Exposure therapy: what it is, and how to do it yourself

Hi everyone!

Following on from last week's post, I thought I'd do a quick 'demystifying exposure therapy' post this week. Exposure therapy is one of the most effective forms of treatment for phobias (this review says it's THE most effective!), but because it sounds intimidating lots of people don't want to try it. Personally, I 100% credit doing my own exposure therapy to my recovery, so I'm excited to share just why I think it's so brilliant with all of you!

What is exposure therapy?

Exposure therapy is a form of therapy that works by exposing sufferers to feared stimuli in a controlled environment and then preventing them from engaging in safety-seeking or reassurance behaviours (e.g. escape, using hand sanitiser, performing rituals). That sounds like a lot of jargon, but what it essentially means is that you face your fears gradually in a safe space. You either repeat the anxiety-inducing task or sit in the presence of an anxiety-inducing stimulus stimulus until it no longer makes you anxious.

However, you don't get thrown in the deep end! The first thing that you'll do when preparing for exposure therapy is draw up a fear hierarchy. This is a list of triggering situations/stimuli that are ordered from least anxiety-inducing to most anxiety-inducing. You might draw up several hierarchies that focus on different aspects of your phobia, such as social aspects, bodily sensations, and travel. Your therapist will then teach you techniques to reduce anxiety. When having exposure therapy, you start from the bottom of your hierarchy (for example, you might start by taking a short bus journey) and you only move up to the next stage when you have no anxiety at all in the level you're on. Throughout the exercises, you'll use techniques such as breathwork to mitigate any anxiety you might be feeling.

Why does it work?

Exposure therapy is based on the behaviourist approach to explaining phobias (for more on this approach and explanation, click here for last week's blog post!), which essentially says that all phobias are caused by learning an association between being s*ck and negative emotions such as pain, terror, and anxiety. This association is learned and strengthened over time, as every time we come across an anxiety-inducing situation and we don't face it head-on, we reinforce the connection. Exposure therapy aims to de-condition the learned response by helping sufferers to make a new association between being s*ck and calm, rather than stress and anxiety.

How do I do it myself?

If you follow me on Instagram, you've probably heard me talk about "DIY exposure therapy" as my 'holy grail' in emetophobia recovery! I didn't get any professional help for my phobia until I was 17, and even then I only spent two NHS CBT sessions looking at it (which quite frankly didn't help as I already knew the CBT model for emetophobia!). By the time I had CBT I'd also made leaps and bounds with my phobia through my own exposures, so it wasn't really necessary by that point!

Over the past 3 years or so (since I knew that exposure therapy was a legitimate thing!), I’ve been doing exercises designed to tackle different aspects of my phobia. For example, recently I've been pushing myself to perform less escape and safety-seeking behaviours when someone is s*ck. This has been a great way of doing it for me, as it allows me to expose myself to actual v***t without the contamination aspect. And you know what? It’s working!

So, here’s how to do exposures in a way that feels manageable and safe (there’s nothing wrong with making it planned and as comfortable as possible – it’ll hopefully prevent you from chickening out!):

1. Decide which aspect of your fear you’re going to tackle. (I suggest doing one aspect at once to start with as it feels more manageable (that’s what I’ve been doing), but you can work on them all at once if you choose to.)

2. Draw up a hierarchy of fears for that aspect. For example, I divided people being s*ck at parties into leaving the room but hearing them, staying in the room for 1 second before leaving, then 3 seconds, then 5, then longer all the way until holding someone’s hair back for them while they’re being s*ck (I'm almost there, but not quite yet!).

3. Begin to work up your hierarchy in a manageable way. Don’t move up a level until you feel completely comfortable at the lower one. For example, I only moved to seeing someone be s*ck when I was completely comfortable with hearing someone be s*ck.

4. Keep going and don’t be disheartened! If you need to move back down a level or you have a wobbly moment, don’t beat yourself up about it. Remove yourself from the situation, breathe, and try again another time. I’ve had to move up and down my hierarchy loads of times, as sometimes stress and other anxieties can make things more difficult.

And that’s it! The best thing about exposures is that if you’re willing to, you can absolutely do them on your own. If you need some encouragement, it might be worth doing it with a professional (or even a parent or friend), but personally I’ve been able to force myself to do it alone. Just remember that you want to get rid of your fear, and the only way to do that is to do the (sometimes unpleasant) exposures. Whenever I want to leave an uncomfortable situation, I repeat “three more seconds” to myself over and over again. It kind of turns it into a competition with myself to push as far as I possibly can.

A really good place to start for me was exposures with words, so if you're wondering where to begin I'd recommend that. Here's an example of my own process too, if you're still unsure how it all works!

My words exposure process

1) I put a list of triggering words in order of least to most triggering (this started with s*ck and ended with v***t). For me, the jump from word to word was quite significant, so I worked on one word at a time and only moved onto the next word when I was totally comfortable with the previous one.

2) I typed the word, and read it over and over again until it no longer made me feel uncomfortable.

3) I hand wrote the word over and over again, until I felt comfortable.

4) I googled a clip of someone saying the word ("Emma saying" on youtube is quite good for this!) and listened to it over and over again until I was comfortable.

5) Finally, I said the word out loud over and over again until I didn't feel anxious saying it.

6) At this point, I moved onto the next list on my hierarchy, and kept repeating steps 2-6 until I'd conquered all of them!

Good luck with your exposures – hopefully they help! Let me know if you need further explanation or motivation, either on instagram or by emailing emetophobia.alice@gmail.com.

~ Alice