Step-wise exposure technique

“Our doubts are traitors, and make us lose the good we oft might win, by fearing to attempt.”

William Shakespeare

Difficulty Level:

Difficult

Frequency:

Twice a week for one month

Duration:

Variable

How to do it

You should try this technique when you’ve noticed a situation has gotten to the point of you avoiding it or being afraid of it. Generally, when we experience any sort of self-doubt, fear or anxiety in a situation, we will be more apprehensive of entering a similar situation in the future. The problem with this is that it will become a recurring habit, turning a once minorly uncomfortable situation into something that causes great amounts of fear and anxiety.

Step 1: List all the situations, activities, or thought patterns that cause anxiety, fear or negative self-talk.

Step 2: Create a fear hierarchy, which will consist of the list you just made arranged in order from least anxiety-provoking to most.

Step 3: We’re going to start at the bottom and work our way up. Starting with the situation causing the least amount of anxiety, you are going to write about which aspects of this situation cause you discomfort, how it causes discomfort and the thoughts that generally accompany this situation. For example, in the hierarchy above, you would start with ‘speaking up in meetings’ and you would write down as many things about this situation as you can think of. Here are a couple of examples:

When I have to speak up in front of my peers it makes me really anxious.
My heart beats fast to the point where I can feel it in my throat.
I have difficulty swallowing and breathing.
I lose my train of thought.
I tell myself that I’m going to say something stupid and come off as a dummy.
I talk myself into a panic to the point where I can’t think clearly about what I want to say.
I tell myself that everyone is going to judge me for what contributions I make.
Because of this, I have stopped speaking up even when I have something of value to add.

Step 4: Create a step-by-step process for how you can implement this activity into your life a couple times a week or month (depending on the situation and how you feel). In the above example, the self-doubt comes from speaking up in meetings so here are some ways in which you can gradually implement this activity into your life:

Stage 1: I can start to imagine what I would say to a comment while in a meeting without actually saying anything. If I have any feelings of self-doubt I will acknowledge the thought but let it go within the same breath.
Stage 2: Then, I can outwardly acknowledge points made by others in the meeting by saying, “I agree” or “yes, that’s a great idea” out loud.
Stage 3: I can go up to a select few colleagues after the meeting and discuss some points with them. I feel like talking to a few people isn’t as bad as in front of the regular group.
Stage 4: Then, I can speak up only about things that I am 100% confident about.
Stage 5: Finally, I can interject little bits of information when I feel comfortable in the meeting in front of everyone.

Step 5: You’re going to imagine one of these scenarios at least twice per week for 5 minutes. Use visual imagery to imagine how this situation will go and be thoughtful of any self-deprecating thoughts you might have throughout this process. As with one of the examples in the previous step, you’re going to acknowledge these thoughts while letting them pass by. Try not to lock on any attention to them but don’t ignore them. Acknowledge them and let them go.

Step 6: When you feel comfortable, take these imagined scenarios and start to implement the action based items one-by-one whenever in the situation. Start small and don’t move on until you’re completely comfortable. Should you start to experience feelings of anxiety during your practice, try some mindfulness techniques such as deep-breathing, muscle relaxation or yoga, just to name a few.

Step 7: Once you’re completely comfortable with this first item in your hierarchy (as in there is no more discomfort associated with this discomfort), you can move onto the next item. By relying on this step-wise approach, each exposure item never feels too overwhelming because of the mastery of the previous item you’ve tackled.

Again, if you experience serious anxiety over a situation you should do this exercise with a trained professional. Furthermore, if you start this activity and the anxiety becomes too much causing you to stop the activity, you can make the anxiety worse. You need to follow this through to the end.

Why you should try it?

The research

Exposure therapy is used to treat serious illnesses such as posttraumatic stress disorder. In fact, a 2012 study found this therapy as the gold standard for treating combat and military-related trauma (1).
Additionally, several studies have demonstrated the efficacy of exposure based therapy for anxiety, as summarized in meta-analysis studies (2, 3). While another specific study found that those who participated in exposure therapy reported positive results after treatment and four years after receiving treatment. In addition to this, 90% of participants in these studies reported their anxiety had decreased and 65% of participants no longer experienced anxiety associated with the situation/experience they were receiving treatment for (4).

How it works

This technique is based on the idea of fear “extinction”. The origins are based on the idea that the human brain habituates to stimuli when it can predict what comes after it. Exposure therapy helps you retrain your brain through extinction processes. It’s not about getting used to the fear but rather about training your brain to stop sending the fear signal when there isn’t any danger. You become fearful of a situation because of a bad experience. Naturally, from there on, you start to avoid those situations which then cause the fear to become stronger and stronger. You convince yourself that the fear is real and valid (it’s not). When you use systematic exposure for these situations, you confront the fear for a period of time and then eventually the brain adapts to the stimulus (particularly when there isn’t any negative outcome). It does so to the point where it stops finding the situation stressful at all (6).
So why doesn’t extinction work on its own then? The answer is because in order for this method to work, people have to continuously expose themselves to the stressful experience until it no longer becomes stressful. When most people experience self-doubt, anxiety or fear in a situation, they try to avoid or flee from the things that cause them fear. This acts as a negative reinforcement which actually increases the amount of fear you will experience in that situation in the future.

The evidence

Rauch, S. A., Eftekhari, A., & Ruzek, J. I. (2012).
Review of exposure therapy: a gold standard for PTSD treatment.
Journal of Rehabilitation Research and Development, 49, 679-688.
Norton, P. J., & Price, E. C. (2007).
A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders.
The Journal of Nervous and Mental Disease, 195, 521-531.
Tolin, D. F. (2010).
Is cognitive–behavioral therapy more effective than other therapies?: A meta-analytic review.
Clinical Psychology Review, 30, 710-720.
Öst, L. G. (1989).
One-session treatment for specific phobias.
Behavior Research and Therapy, 27, 1-7.
Bryant, R. A., Moulds, M. L., Guthrie, R. M., Dang, S. T., Mastrodomenico, J., Nixon, R. D., … & Creamer, M. (2008).
A randomized controlled trial of exposure therapy and cognitive restructuring for posttraumatic stress disorder.
Journal of Consulting and Clinical Psychology, 76, 695.
Tryon, W. W. (2005).
Possible mechanisms for why desensitization and exposure therapy work.
Clinical Psychology Review, 25, 67-95.