Exposure therapy is a cornerstone of the treatment of anxiety (check out our Anxiety disorders complete guide) because it enables people who are afraid of something to gather realistic evidence about what that thing is REALLY like, and then make more thoughtful decisions about whether they want to continue being afraid. This is a difficult concept for most people because anxiety usually feels so automatic and scary that it seems odd to consider that we might be able to control it. However, it’s true.
The body is built to protect itself by acting without the need for conscious thought. When we’re young, our brain begins the lifelong process of developing models and understandings about what is ‘safe’ and ‘dangerous.’ We learn from direct experience, by watching others, and by putting two and two together that we should move towards some things stay away from others. Over time, these models become ingrained and we no longer need to spend much brainpower on figuring out what might happen, freeing the brain for other, more important activities. Whenever we see, hear, smell, taste or touch something, the brain consults these models and instantly prepares the body to fight or flee. The physical and emotional arousal that results is what we commonly refer to as ‘anxiety.’
Treating anxiety with exposure therapy involves gradually bringing yourself into contact with elements of the things, places or situations you fear. Over time, two important discoveries emerge: First, you learn that the situation isn’t as bad as you anticipated and, second, you learn that you can actually cope with it. As the body’s arousal comes down beliefs about being in danger are replaced with beliefs about coping (eg, ‘I can do this’). The act of facing your fears instead of running away gives you time to experience the feared object/situation realistically, as it truly is, instead of continuing to view it through the lens of the worst-case scenario.
Consider the case of a young woman on a camping trip who was afraid to swim in a lake. Her brain told her that the murky water was “gross”and “dirty” and full of animals that might be dangerous. She had heard tales of snapping turtles and knew that fish felt slimy when you touched them. She had also seen movies like “Jaws” and others that highlighted dangerous things that might lurk in the shadows. She was terrified of entering the water and avoided it even though her friends were having a great time swimming in the sun.
With encouragement and a strong desire to see what she could do, she broke the challenge of entering the lake into smaller, more manageable steps and began the process of exposing herself to her fear. First she sat with her legs in the water and waited about 10 minutes for her anxiety to come down. When she was comfortable with that she eased more of herself in and stopped when she felt to afraid to continue. Again, she waited about 10 minutes until her fear came down and asked her friends to stay close by, ‘just in case.’ When she felt comfortable with that, she pushed off the rocks and moved cautiously out into the lake. She left the water after only a few seconds on her first try, but calmed herself and tried again. Within a few minutes her anxiety came down and she was able to swim farther out.
Although the young woman never totally lost her fear and continued to dislike it whenever her feet touched the slippery rocks below, she took the time to believe in herself. With exposure and the support of those around her, she discovered that she could actually cope with something that scared her.