Exposure Therapy for Anxiety: The Ultimate Guide

Exposure Therapy for Anxiety: The Ultimate Guide

March 15, 2019 0 By Ben Yearwood

It’s funny how much some things can terrify you.

Take eye contact, for example, which used to be a huge problem for me, triggering a serious amount of anxiety.

I had heard about using exposure therapy for anxiety and I wanted to try it.

The idea was to work through my list of fears, from the bottom to the top until I was no longer socially anxious.

Armed with some relaxation exercises and a healthy amount of motivation, I made my way to Leicester Square and spent five or six hours fighting my anxiety.

Trying my best not to seem like a crazy person, I made eye contact with as many people as possible. Sometimes I couldn’t hold it and had to look away. But, other times I was able to keep it up long enough to give them a smile and then pass by. Though making the eye contact probably only took a second, my anxiety made it feel like an eternity. Until it just didn’t.

Through forcing myself to face that fear and anxiety over and over again, I found myself better able to cope and move past it.

Since that day, I’ve been able to use exposure therapy to remove more than just a fear of making eye contact with strangers. In this post, I want to show you how to use exposure therapy for anxiety treatment and how you can use it to better cope with your anxiety today and in the future.

What Is Exposure Therapy?

Exposure therapy is a cognitive behavioural therapy tool which is mainly used for PTSD and phobias.

Through exposure to whatever is causing your fear or panic to trigger, you can learn to cope with and, eventually, overcome them. In addition to facing your fears, you can begin to learn which relaxation techniques and coping mechanisms work best for you.

There are two types of exposure therapy: flooding and systematic desensitisation.

Flooding involves being forced into a fearful situation with no possibility of escape. For example, if a person was suffering from arachnophobia then flooding might be locking them in a room with spiders until they calmed down.

The idea behind flooding is that the body cannot maintain the fear response indefinitely. Once the fear response is diminished, then we begin to realise that there really was nothing to be afraid of.  As the body and mind relax, the fear melts away.

Systematic desensitisation, on the other hand, is gradual exposure to whatever scares you. Starting with something quite low on the fear hierarchy and working through until you have overcome your biggest fear.

Instead of being locked in the dreaded spider room, a person might first look at a picture of a spider. Then they might be in the same room as a caged spider, then a spider in its keeper’s hand. This might progress onwards until they were able to hold the spider or even enter the dreaded spider room.

So, does it work?

 

Jia Jiang and Rejection Therapy

Jia Jiang was a young entrepreneur with a brand new business startup and a family to feed. He knew that he had a great business idea, but one thing was holding him back.

Jia was terrified of being rejected.

So, in one of the most inspiring self-experiments of all time, he set out to overcome this fear using exposure therapy. In this case, he called it Rejection Therapy.

Jia initially set out to learn how to make rejection hurt less. He ended up embarking on 100 days of Rejection Therapy which he chronicled and discussed during a truly motivational Ted Talk.

Each time he went out and got rejected, he was teaching himself an amazing lesson. He was learning that rejection didn’t matter. It didn’t kill him and he could quickly get over the hurt.

That’s what exposure therapy is all about. Facing your fears over and over again until you’re no longer afraid or you’ve found a constructive way to cope with the fear.

 

How To Use Exposure Therapy For Anxiety

Before we begin our journey into using exposure therapy for anxiety, you will need to understand the core elements. There are five initial concepts to understand before the real work can begin.

Concept 1) Irrational Beliefs

Most fears and anxieties are irrational beliefs.

If you get rejected at a bar by some attractive stranger, it won’t kill you. Most people won’t even notice what’s happened. Yet, most people fear rejection so much they are unwilling to take a chance at being happy and having new memories and experiences.

If you try to strike up a conversation with someone you don’t know too well, it won’t hurt. But still, this is something that a lot of people avoid.

Almost all anxiety is rooted in totally irrational beliefs.

Next time you feel anxious about something, follow the thought to its conclusion. “If X happens, then Y and Z will surely happen.” You’ll probably find that in 95% of the cases, it’s a wholly irrational leap.

