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Exposure is a lifestyle, not a technique

Cognitive behavioral therapy is known for its techniques, including self-monitoring, cognitive restructuring, exposure, and relaxation training. The original theory was that a skilled clinician can apply techniques to get her client to think differently and the consequence of thinking differently would be behavior change and provide relief from suffering.

From this perspective, although the clinician acknowledged the impact of the relationship, she was functioning a lot like a physical therapist. That is, the physical therapist knows more about the body than the client and can teach the client to manipulate her body through practice in ways that will provide relief. Similarly, a cognitive behavioral therapist knows more about the mind and its interactions with the body than the client, and the therapist can teach a client to practice thinking and behaving in ways that will provide them relief. For many interventions related to behavior change, this parallel continues to be accurate. 

Exposure, however, needs to be understood as a a way of being, not as a technique to apply. My post about exposure described what it is and how it relates to CBT. Willing exposure requires an attitude shift. It requires the person who has previously experienced his anxious thoughts, sensations, and urges as dangerous to practice thinking about his anxious thoughts, sensations, and urges as an opportunity. 

People often get relief when they first try exposure, because it’s so different than how they had previously interpreted those thoughts, sensations, and urges. However, if an individual starts using exposure as a technique that helps alleviate her anxiety, in the long-term she will not actually learn to embrace uncertainty. In the long-run, she will not get relief. 

Guided exposures give a client the chance to practice adopting the new attitude in the presence of the therapist. The therapist helps them practice gradually and points out where their thinking perpetuates their anxiety. Eventually the client learns to practice exposure alone. Indeed, exposure shifts from being a homework assignment done for therapy to an attitude towards one’s thoughts and feelings that is embraced on a daily basis.