In the exposure treatment model, anxiety is seen as something that comes about when we're avoiding something we need to face.
Dr. David Burns has the analogy that anxiety is the monster we're running away from. Every time we run away, we do get away from it, but then the monster comes after us again, sometimes becoming bigger and scarier. But if we choose to finally face that monster, we'll realize that it has no teeth and will not eat us up. It actually is kept alive due to our running away/avoidance of it.
So in the exposure treatment model, you have to gather up a lot of courage to face whatever it is you've been running away from. The most challenging part is to stay there, let the anxiety increase until it burns out. It always will if we stay to face the monster and stop running away.
First you have to ask yourself, what is it that I'm avoiding or running away from? It's helpful to look at the benefits of continuing to run away and the cost of facing it before you decide to move forward with these exercises.
Once you start, it's important to follow through on a daily basis until anxiety about the "monster" has burnt out.
I highly recommend engaging in the other 3 treatment models first before beginning exposure work. It may also be helpful to have a friend, partner or therapist be involved to support you through this process.
Types of exposure techniques and examples:
🔸Flooding: A person who is terrified of her baby fussing in public and looking like a "bad mother" will force herself to go out in public and stay out in public until her anxious thoughts are challenged. Her goal is to stay in the anxiety instead of running away from it. She may stay until her baby starts crying and works to soothe the baby in various ways instead of running back home to go back into hiding. This is a behavioral experiment that can feel terrifying, but will challenge negative thoughts in a powerful way.
🔸Systematic desensitization: The woman chooses to take take smaller steps instead of facing her fear all at once. She will make a 10-item list from least anxiety provoking to most anxiety provoking. 1 could be to go to the park for 10 minutes, then go back home, 2 could be to stay for 30 minutes; 10 may be to go out in public when the baby is fussing and work to soothe the baby in various ways. Then she can challenge her thoughts on people judging her, that she is a bad mother for her baby fussing, etc. Both flooding and systematic desensitization will work. Flooding is scarier but works faster. Flooding is like ripping off the band-aid and systematic desensitization is like slowly peeling it off.
🔸Cognitive flooding is for anxieties that can't be recreated in real time, so the exposure is done only in the mind. For example, a person who has been abused may have continued to avoid triggers and anything that reminds them of the abuse. With cognitive flooding, they would take 20-30 minutes per day to actually fully immerse in ONE moment of the abuse they've experienced. It doesn't matter which one they choose. They can write about it over and over again until they're desensitized to the memory or just replay it over and over again in their mind. It usually takes roughly 3-7 days to see that the memory can no longer get them to that same level of anxiety.
🔸Memory Rescripting combines Cognitive Flooding with Image Subsitution. After they do cognitive flooding, they can rewrite any parts of the memory that they want to change and replacing it with any images they'd like. This is also effective for nightmares. We don't want to do the cognitive flooding with nightmares, but it can be very effective to write over and over again what images you want to replace the nightmare images, and we see that the replacement images actually substitute the nightmare when it comes up again.
🔸Self-disclosure. If a person is terrified of judgment, or feels like they have to achieve, be strong, be perfect to be good enough, it can be powerful to face their fears and share their imperfections and vulnerabilities with multiple people. If it sounds terrifying to you to do this, it may be the exact monster you need to face. Someone with social anxiety can benefit from sharing that they're feeling shy and have struggled with this all their lives instead of trying to cover it up. Someone is feels ashamed of her struggle with postpartum depression and anxiety can openly share about it instead of continuing to hide it.
🔸 Negativity/Worry Breaks: A mom worrying about her kids take 5 minutes every hour to channel all of her worry and anxious thoughts. Then they give themselves permission to move forward until the next worry break. This can be more effective than continuing to try to stuff the anxiety or suppress the worry.
🔸Smile and say hello: Someone with social anxiety can also benefit from smiling and saying hello to 10 people throughout the day, making this a social experiment. The keep track of how many positive responses, neutral, or negative responses they get when engaging in this. They often see that if they smile and act friendly compared to their usual demeanor, people aren't often as scary or dangerous as they thought.
It can also help to let go of feeling like you have to impress others and be charming. Instead turn the spotlight on them and 1) ask them questions about their interests, family, etc 2) give them genuine compliments 3) find things in what they're saying that you genuinely agree with and say it. This actually allows them to see you as more interesting than if you were to try to impress them with your charm or achievements.
Disclaimer: Emotions get heightened and worsen before they get better when engaging in exposure.
It often takes all 4 treatment models to defeat anxiety.
For more great ways to defeat anxiety, read the book When Panic Attacks by Dr. David Burns.