Exposure for Treating Anxiety

A hallmark of cognitive-behavioral treatment for anxiety disorders is exposure. In some ways this is a common sense notion: you must face your fears in order to overcome them. However, there is more to it than just jumping in to face your fear. Both research and clinical practice have contributed to a set of guidelines for maximizing the benefit to be gained from exposure. Some of these guidelines are as follows.

Begin by developing a hierarchy of feared situations. Use a subjective rating of anxiety (0 – 100) for ordering how much anxiety is likely to result from exposure to specific situations. Although it is not really necessary to approach exposure gradually, most clients prefer to do it this way. Begin working up the hierarchy by putting yourself in the situations listed in the hierarchy. When in a situation, keep track of your peak anxiety level (0 – 100) and stay in the situation until your anxiety level decreases by about half. Although the 50% reduction is merely a rule of thumb, it is very important that you let your anxiety level come down and do not flee from the situation because you are anxious. Fleeing (“escape”) is reinforcing, and you will be more likely to flee the next time you are in this situation or are feeling anxious. This happens because fleeing does make you feel better, at least temporarily. When you leave the situation you immediately feel relief. But what happens is that your short-term relief comes at the expense of strengthening your problem with anxiety.

There are several other important aspects of exposure treatment for anxiety disorders, and I will talk about them in future entries.