In a nutshell, the rationale behind exposure therapy is “short-term pain, long-term gain.”
It is meant to have the opposite effect of avoidance, which provides short-term gain but long-term pain by reinforcing anxious thinking patterns.
Fear is in the unknown
Think of it like watching a scary movie over and over. The movie gets less scary the more you watch it. But why does it get less scary?
- You’ve watched it before, so you know what’s coming.
- You know you’ve gotten through it before, so you have more confidence about your chance of making it through this time.
- You get to start noticing things you couldn’t notice when you were too scared and hyper-alert, and that opens you up to new and fascinating observations.
Fear is also in the memory of the unknown
By which I mean, I find it scarier to think back on a scary movie than to actually re-watch the thing.
(Para)sympathy for the devil
In my CBT program, our group leaders told us that our bodies can only sustain a high level of anxiety for so long until our parasympathetic system kicks in and brings down our anxiety naturally. If you flee the situation too soon, you’ll never get to that lower-anxiety place.
Basically, if you’re willing to have a standoff with your anxiety, it will eventually fall asleep, unlike the kindergartner who tries to engage me in deep, convoluted conversation at bedtime every night.
But what do you actually DO for exposure activities?
Here are some examples we were encouraged to consider:
- Make a telephone call
- Read in front of others
- Refuse an unreasonable request
- Offer an opinion that is different from someone else’s
- Buy one Timbit from Tim Horton’s
- Ask for the time in a location where the clock is clearly visible
- Buy, and five minutes later, return, the same book
- Engage a stranger in conversation while trying to be as boring as possible
- Order something that is clearly not on the menu, like pizza at a coffeeshop
- Intentionally make a grammatical mistake online
Just looking at this list makes me a little anxious. (Sadly, just looking at the list probably doesn’t count as exposure therapy.)
Hospital parades and other shenanigans
I did many of the items on the list during therapy, and since.
One notable activity that’s not on the list was the day our group leaders presented us with a trunk full of ridiculous costumes and announced we were going to get dressed up and do a parade through the whole hospital, each taking 2 turns as leader of the crazy-parade.
It was a fuchsia feather boa and garish CANADA DAY headband for me, by the way.
No, I don’t have photos.
We did a bunch of other silly stuff too. But I shall regale you with those tales another day.
Trite and true
In closing, I will say that two cliches are certainly true for anxiety and exposure therapy:
- You can’t have courage without fear.
- Sometimes the only way out is through.