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Happy Monday and welcome to your
mental health mini. 

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This week we have a solo and we 
are talking all things exposure 

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therapy. 
I really do see exposure therapy

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as the anecdote to any type of 
avoidance, anxiety, emotional 

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aversion, whatever you want to 
call it. 

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Whenever those feelings come up 
for me, I'm like OK, it's time 

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for some exposure. 
So what is exposure therapy? 

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The basic idea of exposure 
therapy is that you were 

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exposing yourself to the thing 
that is causing anxiety, fear, 

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etcetera, and a small safety 
doable way. 

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You are slowly building yourself
up to the thing that makes you 

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so anxious and so overwhelmed. 
And as you get more effective 

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with your ability to cope with 
the emotions that arise, to 

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shift the thoughts you're 
having, you're able to overcome 

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the anxiety, the phobia, the 
thought pattern, etcetera. 

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If you are doing exposure 
therapy, the way that I would 

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approach this and the way that 
I've approached this in the past

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is I would do an exposure 
hierarchy. 

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So what I would do is I would 
write down the thing that I am 

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most afraid of and most scared 
of. 

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So if it is public speaking, 
you're going to say my biggest 

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fear that I am going to have to 
navigate as I have to give a 

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speech at the end of the 
semester. 

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And I have so much anxiety. 
The idea of doing that makes me 

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want to like throw up, faint, 
run away, drop out of college. 

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If that's your fear, that is 
going to be at the top of the 

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hierarchy. 
That's what we're working up 

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towards. 
And you're going to work 

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yourself backwards. 
You could say like what is one 

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step below giving a speech? 
Maybe it is in the room watching

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other people give their 
presentations and knowing that 

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you probably are going to be 
next. 

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And maybe below that is 
practicing giving a presentation

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to a friend or two. 
And then below that, maybe 

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you're giving the presentation 
in an empty classroom. 

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Before that, maybe you're 
prepping for the presentation, 

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you're creating your slides, 
you're preparing your speaker 

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notes. 
Then maybe it's watching a video

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of someone that is giving a 
presentation and like the very 

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lowest freebie almost is 
mentally going through the 

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process of giving the 
presentation. 

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Again, this will be different 
for everyone, it's so 

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subjective, but you're going to 
make this hierarchy that feels 

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very doable to move from one 
step to the next and you want to

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have these be things you can 
check off. 

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Yes, I did this or no I didn't. 
We want to be really specific. 

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Are you exposing yourself to the
physiological sensation of being

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short of breath? 
Are you mentally going through 

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the thought process that might 
come up when you're giving your 

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presentation? 
Are you imagining the worst 

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possible scenario that could 
happen and coping through that 

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worst case scenario in your 
head? 

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So once you have your exposure 
hierarchy, you are going to 

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begin process of coping ahead. 
So if we use the example of 

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maybe the thought of going to 
the gym is like so anxiety 

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provoking for you, but the cope 
ahead skill, we are planning 

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exactly how we're going to cope 
with the situation. 

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You're going to describe the 
situation. 

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You're texting your friend to 
make the appointment to go to 

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the gym. 
You are walking to the gym with 

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your friend. 
You're swiping your card in. 

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Maybe you're filling up your 
water bottle. 

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You're getting to the treadmill,
you're putting the treadmill on.

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Are you listening to music? 
Are you talking to your friend 

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and you're also going to 
describe what potential anxiety 

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might come up for you? 
Are you anxious when you're on 

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the treadmill? 
Are you anxious before you enter

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the building? 
Like what are the pain points? 

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You're being super specific and 
you're also using the check the 

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fact skill here. 
So if you're like, what's going 

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to make me most anxious is when 
I fall off the treadmill on my 

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face in front of everyone and 
the whole gym laughs at me and 

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kicks me out and tells me that 
I'm never again allowed to go to

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the gym. 
We got to check the facts there.

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That's probably not going to 
happen. 

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Yes, you could fall off the 
treadmill, but the most likely 

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course of events, if that 
happens, we were like, Oh my 

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gosh, are you OK? 
You're going to get back on the 

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treadmill. 
You're going to keep doing your 

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thing. 
No one is going to ban you from 

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the gym for the rest of your 
life. 

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So we are writing down the 
possible situations that might 

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happen, but we're also being 
realistic. 

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And then you're going to decide 
what coping skills you're going 

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to use when. 
So if I was going to the gym, I 

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would really lean on 
distraction. 

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I'd be like, OK, I know that 
like I really have a lot of time

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to be in my head and get 
overwhelmed once I'm on the 

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treadmill. 
So I'm going to scroll on TikTok

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because that's super engaging 
and at least in the short term 

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that will distract me. 
I'm also going to practice deep 

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breathing. 
I don't want to be totally out 

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of breath while I'm walking on 
the treadmill. 

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So I'm going to pace my 
breathing with my walking. 

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So these are some examples of 
skills you would use. 

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So go through, see what the most
overwhelming things that would 

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happen in this anxiety provoking
situation are and you're going 

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to plan what coping skills you 
are going to use and this you're

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even going to mentally go 
through it. 

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So you're imagining yourself 
doing it. 

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You're imagining yourself coping
with the skills, you're 

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imagining rewiring the thoughts 
that are coming up. 

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You're imagining doing your 
distraction, doing your deep 

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breathing, getting through the 
situation effectively, and then 

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you always want to make sure 
that after these really intense 

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emotional situations, you're 
recharging, you are doing some 

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self-care. 
You're going to be like, OK, 

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next week is my next item on the
exposure therapy hierarchy. 

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You're not like, let me bang out
all ten of these exposures right

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at once. 
We always want to get back to 

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our baseline after being in the 
situation that is making us 

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anxious. 
So once we have gone through the

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motions, we've done the thing 
that makes us anxious, we've 

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used our skills, we've overcome 
that anxiety in a way that is 

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safe, that is not overwhelming, 
that's not causing us to avoid 

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more. 
We can check that item off the 

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exposure therapy hierarchy. 
And as we keep moving up this 

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hierarchy, over time, our level 
of fear, our level of avoidance,

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our level of anxiety will 
decrease. 

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And this is the beauty of 
exposure therapy. 

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Every single time you check off 
this thing on your hierarchy, 

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you are getting better. 
Using your coping skills, you 

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are getting better and 
navigating anxiety, thought 

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patterns, avoidance, whatever it
is. 

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And it gets easier with time.