Exposure Therapy to Overcome Emotional Disturbance

Graduated (Traditional) Exposure

What is Exposure Therapy? The costs of phobias – emotional disturbance and coping difficulties; the course of treatment with graduated exposure therapy

Exposure Therapy for Phobias

More than one out of ten Americans will contend with an anxiety disorder at some point in their lives. When this occurs, anxiety, fear, and phobias may inhibit them from accomplishing valued goals, taking actions that they care about, and feeling free and vibrantly alive.

So much is at stake!  The emotional disturbance of persistent anxiety can jangle our nerves, engender self-doubt, and tangle our thinking . Our confidence can erode; our happiness may be jeopardized.

Help That Works Is Available

If this begins occurring, please know that anxiety disorders can be treated, generally with effective and cost-efficient methods. Exposure Therapy (ET) is the Blue Ribbon treatment for phobias – intense, irrational fears and avoidance of objects or situations that is very much out of proportion to the actual threat.

Exposure therapy for phobias is based on the fact that the avoidance of what is feared actually creates and maintains phobic anxiety. The more a person avoids what they fear, the greater their fear becomes. When we therapists do ET for phobias, we create a safe psychological environment with and for our clients, in which our clients they can safely be exposed to the things they fear and avoid. They are enabled to engage in feared activities and anxiety-provoking situations long enough to discover that the negative consequences they expect do not occur.

Clients can work at their own pace – gradually, if they prefer, and in small steps. They need not engage in any exposure assignments that feel too negative or overwhelming.  If exposure practice in real life isn’t feasible, they and their therapist can do imaginal exposure to frightening scenarios that capture their fears. Treatment enables them to see through the frightening illusions of their fears, find their determination and courage to stride forward, and do what’s needed to get the upper hand.

After clients start getting through exposure practices “unscathed” and the disturbing feelings and frightening events they fear don’t actually occur (this is known as an “expectancy violation” – a good thing!), their rationality and a surprising sense of relief step in and start squaring things away in their minds, and their anxiety diminishes. Up to 80% of clients experience a significant reduction in anxiety. This habituation learning results in an overall decrease of their anxiety responses. 

Targeting Phobic Fears with Exposure

Why phobias matter; How exposure works; Overcoming fear and impairment in coping.

Our phobias are strongly linked to things we care about a great deal – such as swift transportation, safe travel, caring relationships (in a phobia for dating), and clear communication, so trivial matters don’t activate the intense emotional disturbance of phobias. Rarely are people phobic for file cabinets or clouds shaped like kittens.

Exposure therapy is the treatment of choice for a great many people with phobias. In graduated exposure therapy, they create a separate hierarchy for each of their phobic fears (such as dating anxiety, driving in heavy traffic or on freeways). Clients work on each item of the hierarchy for a given phobic fear until they can reasonably comfortably and skillfully engage with that situation or activity. Then they tackle the next item up until they reach the top item, their most anxiety-provoking fear, and relieve or even overcome it.

They do exposure therapy with each item – e.g.,   – until they overcome their coping difficulties and most of their fear for that item.  Exposure for a phobia for a phobia for driving in heavy traffic may begin as follows:

1. Driving on a street with a few cars on it;
2. Driving on a busy street at 4:30 am when it’s empty, and
3. Driving on a busy street for 3 blocks when there are a few cars at 10 am

Different Focuses for Different Phobias

In planning practices with their therapist, clients work up from situations or activities that incite lower anxiety levels toward the higher levels of emotional disturbance. The client begins by practicing at the bottom with the least frightening phobic situation.  When there’s no longer much fear associated with it and the client is able to function in the situation, she or he moves up the ladder  to the next, more anxiety-provoking phobic situation.

• In exposure therapy for panic, clients are exposed to bodily sensations associated with panic, like a pounding heart and shortness of breath, and explore the fears these sensations engender and the sense of losing control .
• Anxiety about loss of control or becoming hemmed in or trapped are the triggers of fear of driving on busy streets or freeways addressed in ET.
• In fear of flying, ET focuses on the threatening bodily sensations and anxiety about loss of control that are triggered by takeoffs, the trapped feelings when the cabin is sealed, fear of the seven-mile downward view from the plane, turbulence, or the unnerving rumble of the landing gear.
• For social anxiety, the target of exposure is triggering social situations, especially social interactions and public speaking anxiety.

In the past, the criterion for overcoming a phobic fear and moving up the hierarchy was overcoming most of the anxiety related to that item. Now we  practice exposure with each phobic fear until we’ve overcome much of our impairment in coping and can  function with little anxiety and a sense of mastery.

Helpful Topics

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