It’s true that most anxiety is irrational, but not all of it. For those that remain that are rational, you have to learn to cope and exposure therapy can help you with that too.

Concept 2) The ABC Model

“There is nothing either good or bad, but thinking makes it so.” – William Shakespeare

It’s so easy to think that events cause us to feel or act a certain way.

“I got passed over for promotion by my boss. It must be because she hates me and thinks I do a poor job.”

For every behaviour, thought or emotion, there is a preceding event such as not getting a promotion. Our most common mistake as fallible humans is thinking that the activating event (A) causes the behavioural, mental or emotional consequences (C). But this isn’t the case.

Actually, it’s our beliefs (B) about the event which give it an emotional charge.

Imagine if, instead of feeling sorry for yourself or anxious, you believed that you would simply do better next time and that, over time, you will get that big promotion (new belief).

Our beliefs are at the core of everything we do, feel or think. William Shakespeare had it right when he wrote that line in Hamlet. “Thinking makes it so.” Our beliefs shape our internal reality.

So, is it the attractive stranger at the bar who is making you feel anxious? Or could it be your belief – whatever that might be – about the situation.

Maybe it’s time to rethink some of the beliefs that you already have.

Check out my detailed post on how to use the ABC model to tackle irrational beliefs for more information.

Concept 3) Behavioural Experiments

OK. So, we now know that most fears are based on irrational beliefs. We also know that beliefs tend to moderate our behaviours, thoughts and emotions.

So, how can we overcome these irrational beliefs?

We tackle it as any good lawyer or scientist would. We’ve got to go out and find some evidence that refutes the irrational beliefs and that supports a new, more positive belief.

When you commit to a behavioural experiment, you are looking for evidence to prove the irrational belief wrong. When I went out to get over my fear of making eye contact with strangers, I was trying to prove to myself that nothing terrible was going to happen.

Turns out, I was right. Nothing bad happened at all, not even any dirty looks or glares.

If you are anxiety is telling you one thing, go out and test to see if it’s true.

When you screw up during a meeting presentation, you won’t be laughed at or immediately fired. If you compliment someone, 99% of the time they won’t fly into a rage. Go out and try it and see what happens.

You may just find that you’re surprised with a lot of the results of your behavioural experiments.

Concept 4) Exposure Therapy Is Like Taking A Life Class

When Jia Jiang went out to get over his fear of rejection, he went to learn a new lesson. He was determined to learn how to make rejection hurt less.

Exposure therapy is like taking a class on how to deal with life.

Through repeated exposure to whatever it is that scares you, you begin to learn how to deal with it.

And believe it or not, this can work for almost every area in your life.

The more you do something, you more accustomed to it you become. You can learn how to better cope with anxiety, rejection, depression and so much more.

All you have to do is commit to being open to whatever lessons life is about to teach you.

Concept 5) Create A Plan

It’s no good just going out to see if you can overcome anxiety in general.

You have to have a plan of attack.

Instead of seeking to overcome all of my social anxiety at once, I focussed on one part of it: eye contact. After that, I was able to work on my fear of eating alone, talking to strangers, meeting new people, talking to women and much more.

But, I would never be in the place that I am now if I hadn’t first made a plan of how I was going to do it.

In the next section of this post, I’m going to share the most important tools for using exposure therapy for anxiety. You can use these tools to structure your own plan for how to use exposure therapy for anxiety relief.

 

Arming Yourself With The Right Tools

Before you make a plan to overcome your fears using exposure therapy, you need to have the tools to succeed. It isn’t just as simple as throwing yourself into situations and hoping for the best. That would be like turning up to an exam having no idea what the test was on or what materials you need.

Using these tools are what make it easy to learn the lessons from exposure therapy. After all, it’s not really the exposure to the fearful stimuli that is the lesson. Rather, it’s how you cope with whatever it is.

Tool 1 – The Fear Hierarchy

Last week, I wrote about how creating a fear hierarchy can help you to overcome your anxiety.

You create a list of things which cause you anxiety, giving them a rating from 1 to 10. This becomes your fear hierarchy.

