Exposure Therapy

Step by step anxiety can be overcome by exposing yourself to the thing you fear. One of the major behavioural symptoms of anxiety is avoidance. The first thing to know is that Avoidance is the Enemy!!!

Avoidance reinforces the object of your fear. Not until you face the object of your fear and learn to deal with the anxiety will you overcome your fears.

The way to do this is to come up with an exposure hierarchy that gradually exposes you to the thing you fear. This is also referred to as systematic desensitisation. You learn to go closer to the thing you fear step by step in a relaxed manner until you can handle it. You are always in control. This can be done first in imagination and then in real life.

Creating an exposure hierarchy

To create a hierarchy, take one thing you fear then break it down into smaller steps.

Example Hierarchy

Fear: going into shops and buying things

• Go to outside of shop with support person
• Go inside shop with support person and browse together for 5 minutes
• Go inside shop with support person and browse alone for 5 minutes
• Go inside shop alone and browse for 5 minutes
• Go inside shop alone and browse for 10 minutes
• Go inside shop with support person and observe while they buy something
• Go inside shop with support person and buy something
• Go inside shop alone and buy something

Fear: joining social anxiety group

• Join forum, read posts
• Write one post saying hello
• Answer someone else’s post
• Join chat and just say hi
• Join chat and make attempt to join in
• Attend meetup event and stay for half an hour, just say hi and listen
• Attend meetup event and make attempt to speak up

Start with the easiest and repeat the step until you feel comfortable with it, then move up to the next step. If one step seems too hard, break it down into more steps. Stay in the situation even when you feel a little uncomfortable, up to the point where your anxiety is a little unmanageable. You can temporarily leave if the anxiety gets too bad until you feel better, then return to the situation. Don’t run away as this reinforces your fear. To help control your anxiety when facing the thing you fear it helps to use relaxation techniques, such as deep breathing, as well as practicing positive self-talk.