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What is exposure and how does it relate to CBT?

As explained in the spectrum of responses to anxiety post, the spectrum of responses to anxiety an individual could display ranges from avoidance to exposure. The belief of a person who avoids is that he or she is in danger. In contrast, the belief of a person who exposes herself to the anxiety on purpose is that the anxiety is an opportunity to learn.

Exposure is the willing act of putting oneself in psychological and physical situations that induce fear and anxiety. 

Willing exposure is challenging in the moment of anxiety, but in the long-term it decreases anxiety. 

One theory of why exposure works is habituation. This theory understands the fear response to be similar to other senses. For instance, if you were to enter a room that smelled distinctly, if you stayed there, after a little while, your sense of smell would adapt to the smell in the room and stop notifying you of the smell. If, one the other hand, you left the room and reentered repeatedly, you’d notice the smell anew each time. In the first situation you are habituating. In the second situation you are not. 

As it relates to anxiety, the theory is that you expose yourself to the fearful stimuli until your anxiety decreases and overtime you’d become less and less anxious when presented with the trigger. 

Another more recent theory is suggests that habituation isn’t as important as willingness to have the sensations, thoughts, and behavioral urges that accompany anxiety. The willingness is important because of the cognitive component of anxiety. Unlike your sense of smell, which habituates regardless of what you think about the smell, anxiety increases and decreases based on how you interpret the situation. That is, if while your heart is beating quickly or you have unwanted intrusions or you cross over a bridge, you think to yourself, “This really is dangerous” or something equivalent, your brain will pump more of the fear response through your body and you will feel more afraid.

Again, this is unlike your sense of smell in that even if you thought, “this really smells bad” you would still eventually stop noticing the smell. The way in which cognitive interpretation  influences the fear response is called anxiety sensitivity, or second fear. Anxiety sensitivity is responsible for anxiety disorders, not anxiety states themselves. 

Thus, exposure in and of itself is not sufficient for overcoming anxiety disorders. Exposure must be done the right way. Exposure is done the right way when the individual understands the point of exposure and she willingly exposes herself to the possibility of anxiety with the belief that experiencing anxiety will actually help her body learn that she is not in danger, over time. 

Frequently when an individual embodies this attitude he will not feel anxiety. This attitude effectively conveys to the mind that it is not in danger! However then individuals start trying to trick their minds into wanting the anxiety, when they truly prefer not to have it. This is a common experience in the process of therapy: individuals start exposing themselves and get quick relief. Then, if they still fear anxiety, it is likely to come back or pop up at different times. You cannot trick your own mind. The attitude of acceptance towards the thoughts, sensations, and behavioral urges that occur when the fear response is triggered must be authentic for long-term relief.