The Ultimate Guide to Exposure Therapy for Phobia (4 Easy Steps!)

written by

This is a complete guide to exposure therapy.

In this guide you’ll learn

  • What exposure therapy is
  • The different types of exposure therapy
  • What exposure therapy can treat
  • How to practice it the right way
  • And lot’s more!

If you want to practice exposure therapy, this guide is for you!

Let’s dive right in!

The Reason you need Exposure Therapy

What is Exposure Therapy for Phobia?

So… you’ve made the decision to overcome your anxiety and read the word “exposure” multiple times. But what is exposure? And why should you expose yourself to your fears? It seems counterintuitive: scaring yourself when you don’t have to. But hang on!

Let’s tackle your first question: Why exposure? 

Your amygdala is responsible for activating your fight and flight response. Whenever it thinks you are in danger, it activates your fight or flight response in order to keep you safe from the perceived danger. 

Your amygdala only believes you are in danger, when it associated “danger” to a certain trigger or situation. The associating could have happened when you were very young or at a later stage in life. Sometimes you don’t even remember what got you scared. But your amygdala won’t forget the event that caused the fear. This explains why your trigger sometimes makes no sense to you. 

According to Healthline, the point of exposure is to willfully expose yourself to a certain trigger for your anxiety in order to associate safety with the trigger. But when you keep avoiding your trigger, it just reconfirms to your amygdala that the trigger is dangerous.

When you start doing exposure work, you create your fear ladder (see the end of the article) to successfully overcome your phobia.

With this fear ladder, you write down the least scary, and most scary behaviour. You pick the least scary behaviour and start exposing yourself to it until the fear is ideally 50% less intense. When you successfully expose yourself, you can gradually build up the intensity.

The criteria of good exposure therapy is to do it willfully and without using any safety behaviours.

What is a safety behaviour? For example: going to the cinema, but sitting near the exit in case you cannot escape. When you do this, the exposure therapy is not as effective.

Just remember that how bad you may feel, the wave of anxiety cannot hurt you. It’s just a feeling. 

These are the different types of exposure therapy

There are four types of exposure therapy and two different pacings of exposure therapy.

In Vivo Exposure

This means directly facing a specific trigger, situation or object in real life. This could be a fear of spiders or going to a party, if you have social anxiety.

Imaginal Exposure

If it is impossible to use in vivo exposure, like for someone with Posttraumatic Stress Disorder, imaginal exposure could be used. This person might be asked to recall his or her traumatic experience to generate feelings of anxiety, in order to reduce them.

Viritual Reality Exposure

Sometimes it is not possible to use in vivo or imaginal exposure. Then virtual reality exposure could be used to practice exposure therapy. This could be useful for having a fear of flying for example. 

Interoceptive Exposure

Most people with panic attacks fear physical sensations like a racing heart. To help them associate safety with this sensation, they might be asked to run in place in order to make his or her heart speed up. Then they have the opportunity to associate safety with the physical sensation.

Pacing #1: Flooding

This is the most intense form of exposure therapy, but often has the fastest results. When you created your fear ladder (see the end of this article) you will start to expose yourself to the scariest trigger/situation that causes anxiety. If you are scared of visiting the supermarket, you might want to start by doing groceries and standing in line to pay. 

Pacing #2: Gradual Exposure

On the other hand, gradual exposure is less intense. Again, you grab your fear ladder, but now you start to expose yourself to the “least” scary trigger/situation. When you successfully decreased your anxiety about the specific trigger, you go to the next step on the ladder, which is scarier.

What conditions can exposure therapy treat?

Exposure therapy is the most effective treatment for phobias to date. Why? Because it creates fast and lasting results when done correctly. Exposure therapy has been a helpful treatment for a range of phobias, including:

The Truth About Exposure Therapy…

But why does exposure therapy even work? Is just talking with a therapist not a better and more convenient way to overcome my phobia?

It sounds scary: exposing yourself to your fears. But just talking with a therapist is not nearly as effective as practising exposure therapy.

Do you know why?

Your amygdala is a very hard listener. It doesn’t like to listen to what you tell him: it wants you to show him things. You have to show that you are safe in order for him to believe it. 

That’s why simply telling yourself that there is no need to be anxious is not effective. You can maybe slightly decrease the anxiety you feel by changing the words you use, but showing your amygdala that you are safe is the fastest way to overcome your phobia.

Actually, your amygdala is like an overprotective parent. Arguing and fighting with it doesn’t help, but showing it you are safe, will make all the difference in the world. 

And when you expose yourself, understand that the more anxiety you feel during the exposure, the more effective the exposure therapy will be. That’s because your brain needs the anxiety in order to activate the neural pathways and rewire itself, because then those neural pathways are activated.

It’s worth practising… so let’s tell you how to do it!

How does exposure therapy really work?

Step #1: Make a list

The first step of exposure therapy is to make a list of the things you are anxious about. Be honest: what are you really anxious about?

Is it driving? Spiders? Public speaking? Or visiting a shopping mall?

Whatever it is, write them down and make a list. After you wrote down what triggers your anxiety, it’s time to order the list. 

Put a number behind every item on the list and order them from least, to most stressful.

For example:
Going to the mall (9)
Being in an elevator (6)
Talking to people at a party (2)

Decide which trigger or situation has the most impact on your life and generates the most anxiety. We are going to pick that specific trigger to work with. And related to the example above… it’s going to the mall.

Step #2: Make a fear ladder

The second step of exposure therapy is to create a fear ladder. 

Wouter, what on earth is a fear ladder?

It’s an ordered list of behaviours from least- to most scary, that generate anxiety and are related to going to the mall (because that is the trigger we chose in this case!).

