Therapy

Face the fear! Why exposure therapy helps

Exposure therapy is an important component for the treatment of anxiety disorders. Patients are taught to gradually approach anxiety-provoking situations without engaging in any subtle or overt avoidance strategies.

Posted on September 16, 2019

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Exposure therapy is an important component for the treatment of anxiety disorders. Patients are taught to gradually approach anxiety-provoking situations without engaging in any subtle or overt avoidance strategies.

How do I explain this treatment to my patients? Basically, I am asking people to face situations that they fear and typically avoid at all cost. This idea can be terrifying to people. As a therapist, I gently introduce this idea with a strong rationale for why exposure is helpful. The problem with avoidance is that people never really discover that their fears are unfounded. They never face the situation so their catastrophic ideas live on. And, people pay a high price for avoidance - it takes pleasure out of life and can lead to loneliness and despair.

Let’s use the example of Social Phobia. People with this condition fear that others will reject them. They worry that people will notice they are anxious. They avoid social situations. They avoid eye contact when they must be around people. They closely monitor what they say to others in an attempt to avoid showing people their true selves.

For these patients, I conduct exposure therapy. First, I teach them relaxation skills to reduce their anxiety. Together, we examine the thoughts and interpretations they make about people. We develop more accurate, helpful ways of thinking.

Next, we develop a hierarchy of feared situations that we order from lowest to highest difficulty. For example, a low ranked item could be making eye contact at a social event. The highest ranked item might be making a joke at a party.

The patient then faces their fears gradually and repeatedly, starting with the lowest ranked item. Once the patient has successfully desensitized to the situation (e.g., he or she no longer feels anxious), the patient can move on to the next situation.

The key to exposure therapy is that it is repeated and done regularly. I usually tell my patients that 10 exposures done over 10 days is far more effective than 10 exposures over 10 weeks.

Exposure therapy can be challenging but it is effective. There is considerable research to support its use in the treatment of anxiety (Stewart et al., 2009).

For more information on exposure therapy for anxiety disorders, I recommend: The Anxiety and Phobia Workbook - 5th Edition by Edmund Bourne.

For individuals that require assistance and guidance with exposure therapy, I suggest seeking a therapist who has specialized knowledge in Cognitive Behavioural Therapy.

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