Anxiety: Treatment – Exposure Therapy In Vivo

Exposure therapy has for many decades been one of CBT’s most powerful and effective methods to help clients, who limits their life by avoiding objects, activities and situations they fear, to confront their fears.

The foundational reasoning is that the normal human tendency/learning strategy of avoiding what is feared can reduce fear in the short run, but in the long run often makes fear worse, restricts one’s life and also has a tendency to spread to more areas of life over time.

Last post was about imaginal exposure, exposing oneself to one’s fears by visualizing the feared object, activity or situation. Today’s post is about exposure in vivo, that is, confronting in reality the feared object, activity or situation. I have chosen the fear of riding in an elevator as an example.

The first step is to make an exposure hierarchy like the one in the picture. The exposure hierarchy consists of feared activities with regard to what is feared ranked as steps on a scale of 1 minimal level of experienced distress to 10 – the maximum level of distress, SUDS – subjective units of distress scale. Hence, the exposure hierarchy shows different feared scenarios at the step of self-rated level of discomfort of actually doing the posted action.

Thereafter, activities on level 4 to 7 are performed, if necessary using the anxiety/stress reduction techniques posted under stress, see www.jennyrapp.com. The activities are repeated several times, days and weeks until the level od SUDS is at 3 or lower. What often happens is that the whole flight of steps will sink/decrease making each activity less feared than originally thought.

Remember: if you feel fragile or concerned, then these kinds of exercises are best done together with a licensed and experienced CBT-therapist.

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