Guide
Avoidance is the fuel of anxiety: each time we avoid, we feel relief, but we never learn that the situation was bearable. Exposure means gradually facing what we fear, in order to learn something new.
How it works
According to current research, exposure works above all because it allows you to learn something new: that the disaster doesn’t come, that you can cope or that you can bear the anxiety. This new learning is added on top of the old fear.
A little theory · Foa and Kozak proposed that exposure works because it provides new information that corrects the “fear memory”. More recent work emphasises learning: what matters isn’t that anxiety falls during the exercise, but that you discover that what you feared doesn’t happen, or that you can bear it (Foa and Kozak, 1986; Craske et al., 2014).
The principles
- Moving forward in steps, starting with manageable situations.
- Staying long enough to learn something, without safety behaviours.
- Repeating and varying the situations.
- Not waiting for zero anxiety before moving on to the next step.
You build a ladder of situations, from the easiest to the hardest, and climb it rung by rung, at your own pace (worksheet 09). Varying situations and contexts helps what you learn to “hold” in real life.
A little theory · Exposure is one of the best-validated techniques for fears, phobias, panic disorder, OCD and post-traumatic stress. It is done gradually, prepared and chosen: never by surprise or by force (Abramowitz et al., 2019).
What it isn’t
It isn’t throwing yourself at your biggest fear or being made to. Exposure is decided and prepared, ideally with a psychologist.
Watch: short videos
- What is the Cycle of Anxiety?, by Therapist Aid: why avoidance keeps fear going.
The videos open on YouTube. They complement this guide and are no substitute for support.
Worksheets to practise
- 09 · The ladder of small steps · Building a gradual exposure plan
- 10 · What I fear, what happened · Testing an anxious prediction (behavioural experiment)
- 21 · Doing the opposite of what fear dictates · Opposite action (DBT)
- 69 · Bringing on the sensations on purpose · Learning that the sensations of anxiety are not dangerous (interoceptive exposure)
- 13 · Living with doubt · Living with uncertainty instead of seeking certainty
Sources
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T. & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.
Clark, D. A. & Beck, A. T. (2010). Cognitive Therapy of Anxiety Disorders: Science and Practice. Guilford.
Foa, E. B. & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20-35.
Abramowitz, J. S., Deacon, B. J. & Whiteside, S. P. H. (2019). Exposure Therapy for Anxiety: Principles and Practice (2nd ed.). Guilford.
These worksheets do not replace therapy. If you are in distress or having suicidal thoughts, call your local emergency number (112 in Europe; 3114 in France, free, 24/7).
