An introduction to willing exposure practice

The spectrum of responses to anxiety you could display ranges from avoidance to exposure. The belief of a person who avoids is that he or she is in danger. In contrast, the belief of a person who exposes herself to the anxiety on purpose is that the anxiety is an opportunity to learn.

Exposure is the willing act of putting yourself in psychological and physical situations that induce fear and anxiety.

Willing exposure is challenging in the moment of anxiety, but in the long-term it decreases anxiety.

One theory of why exposure works is habituation. This theory understands the fear response to be similar to other senses. For instance, if you were to enter a room that smelled distinctly, if you stayed there, after a little while, your sense of smell would adapt to the smell in the room and stop notifying you of the smell. If, one the other hand, you left the room and reentered repeatedly, you’d notice the smell anew each time. In the first situation you are habituating. In the second situation you are not.

As it relates to anxiety, the theory is that patients expose themselves to the fearful stimuli until their anxiety decreases and overtime they become less and less anxious when presented with the trigger.

Another more recent theory suggests that habituation isn’t as important as willingness to have the sensations, thoughts, and behavioral urges that accompany anxiety. The willingness is important because of the cognitive component of anxiety. Unlike your sense of smell, which habituates regardless of what you think about the smell, anxiety increases and decreases based on how you interpret the situation. That is, if while your heart is beating quickly or you have unwanted intrusions or you cross over a bridge, you think to yourself, “This really is dangerous” or something equivalent, your brain will pump more of the fear response through your body and you will feel more afraid.

Again, this is unlike your sense of smell in that even if you thought that something smelled badly, you would still eventually stop noticing the smell. The way in which cognitive interpretation influences the fear response is called anxiety sensitivity, or second fear. Anxiety sensitivity is responsible for anxiety disorders, not anxiety states themselves.

Thus, exposure in and of itself is not sufficient for overcoming anxiety disorders. Exposure must be done the right way. Exposure is done the right way when you understand the point of exposure and you willingly expose yourself to the possibility of anxiety with the belief that experiencing anxiety will actually help your body learn that you are not in danger, over time.

Frequently when you embody this attitude you will not feel anxiety. This attitude effectively conveys to the mind that it is not in danger! However, if then, you may start trying to trick your mind into wanting the anxiety, when you truly prefer not to have it. This is a common experience in the process of therapy: you start exposing yourself and get quick relief. Then, if you still fear anxiety, it is likely to come back or pop up at different times. You cannot trick your own mind. The attitude of acceptance towards the thoughts, sensations, and behavioral urges that occur when the fear response is triggered must be authentic for long-term relief.