant or grocery store.  Other triggers might include loud noises or small spaces.

2 – Identify and challenge thoughts: Explore thoughts associated with the anxiety and challenge those thoughts. Are they rational, helpful, and realistic?  Often times, these thoughts are not any of the above.

Example: Person who has social anxiety might think “What if I make a fool of myself?” or “I never make a good first impression”.  After a social event, they might spend a good deal of time thinking about things they said and how they might have been perceived by others.  Challenging these thoughts might mean exploring assumptions and coming up with alternative and more balanced ways of thinking about them.

3 – Explore feelings: Explore the emotional consequences of the response one has to anxiety and the thoughts associated with the anxiety.

Example: Someone who escapes a social situation might feel better temporarily, but later might have feelings of insecurity or decreased confidence.  Someone who assumes they were perceived negatively by others in a social situation might feel foolish or inadequate.

3 – Develop coping skills. To prepare for gradual exposure, it is important to learn skills for dealing with those situations.

Example: Person might learn deep breathing, mindfulness techniques, or thinking strategies to better cope when exposed to anxiety-provoking situations. One very powerful strategy for starting to cope with triggers, is to begin viewing those triggers as opportunities! They are an opportunity to start the process of change, to practice, and to overcome the anxiety that has been holding one back.

4 –Outline a plan for gradual exposure. During this part of the process, plan for slowly exposing oneself to triggering situation is developed. This is done by making a list starting with least and ending with most anxiety-provoking  situations.

Example: If the anxiety issue is linked to fear of public places where there are a lot of people present, least might be something like going to a small coffee shop with most being attending a major sporting or event.

5 –Start taking action.  Using learned coping skills, exposure starts by doing the first things on the list and gradually working towards the end of the list. While these exposure activities are being completed, the goal is to avoid temptation to escape the situation and to stay until the anxiety has passed.  Sometimes this means doing items low on the list several times before moving on to the next.

Example:  Person with fear of crowded social situations might start by getting coffee with a supportive friend a few times.  They will then progress through the list until eventually taking on the challenge of doing something they may have recently thought unbearable or impossible. By taking small steps at a comfortable pace, there is never a dramatic move from one item to the next.  Although this does not mean anxiety will be absent, the most daunting of scenarios originally outlined are usually not as difficult to encounter by the end of Exposure Therapy.

Final note: Exposure Therapy is best facilitated by a Therapist trained in Cognitive Behavioral Therapy (CBT).  Although CBT can be very effective alone, results vary depending on the individual, motivation for change, and other various factors. Some people find the most success by combining therapy for anxiety with medication-management services through a Psychiatrist or Primary Care Physician.

If you’re thinking about starting therapy for anxiety or want to learn more, you can send us a message to schedule an appointment or to ask any questions you might have! You can also call 727-258-5231.

Joel Schmidt, MA, Licensed Mental Health Counselor


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