You can follow the whole process of how to create a fear hierarchy here.

Once you have your list, it becomes easier to see where to begin. It also gives you easy first steps and simple increments with which to increase your exposure.

You start by tackling the lowest rated anxieties on the list. For me, it was making eye contact and then I could move up my list from there.

Your fear hierarchy can serve as a great tool for focusing your exposure therapy. Before you do anything, make sure that you have one of these.

Tool 2 – Accountability

One of the easiest ways to make sure that you are striving towards completing a goal is to become accountable for it. Every month, I share my progress on my yearly goals. Because my goals are public, I have more eyes on them than ever before. This drives me to pursue my goals in new and interesting ways so that I can achieve greater success month upon month.

I have made myself accountable and, because of that, it is hard for me to not succeed. Not only do I know that I’ll be letting myself down, but I’ll also have to face everyone else who knew where I was heading.

Don’t give yourself a chance to get out of your behavioural experiment.

If you can get someone you trust onboard, then that will be a great help when it comes to actually move forward with your experiment.

This leads easily to the next tool.

Tool 3 – Get Support

One of the most important things you could have on your self-improvement journey is support.

When you have someone that you can turn to in the hard times, then you will find exposure therapy much easier.

This isn’t to say that you should become wholly dependent on others for your success. You should be as independent as possible. But, it’s never a bad thing to have someone in your life who can support you.

It could be a friend or a family member or it could be a coach or therapist. It can be anyone you can rely on in times of need.

Though it isn’t essential, you will find this whole process a lot easier if you have someone to support you along the way.

Tool 4 – Consistency

Unfortunately, there is no one-and-done therapy, skill or life tool.

There is no miracle cure.

You cannot use exposure therapy for anxiety once and expect to be free from fear forever. In the same way, you wouldn’t expect to get ripped from going to the gym once.

Whatever fear or anxiety you are trying to overcome, you will have to face it over and over again. You have to go at it again and again and again.

Unfortunately, anxiety is not something that you one day just get over. The sad truth is that it is a lifelong companion. Everyone suffers from it at some point or another.

But, consistently fighting your fears and anxiety will give you the tools to cope with them. You may still feel the fear, but over time you will be able to learn how to control and cope with your emotions.

That’s what being fearless or courageous is all about. Facing fear over and over again because you know that you are stronger than it.

So, be consistent.

Tool 5 – Metacognition

When you’re having an anxiety attack, your thoughts seem to move at the speed of light.

Your mind is searching for the source of danger that may never occur.

It can seem like your thoughts are out of your control, that you have no control over your feelings. But, there is another way.

Within each of our minds, there are two parts. The first part of your mind is the place that we most often reside. Let’s call that part The Thinker. It is the side of your mind which has a constant stream of thoughts, emotions, feelings and states rushing through. At the best of times, it can seem chaotic and disorganised. During anxiety, it can feel much worse.

However, there is the second part of your mind: The Observer. Most people hardly ever touch this side of their minds because they don’t know that it’s there.

This is the side of the mind which recognises that thoughts are just thoughts and feelings are just feelings. They don’t really have a basis in reality.

When we are mindful, we become The Observer. We can sit back and watch our thoughts and feelings as they happen.

This is called metacognition – thinking about thinking (or rather, observing the process of thinking).

Through this process, we can begin to separate our thoughts and feelings from reality.

This leads to the next tool.

Tool 6 – Mindfulness

We’ve just covered how there are two sides of the mind: The Thinker and The Observer.

Initially, it might seem difficult to try and separate the two from one another. That’s where mindfulness comes in.

If you’ve ever been angry, anxious or sad and stopped to take a deep breath, then you were using mindfulness. Not only that, but you had also just shifted into being The Observer.

Mindfulness is all about becoming aware.

We filter out most of what is going on around us. Most of the time, we just don’t pay attention to our inside or our outside world. They seem like they just happen.

But, by taking a moment to remain present, you can see more of your inner and outer world.

Instead of reacting to the feeling of anxiety, you can choose to observe it in whatever form it takes.

