Happy Monday and welcome to your mental health mini.
This week we have a solo and we are talking all things exposure
therapy. I really do see exposure therapy
as the anecdote to any type of avoidance, anxiety, emotional
aversion, whatever you want to call it.
Whenever those feelings come up for me, I'm like OK, it's time
for some exposure. So what is exposure therapy?
The basic idea of exposure therapy is that you were
exposing yourself to the thing that is causing anxiety, fear,
etcetera, and a small safety doable way.
You are slowly building yourself up to the thing that makes you
so anxious and so overwhelmed. And as you get more effective
with your ability to cope with the emotions that arise, to
shift the thoughts you're having, you're able to overcome
the anxiety, the phobia, the thought pattern, etcetera.
If you are doing exposure therapy, the way that I would
approach this and the way that I've approached this in the past
is I would do an exposure hierarchy.
So what I would do is I would write down the thing that I am
most afraid of and most scared of.
So if it is public speaking, you're going to say my biggest
fear that I am going to have to navigate as I have to give a
speech at the end of the semester.
And I have so much anxiety. The idea of doing that makes me
want to like throw up, faint, run away, drop out of college.
If that's your fear, that is going to be at the top of the
hierarchy. That's what we're working up
towards. And you're going to work
yourself backwards. You could say like what is one
step below giving a speech? Maybe it is in the room watching
other people give their presentations and knowing that
you probably are going to be next.
And maybe below that is practicing giving a presentation
to a friend or two. And then below that, maybe
you're giving the presentation in an empty classroom.
Before that, maybe you're prepping for the presentation,
you're creating your slides, you're preparing your speaker
notes. Then maybe it's watching a video
of someone that is giving a presentation and like the very
lowest freebie almost is mentally going through the
process of giving the presentation.
Again, this will be different for everyone, it's so
subjective, but you're going to make this hierarchy that feels
very doable to move from one step to the next and you want to
have these be things you can check off.
Yes, I did this or no I didn't. We want to be really specific.
Are you exposing yourself to the physiological sensation of being
short of breath? Are you mentally going through
the thought process that might come up when you're giving your
presentation? Are you imagining the worst
possible scenario that could happen and coping through that
worst case scenario in your head?
So once you have your exposure hierarchy, you are going to
begin process of coping ahead. So if we use the example of
maybe the thought of going to the gym is like so anxiety
provoking for you, but the cope ahead skill, we are planning
exactly how we're going to cope with the situation.
You're going to describe the situation.
You're texting your friend to make the appointment to go to
the gym. You are walking to the gym with
your friend. You're swiping your card in.
Maybe you're filling up your water bottle.
You're getting to the treadmill, you're putting the treadmill on.
Are you listening to music? Are you talking to your friend
and you're also going to describe what potential anxiety
might come up for you? Are you anxious when you're on
the treadmill? Are you anxious before you enter
the building? Like what are the pain points?
You're being super specific and you're also using the check the
fact skill here. So if you're like, what's going
to make me most anxious is when I fall off the treadmill on my
face in front of everyone and the whole gym laughs at me and
kicks me out and tells me that I'm never again allowed to go to
the gym. We got to check the facts there.
That's probably not going to happen.
Yes, you could fall off the treadmill, but the most likely
course of events, if that happens, we were like, Oh my
gosh, are you OK? You're going to get back on the
treadmill. You're going to keep doing your
thing. No one is going to ban you from
the gym for the rest of your life.
So we are writing down the possible situations that might
happen, but we're also being realistic.
And then you're going to decide what coping skills you're going
to use when. So if I was going to the gym, I
would really lean on distraction.
I'd be like, OK, I know that like I really have a lot of time
to be in my head and get overwhelmed once I'm on the
treadmill. So I'm going to scroll on TikTok
because that's super engaging and at least in the short term
that will distract me. I'm also going to practice deep
breathing. I don't want to be totally out
of breath while I'm walking on the treadmill.
So I'm going to pace my breathing with my walking.
So these are some examples of skills you would use.
So go through, see what the most overwhelming things that would
happen in this anxiety provoking situation are and you're going
to plan what coping skills you are going to use and this you're
even going to mentally go through it.
So you're imagining yourself doing it.
You're imagining yourself coping with the skills, you're
imagining rewiring the thoughts that are coming up.
You're imagining doing your distraction, doing your deep
breathing, getting through the situation effectively, and then
you always want to make sure that after these really intense
emotional situations, you're recharging, you are doing some
self-care. You're going to be like, OK,
next week is my next item on the exposure therapy hierarchy.
You're not like, let me bang out all ten of these exposures right
at once. We always want to get back to
our baseline after being in the situation that is making us
anxious. So once we have gone through the
motions, we've done the thing that makes us anxious, we've
used our skills, we've overcome that anxiety in a way that is
safe, that is not overwhelming, that's not causing us to avoid
more. We can check that item off the
exposure therapy hierarchy. And as we keep moving up this
hierarchy, over time, our level of fear, our level of avoidance,
our level of anxiety will decrease.
And this is the beauty of exposure therapy.
Every single time you check off this thing on your hierarchy,
you are getting better. Using your coping skills, you
are getting better and navigating anxiety, thought
patterns, avoidance, whatever it is.
And it gets easier with time.