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How (and Why) to Create an Anxiety Exposure Program
By Garrett Ray Harriman
©2014 Garrett Ray Harriman
If you are someone incapacitated by fear and anxiety, the title of this article may raise your hackles. “Why
would I want to ‘expose’ myself to anxiety?”
Good question. Here’s why.
Exposure therapy is a tenet of cognitive-behavioral therapy (CBT), one of the most widely used
therapeutic schools to help people with anxiety. 1 Simply put, exposure involves willingly placing yourself
in situations where you experience anxious reactions.
This may sound like “facing your fears,” but it’s best to do away with this misleading, if well-intentioned
phrase. Fear is not the enemy; there is no enemy. There is only a reinforced misunderstanding between
your internal call to action and the ways you choose to act in the presence of stress. Instead of “facing” and
thus antagonizing fear, the goal of any exposure program is to feel your anxiety, to co-exist with both the
mental and physical sensations in increments that remind your mind and body, “Hey—this situation isn't
dangerous at all. I can handle this!”
Why does this matter? Because continually skirting situations that make you feel anxious further
reinforces your mind and body to react negatively to people, places, or events that are innocuous, neutral,
and safe. The situations you dodge, avoid, or run away from are not dangerous. The symptoms of
anxiety—the racing heart, the tingly fingers—while certainly visceral, are not dangerous. They are only
the exaggerated bells of your biologically perfected alarm system temporarily clanging by
mistake.2 Exposure therapy reverses these ingrained reactions, and allows you to systematically approach
and reflect on anxiety-inducing situations, bit by bit.
So how do you begin developing an exposure program? Below is a basic template: 3, 4
1.
Grab a pen and paper. Write down every situation that you currently feel triggers your anxiety,
fear, or panic. It could be a place you visit, a person/group of people you talk to, etc.
2. Rank each scenario on a scale of least anxiety-inducing (1)—tolerable—to the most anxietyinducing (5)—situations you can’t imagine tolerating.
3. Set aside time, ideally every day, in which you focus on your exposure. Begin with the lowest
anxiety-inducing situation on your list. Perform this task or visit this spot a little longer every day.
Slowly, your body’s fear reactions will dissipate as you transition from enduring the situation to
acknowledging there is no inherent danger (a process psychologists call “extinction”). 5
4. Before moving onto the next activity/place on your list, be sure that you can do the earlier tasks
without any trace of anxiety or panic. Revisit these earlier fields of victory as your progress
continues.
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5.
Keep a panic diary or journal on-hand during your exposure program. Writing down our feelings
is a fantastic way to tease them out of the abstract cloud that so easily capsizes our minds.6 Jot
down how you feel, physically and emotionally, before, during, and after each regimen. Your
writing can be sloppy or shaky—that’s okay! What matters is that you chart your progress.
6. Move up your list at a pace that works for you. Remember, the whole point of exposure is to settle
yourself into the non-dangerous discomfort that’s grounded your ambition and daily life. Know
that sharing the moment with these feelings, though intense and unpleasant, is wholly safe. The
more you practice, the easier it will be to internalize this truth.
7.
Be open, curious, and optimistic about your exposure sessions. Gritting your teeth during sessions
is to be avoided. Admit to yourself when you want to flee or curl into a ball—write about it—but
don’t give these thoughts legs! You are here, feeling what you need to feel in the moment. This
fortitude alone is progress.
One final piece of advice: It’s best to approach your exposure tasks on your own. Very often, anxious
people engage in “safety-seeking behaviors” that curtail faster recovery. Convincing a friend to chaperone
your exposure sessions falls into this category. Instead of carrying a lucky rabbit’s foot or some other
“magic object” that you feel wards off your anxiety, you cast your friend in the role of a flesh-and-blood
totem.7 Actions like these only feed the falsehood that your current situation is dire and dangerous. (It's
not.)
You should, however, let your loved ones know (as well as your professional healthcare provider) that you
are beginning an exposure program. They will be there to encourage you before and after you venture off
to meet your anxiety for the day, and will avoid becoming the props and playthings anxiety so gleefully
likes to recruit.
Courage is not the absence of fear; courage is your capacity for openness and consistency, which is exactly
what exposure programs provide. Kick-starting an exposure program plants a significant flag in your
uphill recovery from anxiety.
Sources:
1. http://www.essentia.fr/blog/wp-content/uploads/2012/05/HOLLON-2006.pdf
2. http://www.anxietybc.com/sites/default/files/adult_hmpanic.pdf
3. http://bmo.sagepub.com/content/32/4/504.long
4. http://www.psychiatrictimes.com/anxiety/exposure-therapy-anxiety-disorders
5. Michael, T., Blechert, J., Vriends, N., Margraf, J., & Wilhelm, F. H. (2007). Fear conditioning in panic
disorder: Enhanced resistance to extinction. Journal of abnormal psychology, 116(3), 612.
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http://www.kli.psy.ruhr-uni-bochum.de/klipsy/public/margraf%20Journals%20with%20PeerReview/Michael%20et%20al.%20(2007).%20Fear%20conditioning%20in%20panic%20disorder_Enhan
ced%20restistance%20to%20extinction.pdf
6. https://www.psychologytoday.com/blog/shyness-is-nice/201404/how-keep-thought-diary-combatanxiety
7. Sloan, T., & Telch, M. J. (2002). The effects of safety-seeking behavior and guided threat reappraisal on
fear reduction during exposure: An experimental investigation. Behaviour Research and Therapy, 40(3),
235-251. http://homepage.psy.utexas.edu/homePage/Group/TelchLAB/Publications/Sloan2002.pdf