A Guide to Exposure Therapy

This article on exposure therapy is the companion piece to another article on overcoming phobias and irrational fears. If you haven’t read it yet, I advise starting with the other piece first; I think you’ll find better results that way. As always, exposure therapy is best conducted with the assistant of a trained therapist.

I don’t know anyone who enjoys fear. Fears can overtake our lives and limit our ability to live fully. Personally, I am not a fan of fear.

I’ve often been told that facing my fears is the best way to overcome them. While this is excellent advice for those whose fears don’t limit them, extreme fears and phobias can seem impossible to face.

They’re not. We just have to be wise about how we approach them.

When it comes to facing our fears, small wins matter. In fact, small wins are how we get across the exposure therapy finish line.

Exposure therapy, in its basic, most simple form, is choosing to face our fear. It’s deciding not to let the fear rule or inhibit us, and finding a way to conquer it.

Exposure therapy is about choosing freedom over fear.

That said, there’s no Exposure Therapy Police insisting that we tackle our most overwhelming fear first. In fact, the common guidance is to start with smaller fears and learn to conquer those first.

Doing so, I was told, helps us build confidence that we can tackle those more significant fears successfully.

A Guide to Exposure Therapy

1. Start by listing all the fears you have.

Include the most mundane fears (for me, this is a fear of spiders) to your most serious and extreme fears. For a long time, I had a severe fear of sharks that caused me to avoid pools of water (including baths); exposure therapy helped me a lot here.

2. Rank your fears.

Identify which fears are relatively small and reasonably straightforward to challenge, and which are the most serious. If it helps, you can use the SUDS scoring system available here.

3. Pick the mildest fear to tackle first.

For me, this is a fear of spiders. I’m uncomfortable around them and always make my hubby deal with them when I see them. I don’t know why I’m afraid, but I am.

From here on out, I’m going to assume you are tackling a major phobia. The exposure therapy approach is the same regardless, but milder fears will move more quickly through these steps and may even skip a few. I’m going to share how I used exposure therapy to overcome my great white shark phobia for these examples.

4. Write out a list of all the steps you can take to overcome your phobia from smallest to most significant.

As an example, I wouldn’t start with a cage dive to encounter a great white shark in the wild.

Instead, since my phobia had me even afraid of baths and swimming in pools, I started much smaller.

My steps looked more like this:

– Get comfortable in a bath full of water
– Wade in a clear pool
– Swim in a clear pool
– Wade knee-deep in a high-visibility lake
– Swim in a high-visibility lake
– Wade into a lower-visibility lake
– Swim in a lower-visibility lake
– Wade into the ocean
– Swim in the sea
– Scuba dive

When we break down the challenge into smaller steps, it has a strong psychological effect on us. For me, I didn’t have to think about whether or not I saw a shark in the bathtub; the entire goal was merely to get comfortable in a tub.

This is the magic of exposure therapy: by breaking the challenge into smaller steps, we set ourselves up for maximal success.

5. Take the smallest step and see if you can break it down into an even smaller piece.

What this might look like in my situation is:

– Stay in the bath for 1 minute
– Stay in the tub for 5 minutes
– Stay in the tub for 10 minutes
– Stay in the bathtub for 20 minutes
– Spend an hour in the bathtub

Once I spent an hour in the bathtub – comfortably and without distress – it would be time for me to move on the next step.

6. Make your first attempt.

I had a pretty extreme fear level. Even getting into the tub was a win for me (and honestly, probably could have been a step on its own). Knowing that I only had to stay in for 60 seconds made the experience more manageable for me.

Also, I dictated the circumstances. I didn’t use bubble bath or bath salts or anything that might cloud the water.

With the first attempt, it was about getting in the tub and staying as long as I could up to 60 seconds. If I made it to 60 seconds, I got out of the tub – no matter how I felt.

I actually did make the 60-second mark on the first attempt and thought I was doing all right with it. I did a body scan (where you check in with each body part to check your breathing and where/if in your body you are carrying stress), and I realized that I was tense in my shoulders and breathing more shallowly than usual.

These signs of distress told me that I was not yet ready to move on to the next step of staying in the tub for five minutes.

Also, don’t minimize your reaction. Rationalizing your way to taking the next step early because “I really should be able to sit in a bathtub for one minute” is a great way to sabotage this process.

7. Take some time off.

Take some time between each of your attempts to give yourself time to emotionally and mentally unwind from the experience. You’ve just done something terribly challenging, and it’s good to honor your hard work.

Some people even set themselves up with rewards, like getting a slice of cake, for each attempt.

8. Continue steps 6 & 7 until you no longer are in distress in that situation.

It took me three or four attempts, each made about three days apart, before I was able to sit comfortably in the tub for 60 seconds and not feel distressed over the experience.

Also, celebrate this victory!! This is huge and worthy of celebration.

9. Move on to the next baby step.

My next step was to sit in the bathtub for five minutes without distress – NOT to move on to wading into a clear pool.

Repeat steps 6-8 until this baby step is successfully completed.

10. Once you’ve completed the full step, repeat steps 5-9 for the next level you laid out in Step 4.

For me, this was wading into a clear swimming pool. I broke it back down, just as I had for the bathtub step.

I worked each of those baby steps until I could achieve them without distress before moving on to the next. After that, I was ready for swimming in the pool (which mean putting my head underwater).

Give Yourself Plenty of Time

Yes, it may take a while for you to overcome this phobia – and that’s totally OK and entirely reasonable. Regardless of how or when we developed our fear, it’s real for us and causes genuine distress.

Changing our anxiety response means rewiring our brains so it doesn’t send a distress response when it’s not warranted. Rewiring our brains takes time.

In fact, I think of it like re-wiring a house! We rewire one room at a time. It takes time to move around the furniture, rip out the walls, fix the wiring, get the inspection completed, and get the drywall back up. We don’t expect the project to be finished in a day or two; we know rewiring that room will take time.

It’s exactly the same with exposure therapy. Each step is another room, and each baby step moves us forward in getting that room in our brain rewired so we can be free of our fear.

Have compassion on yourself in the process and celebrate every small success.

Have you tried exposure therapy? What was the experience like for you?