Use the exposure diary to help you to plan and carry out exposure exercises to desensitise yourself to situations that you would like to find less frightening.
Exposure remains a cornerstone technique of the more behavioural approaches to CBT. It is based on a simple principle: the more we avoid situations that we are frightened of, the more frightening they become. And not only that, but our fear is likely to become more general, meaning that there are more and more situations that we avoid, making life restricted and increasingly unhappy. And the opposite is also true: the more we face our fears, the less frightening they become. This principle is known as habituation: the more habituated we get to situations we once found frightening, the more the reflex fear that we experience, or anxiety in anticipation of going into those situations, is diminished until it becomes either negligible or entirely extinguished. Rather than fanning the flames of fear and anxiety we aim to put out the fire at its source.
Habituation is a form of learning that takes place simply by exposing ourselves to frightening situations, letting ourselves experience the fear that they produce, and remaining in the situation until the anxiety has reduced to at least half. It is usually done best in a graded fashion. That is, we make a list of situations that we avoid (or endure with great distress) and rate each situation for the level of fear or trepidation that they produce in us. We usually rate situations out of 100, where 100 is the very worst level of fear we could imagine.
Use the exposure hierarchy worksheet to generate your list of feared situations. Then, start by choosing a situation that would score about 25 or 30 and make a plan to expose yourself to that situation. The key words are prolonged and repeated: prolonged because we have to stay in the situation until our fear has reduced by at least half; and repeated because the key to exposure is to face the fear often enough that we become truly convinced at a gut level that it's not dangerous.
The actual duration you will need to spend on each occasion and the number of repetitions of the exposure exercise will vary from person to person. Sometimes, we find that no matter how often we go into those situations, we do not get any less frightened of them. This is often because we are performing subtle safety behaviours that either distract us from truly facing the frightening situation or that mislead us into thinking that the situation would have been unbearable without these unhelpful coping behaviours. Some examples include, not making eye contact in a social situation, or carrying a bottle of water or mints at all times, or sitting down as soon as we start to feel anxious, or leaving the situation before our level of fear has reduced sufficiently for habituation to take place, or only going out with a friend or family member. You can usually spot safety behaviour by noticing that you have a "just in case" mentality, where you know it's almost certainly not necessary but you do it "just in case". True coping behaviour responds to an actual threat or danger; safety behaviour is based on an exaggerated fear of an unlikely event actually taking place that you believe you wouldn't be able to cope with.
Once you have become confident in facing a fear that scores about 25 or 30 out of 100, try working your way steadily up the list. Over time you will see that your fear diminishes and your confidence increases, opening up opportunities to live your life in a way that is happier and more satisfying.
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