top of page

Exposure Therapy for Anxiety Disorders

If you're trying to get comfortable with negotiating, speaking in public, or other scary activities, professionals often recommend exposure therapy.

This is when you slowly expose yourself to the things you're afraid of, so they're no longer unfamiliar to you.

One study [1] at the Rehab Institute of Chicago found that it can dramatically improve the way people relate to their fears.

It’s done in a series of ordered steps, starting with a relatively low level of engagement with the fearful situation, and increasing levels with each step.

For example, if someone had a cat phobia, you might start with just looking at a very small kitten from a distance of a few metres. You would eventually work your way up to stroking a full-sized cat. The steps of exposure therapy are worked out for each individual, depending on where they are able to start.

There’s a fundamental difference between a fear and a phobia. Fear is a natural response that can be advantageous in some situations, but flawed if it is excessive. Phobia is fear that is excessive and interferes with your life. It is a type of fear disorder.

For instance, being afraid of cats and avoiding them is an example of excessive fear. However, being so afraid of any type of cat that you may avoid going outside in general is an example of a phobia.

Exposure therapy treats both

It works by exposing you to the anxiety source or its context without the intention to cause any danger. Research [2] has shown that doing so helps you overcome the distress that the thing you're scared of gives you. It teaches you to predict and, when possible, control the anxious situation so that it is no longer unpredictable and uncontrollable, which makes it far less threatening.

3 types of exposure techniques:

1. Real life where the exposure exposes you to actual fear-inducing situations e.g. if you fear public speaking, you may be asked to give a speech to a small group of people

2. Imaginal exposure is when you're asked to imagine a situation you're afraid of. This is helpful if you need to confront feared thoughts and memories

3. Interoceptive exposure is when you confront feared bodily symptoms such as increased heart rate and shortness of breath.

All three types of exposure may be used together or separately. [3]

It’s recommended that you use a therapist to help you through exposure therapy. However, that’s not always possible as they will be private and can be expensive. Here are some ways I teach others to reduce their anxiety through exposure therapy on a self-help basis.

Self-Help Exposure Therapy

You may have found yourself in the habit of avoiding situations that cause difficulty. This coping strategy can often make the anxiety worse because you have to spend time and energy avoiding certain situations. Of course, the longer this continues, the more intimidating the situation you are avoiding becomes. And that makes the anxiety worse.

Say, for instance, you avoid going out socially, being in large groups or avoid ‘performance situations’ like presentations. This avoidance strategy means you never have a chance to prove to yourself that you could cope, and cope well. It’s easy to see how avoiding a situation can have a negative impact on your life as you start to avoid more and more situations.

Here’s some steps to follow using exposure therapy is a way of managing your anxiety:

1. List the things that you avoid

Come up with a list of the situations that you often try to escape from or avoid. These could be things like speaking to a group of friends, giving a presentation to small group, making eye contact with a stranger, ordering a pizza, having a one to one conversation with a colleague, asking a stranger for directions etc.

2. Rank these situations

Rank your list of situations in order of difficulty. From the least anxiety provoking to the most anxiety provoking on a scale of 0-100: 0 = no anxiety and 100 = extreme anxiety.

3. Challenge the lowest ranked situation

Try to challenge the lowest ranked item on your list, the one that causes you the least anxiety. You may find that although your anxiety might initially rise, it will drop if you remain in the situation for long enough. Try to stay with the situation until your anxiety has reduced by at least half.

4. Repeat, repeat, repeat…

Repeat the task every day if possible, or as often as possible. Don’t leave too long between times when you challenge this item. This is because the more you challenge something, the more your fear will reduce. You will notice your anxiety getting less and less each time you do so. You may find eventually that it will cause you little or no anxiety at all.

5. Move on to the next situation

When you feel comfortable with an item, try to move on to the next item on your list. Working through your list will help you feel less anxious in fewer and fewer situations. You will find that your confidence grows as you move through your list. You will find that your highest ranked tasks will seem more manageable as you progress.

Quick note

Remember, symptoms of anxiety can’t harm you. Try not to escape situations you fear half-way through. Your anxiety will reduce each time you confront a feared situation. It’s helpful to also challenge any unhelpful thoughts. You may challenge an item on your list which doesn't go as well as you had hoped. Try not to give up. Keep going, and it will eventually get easier.

For instant access to my FREE First Aid Kit, sign up below:


bottom of page