Exposures for Anxiety 101

Exposures exercises for anxiety are pretty much what they sound like: you do the thing you are afraid of. Gasp! Sounds terrible huh? But let's ease into this idea. Unlike daytime talk shows, where someone with a phobia of snakes is forced to hold a snake, and shrieks the whole time, when working with a well-trained anxiety specialist, you and your therapist collaboratively design activities that systematically address your fears and intrusive thoughts. You are supported and guided each step of the way. You are given the right tools to understand and think about your anxiety differently.

Exposures for anxiety treatment

So why do it? Exposures gives your body and brain a chance to learn. First it's important to understand how the cycle of anxiety works. The natural way we tend to interact with situations/objects/people/feelings/thoughts that scare us is to avoid or control them. Makes sense right? And avoidance is tempting because it reduces our anxiety in the short term. But it maintains our anxiety in the long term. If we’re constantly caught in the cycle of anxiety, we never give ourselves the chance to learn that a) the thing we are afraid of and have built up in our minds really isn’t all that scary and/or b) we can handle the feeling of anxiety! Exposures work to habituate us as well as build up our reserves of confidence. This confidence can build quite quickly too! Especially if we've been avoiding a particular thing for a long time (giving it more and more power) and we finally take it on. 

Exposures also help us distinguish between fear/danger and discomfort. Through practice, we can slow down our mind's jump to viewing a situation, sensation, or thought as dangerous. We can instead notice that the situation, sensation, or thought is simply uncomfortable. And the good news is: discomfort tends to be conquerable. Think about how many times you've sat through a meeting or a social event with a headache. Or swam in cold water. Or been in a boring lecture when you were extra tired. You already have this skill. 


So what does an exposure actually look like? Let's explore a few examples: For someone with social anxiety, they might go out of their way to say hello to strangers, speak up in a conversation, order food over the phone, or do something embarrassing in public. For someone struggling with panic attacks, they may do exposures that put them physically in places they avoid due to fear of having another panic attack. Or they might do what are called interoceptive exposures. These are exercises that intentionally recreate bodily sensations associated with panic attacks (e.g., increased heart rate, dizziness, shortness of breath). For someone with intrusive thoughts about harming themselves with a knife, as an exposure, they may hold a knife in their hands for a predetermined amount of time. For someone with constant worry about harm coming to their family, they may practice worrying on purpose and sitting with the discomfort of uncertainty that something catastrophic could occur. 

All of these activities challenge the mind's instinctive, or often learned, belief that all of our thoughts are meaningful. They poke at that anxiety cycle and make room for a different way of interpreting our thoughts and anxious reactions. 


a.    Discomfort and anxiety. This is key for learning. If your anxiety level is too low during an exposure, you won't be getting much, if any, benefit. That said, if it's way too high, you're unlikely to be getting much out of it either. So it's important to be observant of your anxiety level during an exposure. But the point is: you want to feel anxious in order to break out of the cycle of anxiety. 

You are trying to train your brain to catch itself, to give it an opportunity to make that distinction between danger and discomfort, and to then go towards the discomfort. 

b.    Choosing the right exposure, i.e., making sure that what you’re doing as an exposure is actually moving you closer to being in touch with experiencing the deeper fear. Sometimes it is clear what an effective exposure activity would be, but sometimes it requires scratching beneath the surface.

The target of an exposure can be subtle. For example, someone with fear of contamination may engage in the same ritualistic hand-washing as someone else with contamination fears, but for one individual, the real fear might be of catching an illness that leads to vomiting, for the other, it might be that they will get sick and infect their family members. The outward exposure activity, of say, touching a dirty counter top, may look the same, but sitting with the specific discomfort of the varying feared outcomes would be different. 

c.      Mental attitude of openness/willingness/embracing uncertainty. A common experience for clients first starting out with exposures is to do the action of an exposure, but in their minds, still be quite resistant to the experience, or engage in a behavior to reduce their anxiety shortly after the exercise. In order to break the cycle of anxiety, it is imperative to reduce avoidance. In practice, what this looks like is embracing an attitude of objective observance and full willingness.

You don't have to like an anxious experience (who does?!), but if you're willing to feel it, you will be one step closer to conquering it.