Facing Fear: The Power Of Exposure

Facing Fear

“Whatever your emotional vocabulary, no one signs up for anxiety, fear and shame, or for any difficult, uncomfortable emotion. But we can’t avoid these feelings, either. I am convinced that the more we can look at these uninvited guests in the eye, with patience and curiosity, and the more we learn to spot their wisdom as well as their mischief, the less grip they will have on us.”

The above quote is from pgs 12-13 of “The Dance of Fear” by Harriets Lerner.  It summarizes so much of what I discuss early in therapy when someone comes to me hoping for a quick fix to lessen their anxiety.  The truth is that anxiety treatment can, in some situations, be relatively quick.  In fact, the reason I specialize in anxiety treatment is that it’s effective.  The vast majority of the time if someone comes in truly motivated to work on their anxiety, we are able to get them to a place where they feel less anxious, more confident and more free to be themselves.

But it’s not easy.  Anxiety treatment is never easy.  Even when it’s quick, it feels uncomfortable.  Why? Because it involves facing your fears.  It involves inviting that fear, that anxiety, even that shame in for a cup of tea and a long conversation.  When you come to counseling for fear, anxiety, shame or trauma you will be learning to face and even sit with the very emotions you want to eradicate from your life.  You will be facing your fear head on.

So, no, anxiety treatment isn’t for the faint of heart.  If you want a quick way to ignore your emotions, please look elsewhere.  But if you want something effective, you’re in the right place.

First Things First

All of that said…you don’t go through this alone.  We don’t just send you out into the world saying “Go do the thing your most afraid of! Good luck!”  Instead, a good therapist works with you.  We get to know you and build a relationship.  We ask questions so we can understand where your fears come from.  Did you have a single bad experience?  Was a story you heard from a friend so horrific that you live in fear of the same thing happening to you?  Or have you experienced years and years of harassment, abuse or disdain from others?  In a good therapeutic relationship, you’ll feel supported and understood by your therapist first and foremost.  We’ll help you discover the wisdom of your fear and where in your life that anxiety made sense.  You’ll learn to appreciate the role that anxiety may have played in helping you stay safe at some point in your personal history even.

Safety Above All Else

The next thing we’ll do is make sure you are truly safe.  A therapist never wants to put you in emotional or even physical danger.  If you are afraid of an abusive spouse for instance, we don’t want to encourage you to go be more vulnerable and open yourself up to even more pain.  If you’re afraid to confront your rapist, we won’t tell you to go chew him out in the middle of a college campus.  In fact, my college clients often don’t even feel safe reporting a rapist to the Title 9 office and when I seek to understand why that feels unsafe to them there are times where they have good reason to view that as unsafe.

I give these examples, because I want you to understand that exposure therapy for anxiety is never about putting you in danger.  We want to set you up for success, not failure.  Sometimes when people tell themselves that they need to “get back on the horse” or invalidate their own feelings of fear by saying, “Just get over it” and go back to a situation that was previously unsafe their anxiety gets WORSE because they have another unsafe (emotionally or physically) experience.  Putting yourself in grave emotional danger or any physical danger rarely helps anxiety in the long run.  So…safety first.

Coping Skills for Anxiety

The next big thing we do before starting exposure work is help you learn some coping skills.  We’ll work on grounding skills such as breathing exercises, grounding rocks or using the five senses.  These techniques help take you out of the swirling negative predictions going ’round and ’round in your head and back into the reality of the present moment.  These techniques can be powerful antidotes to anxiety in the moment.  A trained anxiety therapist can work with you to help you find the best ways for you to cope with your anxiety.  Learning to cope with your anxiety as soon as it starts is a critical step and must happen before exposure work can begin!

Exposure: The “Cure” for Anxiety

Exposure therapy means systematically, with the assistance of a trained anxiety or trauma therapist, facing the very things that cause you anxiety.  Basically, it’s the more advanced version of “getting back on the horse.”  When done skillfully, it is the single most effective treatment for anxiety.

Fear of Rejection: Standing at the Bottom of an Escalator

In The Dance of Fear (great book-I recommend reading if if anxiety, fear & shame are issues in your life), Harrier Lerner talks about a man who came back to her office after a break from therapy because he was afraid to ask a female coworker on a date.  He had previously worked with Dr. Lerner prior to his divorce so they had already established a therapeutic relationship and in her book she asserts that he was “cured” of his anxiety in a day.  How?

Dr. Lerner and the male client re-defined his problem as instead of being a fear of rejection it was a lack of experience being rejected.  His assignment then was to go to a busy local area (actually it was the Kansas City Plaza for those of us familiar with KC), stand at the bottom of an escalator and ask random women to have coffee with him.  Now, he wasn’t to do it in a harassing way but instead in a very polite way.  His therapist helped him differentiate what would be harassing and gave him a very specific script so he wouldn’t have to even think about what to say.  His assignment was to rack up 75 rejections.  The idea was that this super motivated client (he REALLY didn’t want his anxiety about asking a woman out to hold him back) just needed to get more experience being rejected so it wouldn’t seem so scary.  By the end of the day he had actually called the woman he was so afraid of asking out and invited her to coffee.

Moral of the story? If fear of rejection is holding you back, look for safe ways to gain experience with rejection in a low risk setting.