Stop and take a deep breath. Feel where the anxiety exists in your body and just focus on it. Listen to what it is saying to you with a non-critical ear. Whatever is happening is neither good nor bad. It is just something that happens.

Because you are in control of your observations, you can also control how you will respond to the feelings.

When you realise that your anxiety is not you, then you can begin the process of living without it being in control of you.

You can take control by using mindfulness. It is the key to empowering yourself and living a fearless life.

Tool 7 – Keep A Thought Journal

When you start your behavioural experiment, it will be very useful for you to keep a record of your thoughts, feelings and experiences.

After all, you don’t want to forget your life-changing insights.

You don’t have to write a book about what you’re feeling. But, recording how you felt when you exposed yourself to the fear could help you to understand why you reacted in a certain way later on.

I would recommend carrying around a small book to jot down your actions and reactions. Alternatively, you could keep a record on your smartphone.

Also, the sooner you can record your thoughts and findings after the behavioural experiment, the better. You want to have the details and the feelings fresh in mind. So, don’t wait until you return home to make a new journal entry. Do it as soon as you can.

Tool 8  – Compassion

I am a huge fan of self-compassion.

When you are trying to improve your life, no matter in what way that might be, you are going to screw up. You will fail and you will fall.

Self-compassion means taking an approach of kindness towards yourself.

You have to be willing to let yourself risk failure sometimes. You have to be willing to embrace it when it happens.

Self-compassion is knowing that you did your best today, but that you will work harder to do better tomorrow.

Give yourself a break. You don’t have to be perfect or successful right away. After all, you’ll learn more from your failures than you ever will from your successes.

So, now that you are armed with the tools and you’ve got a plan of attack, it’s time to get into the process.

Getting Out There

In its essence, an exposure therapy plan comes down to four things:

  1. Exposure
  2. Relaxation
  3. Review
  4. Repeat

Exposure

You’ve already got your fear hierarchy and you’re going to start with the lowest anxieties on the list. For example, this might be saying “Good morning” to people at work.

You know that it is irrational to think that people might feel negative towards you greeting them and you’re prepared to find evidence that refutes that belief.

In order to expose yourself to this fear, you might force yourself to say “Good morning” to everyone you pass by at work every morning for one week.

Now, for some people, this might not seem like a big deal. So, feel free to substitute any anxiety or fear that you currently have.

As you might expect, the first few exposures are going to be somewhat nerve-racking. These are the most important ones, so you eventually just have to put your head down and power through them. That’s not to say that you can’t do something about those feelings and that’s where relaxation comes in.

Relaxation

You can use metacognition to remind yourself that what you’re feeling isn’t necessarily reality. Begin to fall into the role of The Observer and you can begin to detach yourself from the emotions of the situation.

Remember, the event isn’t causing those feelings or thoughts. It is your beliefs about them which are causing you to feel afraid. Find evidence to support a new positive belief and you’ll see the fear start to melt away.

You can also use mindfulness to tune into whatever feelings you are experiencing. You can observe whatever thoughts or feelings arise and begin to recognise that what is happening when you expose yourself to fear isn’t dangerous or terrifying at all.

Review

Take some time to write down your thoughts, revelations and insights.

Review them as often as you can and you will soon start to see patterns emerging. You’ll start to find what techniques work best for you.

This also provides you with a place to tweak your plan and your approach to it.

Make whatever changes you need to, but don’t give up on your goal.

Repeat

Remain consistent.

Keep exposing yourself to the fear and anxiety over and over again until you have a great coping strategy which you can use every time without fail.

Find what works for you and use it again and again.

Remember, repetition is the mother of skill and if you don’t keep practising your coping strategies, you’ll quickly lose them.

Final Thoughts

I hope this post has been useful for you and that you now have a solid understanding of how to use exposure therapy for anxiety relief.

Remember to stay compassionate and stay motivated.

You can live a life free from anxiety, but you have to go after that life every single day. If you don’t, the anxiety will rule your life when you could easily rule your anxiety.

Give it a go and start living today.

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