Exposure Is Like A Four-Letter Word

exposureOr at least, it should be, and that’s the word fear. In the book I’m reading about social anxiety disorder, Dying of Embarrassment, there is lots of talk about exposure as the main solution to dealing with most anxious and troubling situations.

The first part of the book helps one figure out what exactly is distressing and anxiety provoking. It’s all very individual, of course. Then we’re supposed to put it in a hierarchy, like from least anxiety-provoking, to moderately anxiety-provoking to severely anxiety-provoking. I’m just reading this book to read it for now. When I sit down to really look at situations and make a list it’s going to take me a while, because my knee-jerk reaction is always “It’s all severely anxiety-provoking! What do you think got me into this mess?!”

Exposure therapy (http://en.wikipedia.org/wiki/Exposure_therapy) as a form of torture began in the 1950s. It’s also known as flooding. Of course, I’m kidding about the torture part (a little). I only say that because I’m actually considering it and I’m afraid. The next section of the book (I forgot the part about the coping skills and changing cognitive distortions) is actually doing it. Exposures take two forms: in vivo (real life) and imaginal (in the imagination). Before we do an actual in vivo exposure, we’re supposed to take ourselves through a few imaginal exposures.

In imaginal exposures, everything is imagined as detailed as possible. All the smells, the sounds, are people sweating, etc., get as detailed as possible. Then go through the situation and let your anxiety rise as you sit through it. Go through the anxiety and stay with it because it will go down again the longer you stay with it, as you remember your breathing exercises and so on.  You might imagine absolute success or you might imagine marginal failure and how you would come at your cognitive distortions in the imaginal exposure.

In in vivo exposures everything is real. The book never mentions this, but to me it is like taking someone who is afraid of snakes and throwing them into a pit of vipers! Of course, it’s not that dramatic, because there’s the hierarchy list; the list of lesser anxiety-provokers and higher anxiety-provokers. So it’s much more within the control of the person with social anxiety disorder. For example, let’s say you’re afraid of public speaking. You might start with saying hello to your neighbor when you’re both working in your backyards. Then a medium task might be giving a talk at the high school. A severe task would be giving the baccalaureate speech for your daughter’s friend’s graduation.

If you read this far, God bless you, Geshundheit, please place your trays in their upright positions, and thank you for not smoking.



Lay it on me!

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