Fear of Social Disapproval: Breaking Social Norms

In high school I was (as so many teenagers are) horribly afraid of social disapproval.  I lived my life trying to do everything “right.”  I think to some extent I still do this, but it was pretty extreme in high school.  I remember an assignment in my high school psychology class (best HS class ever, thank you to the amazing Mr. Drennon!) during our unit on social norms.  My favorite (ok, I’ll admit it, I had a few favorite teachers…most of which were in the social studies department at Rock Bridge) teacher had taught us that social norms were things we just expected people to do.  He then assigned us to go out and break a social norm.  Don’t worry, this was a very responsible teacher who explained that we were NOT allowed to break any laws.

For this assignment, my peers walked backwards down a public sidewalk (or the very crowded RBHS hallway), laid on the ground, spoke too loudly, etc.  I personally racked my brain for a “safe” option so I could still get my grade without humiliating myself.  Eventually I settled on standing backwards on an elevator.  From my own experience and that of others, I learned to laugh at something I was usually afraid of-social disapproval.  It was easier to handle the disapproving glances knowing that I was purposefully garnering it.  But I often think back on that experiment when I worry too much what other people are thinking.

Fear of a Panic Attack: Exposure to the Symptoms

In my career I’ve had the honor of treating several individuals with Panic Disorder.  It’s a little bit different than other forms of anxiety treatment.  You see, if someone is afraid of public speaking it’s pretty easy to assign them therapy homework to gradually speak in front of more and more people. But what do we do when the fear is of fear itself?

With panic disorder, people experience panic attacks seemingly out of nowhere.  They’re fine one moment and feel like they can’t breathe or see straight the next.  Eventually after a person has had a few intense episodes like this, they might start to worry that they could have a panic attack at any time.  This can make leaving the house or even driving feel scary.  I use a manualized anxiety treatment for panic disorder, but it follows pretty much the same format as any other anxiety treatment.  We start with psychoeducation about anxiety and panic.  Then we do grounding and breathing work.  Next…exposure.  It’s just that exposure here means exposure to the symptoms of a panic attack.

In all honesty, this is one of my favorite things to do in session.  It feels silly at first, but it works.  We go through a list of common panic attack symptoms and the client checks off the ones they most commonly experience during a panic attack. Then we purposefully evoke those symptoms.  Usually it’s a 30 second-2 minute exposure followed by immediately using a grounding technique of the client’s choice.  So…if you ever drive by my office and see me outside spinning around with a client, running and lifting our knees up high or breathing through straws, have a laugh with us and know we’re doing really effective (and fun!) anxiety or panic treatment!

Fear of Thinking About a Trauma: Imaginal Exposure

Ok, this one is a lot less fun.  But very effective.

The most intense type of therapy I’ve ever done in my life is Prolonged Exposure (PE).  PE involves something called imaginal exposure where the person has to repeat their trauma narrative (in other words-they tell the story of their trauma) over and over again.  It’s intense.  I fully admit I usually cry the first time I hear someone tell their story.  Real tears because even though I’m a trauma therapist, I’m also a real person who cares about the pain I’m hearing someone relive.

Why do this super intense trauma intervention? Because it works.  Jennie and I were talking last week and between the two of us, we’ve known exactly one client to ever complete the Prolonged Exposure protocol and still have symptoms of PTSD.  It’s effective.  It hurts like all get out.  In fact, it is so intense that I usually see clients twice a week while we’re doing imaginal exposure.  So, they come into my office twice a week for around 8-12 weeks.  Usually the first appointment is the imaginal exposure and the second is processing.

But the imaginal exposure works.  It’s almost a miracle how having people FACE the memories they’ve been trying so hard to avoid and suppress helps them get free and unstuck.  Imaginal exposure is painful.  But the freedom people gain from facing their worst memories?  That’s priceless and life changing.

There’s an Art to Exposure for Anxiety & Trauma

Now, should you go out and start exposing yourself to every memory, place, person or thing you’ve been avoiding?  I don’t know, because I don’t know your unique situation.  The truth is that there’s an art to exposure therapy.  Perhaps if you have a simple fear of introducing yourself to new people you can do exposure on your own by going to a local mall and introducing yourself to 75 people tomorrow.  But if your anxiety or fear is more complicated?  A trained, specialized therapist can help you make sure that your exposure work has the best possible chance of success.

Start Anxiety Treatment in the Mid Missouri Area Today

While most therapists will treat someone with anxiety, not all therapists specialize in this area.  We are a Columbia, MO based counseling practice with therapists who specialize in treating trauma, anxiety, grief & overwhelming stress..  We know the art of anxiety treatment.  We can pair you with a therapist who specializes in your specific type of anxiety.  Have a fear of being rejected for your gender identity or sexual orientation? We have someone who can help!  Are you trying to avoid memories of a loved one who recently passed away? Our grief and loss therapists can help!  Is a memory of a sexual assault haunting you and your attempts to avoid it starting to disrupt your life? Our trauma therapists can help you face that horrible memory.  Whether you’re afraid of shots, escalators, dating, rejection, new places or something else our specialized anxiety therapists can help.

Please contact Aspire Counseling via e-mail or by calling 573-328-2288 today to start anxiety treatment.  Fear doesn’t have to hold you back.

About the Author

Jessica Tappana MSW, LCSW is the founder of Aspire Counseling.  She is passionate about helping people improve their mental health, get unstuck and find ways to live a full, meaningful life.  Jessica specializes in the treatment of PTSD and extreme anxiety. However, her biggest specialty has become working with survivors of sexual assault.  She enjoys working with teenagers, college students & adults in her therapy practice.