When you create your fear ladder, decide the behaviour that is most scary to you. It is probably not driving by the mall, but standing in line to wait for the checkout.

The latter will be your most stressful behaviour. You can also think about your ultimate goal you want to achieve, which would probably standing in line without feeling excessive anxiety.

After you decided the most stressful behaviour, it’s time to decide the least stressful behaviour. Is it buying 1 item? Or just driving to the mall?

For this example, we are going to pick “driving to the mall”.

Now in between those steps you write down the intermediate steps that also cause some anxiety. Come up with at least 5 of these steps.

You can create more scenarios by:

  1. Changing the duration of the behaviour (doing things for 10 seconds or 1 minute)
  2. Time of day (day or night) 
  3. Environment (visiting a shop or a mall)

Let’s take a look at the intermediate steps for someone who is scared of visiting a mall:

  • Walking to the entrance of the mall
  • Walking around in the supermarket
  • Buying 1 item
  • Asking something to the sales clerk
  • Buying several items

After you created your fear ladder, write down how anxious you feel about each step on a scale from 0-100.

Fear ladder

Write down the least stressful behaviour on step number 1 and the most stressful behaviour on step number 10. After you filled out the entire ladder, you successfully created your exposure plan.

Step #3: Expose yourself to your fears

Now comes the exciting part: exposing yourself to your fears. This is the activity that will help you reclaim back your freedom in life.

Grab your fear ladder and start with the least scary thing to do: driving to the mall. Of course, you use your own steps, as this is just an example.

To successfully practise exposing yourself to situations, you have to plan and schedule your exposures. As explained above, your amygdala is responsible for activating your fight or flight response. It can only learn when you show it you are safe, and do so by repetition. Only then it starts to associate safety with the situation.

The more you practice, the less anxiety you’ll experience. When will you practice your exposure? Is it every Sunday morning? Every evening? Every lunch break? Write it down and commit to it. 

During your exposure, you’ll notice that your anxiety increases. That’s a sign you’re doing it right. The more anxiety you feel, the more effective the exposure will be, but only if you do it wilfully! Don’t do it because you have to… do it because you WANT it.

If you want to learn the response I teach my clients when they feel anxious, then download my FREE PDF before it expires!

Your anxiety will increase during the exposure, but that is a sign you are in a state of rewiring your brain to associate safety with the situation. Understand that you don’t have to fight your anxiety. The only thing you have to do is accepting the anxiety to rise, and letting it happen.

You stay in the situation long enough, until the anxiety is decreased by ideally 50%. This is what always happens if you stay in it long enough. Your amygdala doesn’t understand why you’re not running away and is now shown that the situation is perfectly safe.

If you find it hard to stay during the exposure therapy, practice deep breathing or sing a song in your head like: “You’re simply the best!” by Tina Turner! This helps you to believe in yourself.

Remember that no matter how anxious you feel: nothing bad can and will happen. Your anxiety is not reality, but a feeling… which is a chemical cocktail in your body. Never flee the situation, because that can make your anxiety worse, as you show your amygdala that the situation is dangerous, while it is perfectly safe.

To wrap up this step: start with the least scary thing and practice it over and over again, until you’re no longer extremely anxious about it. Then you go to the next step in your fear ladder.

Plan your exposure, keep doing it and repeat it.

Step #4: Reward yourself

No, you’re not done yet. It’s time for step 4: rewarding yourself! After you successfully exposed yourself to your fear, it’s time to celebrate!

I want you to reward yourself and celebrate your bravery. It takes strength and courage to expose yourself to your fears: but you DID IT!

I used to dance and cheer when I came home after I exposed myself to my fears. I turned up the volume and started cheering that I exposed myself to my fears and sang: “you’re simply the best,” or “I’m so excited”.

Not because I have a big ego, not at all. I did it, because then my mind connects celebration to exposing myself.

That means that the next time I expose myself, my brain knows that when I successfully exposed myself, it’s time for a party.

Big tip: what are you going to do when you successfully exposed yourself to the most stressful behaviour on your fear ladder? A holiday? A massage?

Treat yourself. 

Takeaway

You now understand how exposure therapy for phobia works. You gained a better understanding of what phobias exposure therapy can treat, the different types of exposure therapy and why it works. Exposing yourself to your fears and phobias will help you overcome your phobias very fast, if you do it correctly. I highly recommend you find a therapist who could help you with exposure.

If you want to take the next steps on Freeing yourself from anxiety, then watch my FREE Training where I explain the top 3 mistakes anxious people make and what to do instead. 

Recommended to Read Next

Wall 1

Author: Wouter Manders

Wouter is a mindset coach from The Netherlands. For many years he suffered from depression and anxiety. It gave him the motivation to coach people on overcoming their anxiety, out of first hand experience. With more than 6000 blog visitors a month he helps many people on their road to having less anxiety.

About Wouter

Wouter is a mindset coach from The Netherlands. For many years he suffered from depression and anxiety. It gave him the motivation to coach people on freeing themselves from anxiety. With more than 6000 blog visitors a month he helps many people on their journey towards less anxiety.

Do you want less anxiety today?

Watch this FREE Limited Time Training on how to Free Yourself from Anxiety in 60 days!

Share Post

New Posts

YouTube

Masterclass Blue

Watch FREE Training

Learn my 3 step framework to Free Yourself from Anxiety in 60 Days, by watching this limited time free training.

On Trend

Most Popular Stories

Masterclass Blue

Watch FREE Training

My 3 Step Framework to Free Yourself From Anxiety

SNAG YOUR FREE SEAT