Let’s talk about exposures and what they are, and aren’t. I’m always surprised by the number of people that hear the word “exposure” or the phrase “exposure therapy” but completely misinterpret what it means. This is impactful because it leads many members of our community to conclude that either exposures do not work for them, or that they are simply unable to grasp the concept or do it right. This can lead to feeling stuck in recovery, and in needless negative self judgment.
Let’s take a look at a few statements that represent what exposure is, and one that represents what exposure is not.
EXPOSURE
“I am planning to put myself into a situation that I expect will trigger anxiety or panic. I intend to feel those things so I can practice moving through them more productively. I do this consistently and often, making it more challenging as I get better at doing it.”
EXPOSURE
“My thoughts or internal experiences (like DP/DR) trigger me randomly so I can’t plan them but when this does happen I will allow it and do my best to feel what I feel while working through it more productively by not treating it like an emergency.”
EXPOSURE
“Life is forcing me to do a thing I am afraid to do because I fear how I might feel if I do it. I don’t like this but I will intentionally accept those feelings if they happen, understand that there’s a good chance that they will, and do my best to use the experience to practice handling them more productively.”
NOT EXPOSURE
“When I’m having a good day I try to do some things that I normally avoid. I hope - or actively work - to prevent anxiety when I do this. If I do feel anxious or panic, I do what I can to stop the feelings with all my coping skills or I end the event and go back to my safe place. I don’t know when my next try will be. It depends on how long it takes me to get over the anxiety or panic that happened.”
The first three statements are indicative of productive use of exposure (and don’t forget the response prevention part too). This leads to learning and progress, even when that progress is slow. Slow is OK. Slow counts. Do not beat yourself up when things feel like they are not going fast enough.
The last statement is indicative of randomly interrupted avoidance, which is not really exposure. This leads to frustration, even more avoidance, and a mistaken belief that your anxiety is special or worse and that you might not be able to get better. This approach is based on the mistaken idea that you are supposed to do exposures while preventing panic or anxiety. That is completely wrong because the entire point of doing exposure is to intentionally trigger the things you’re trying to prevent. You are not failing if you panic while doing an exposure or meeting a life challenge. You are learning, if you are open to the experience and can allow the lesson.
So if you feel like you have been doing exposures, but your exposure looks or sounds like that last statement in the list, it might be time to stop and re-think your approach. You may be feeling frustrated or discouraged, but there’s every chance that you can address that feeling by getting more familiar with the premise of exposure and how it works, then moving in a new direction.
117. What Is Exposure What Is Not Exposure?