143. EXPOSURE THERAPY: Exactly How to Reduce Anxiety, OCD, & Avoidance

Apr 12

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Today's solo episode is all about exposure therapy! We discuss what exactly exposure therapy is, how it works, and who can benefit from it, the four different types of exposure therapy, my most embarrassing experiences with exposure therapy and how they ultimately lowered my anxiety, and a step-by-step method for how you can try out exposure therapy yourself. This episode is a MUST LISTEN if you struggle with anxiety and are looking for manageable ways to reduce it!

Mentioned In The Episode…

+ STUDY on Exposure Therapy for Adolescents with Anxiety and OCD

+ STUDY on Exposure Therapy for OCD

+ Info on Exposure Therapy

SHOP GUEST RECOMMENDATIONS: https://amzn.to/3A69GOC

Episode Sponsors

🛋This week's episode is sponsored by Teen Counseling. Teen Counseling is an online therapy program with over 14,000 licensed therapists in their network offering support with depression, anxiety, relationships, trauma, and more via text, talk, and video counseling. Head to teencounseling.com/shepersisted to find a therapist today!

About She Persisted (formerly Nevertheless, She Persisted)

After a year and a half of intensive treatment for severe depression and anxiety, 18-year-old Sadie recounts her journey by interviewing family members, professionals, and fellow teens to offer self-improvement tips, DBT education, and personal experiences. She Persisted is the reminder that someone else has been there too and your inspiration to live your life worth living.

a note: this is an automated transcription so please ignore any accidental misspellings!

Sadie: [00:00:00] Welcome to She Persisted. I'm your host, Sadie Sutton, a 19 year old from the Bay Area studying psychology at the University of Penn. She Persisted is the Teen Mental Health Podcast made for teenagers by a teen. In each episode, I'll bring you authentic, accessible, and relatable conversations about every aspect of mental wellness.

You can expect evidence-based, teen approved resources, coping skills, including lots of D B T insights and education in. Each piece of content you consume, she persisted, Offers you a safe space to feel validated and understood in your struggle, while encouraging you to take ownership of your journey and build your life worth living.

So let's dive in this week on She persisted.

When we avoid things that make us anxious, they get exponentially worse.

The anxiety, the fear, the avoidance builds over time and then it's even more challenging to overcome that anxiety. If you're like, I have some anxiety, but it's not debilitating, go use exposure therapy right now because you're going to avoid all of the pain suffering that comes when we [00:01:00] avoid our emotions and they amplify an intensity.

Hello, hello and welcome back to She Persisted. If you're new here, my name is Sadie. I am a sophomore at the University of Pennsylvania studying psychology I started to persisted after a year and a half of intensive treatment at a residential program in a therapeutic boarding school. And today we're pulling from a lot of what I learned in those early days of treatment.

So we're talking about O C D, we're talking about exposure therapy, we're talking about anxiety. I really do see exposure therapy as the anecdote, the solution to any type of avoidance, anxiety, emotional aversion, whatever you wanna call it. Whenever those feelings come up for me, I'm like, okay, it's time for some exposure and I know that that is what is going to help lessen those feelings, decrease the intensity, and it's been a long time since I've done a dedicated episode on exposure therapy. The last time that I did an exposure therapy episode was episode 56, guys, that is almost a hundred episodes ago. I'm sure no one was listening at that point.

That's listening now.

And I [00:02:00] feel like I discuss exposure therapy pretty frequently on the podcast, so it felt like it was time to do a deep dive to give you a really educational overview on what is exposure therapy, how can you use it, how can you implement it in your life, and what I do on a routine basis to use exposure therapy to decrease anxiety avoidance, et cetera.

So when I first came across exposure therapy, it was in a therapeutic group. We had group therapy all the time at residential every single day. And one of the groups that we had on Fridays was called Exposure to Exposure. So we were doing exposure therapy.

To the idea of exposure therapy and practicing this idea of exposing ourselves to things that made us anxious, working through the hierarchy of exposure, and then we would translate it to other things in our life. I love the name of that group still to this day. And so we alternated what we would do in the Exposure to Exposure group.

Some weeks we would learn about how exposure therapy works, what the exposure hierarchy is, which we'll get into. Don't worry, some weeks we did something called Vulnerability [00:03:00] Group where you would share something that required vulnerability, whether it was an emotion you were navigating, a thought, you had something really personal that you wouldn't share with most people, and that really no one in that therapy group knew about you.

So anxiety provoking, as you can imagine. We did karaoke group, which was my worst nightmare to this day. I could probably use some exposure therapy around doing karaoke because I am the worst singer. Fully aware that I have no musical talents. I've accepted it. I've moved on with my life. Singing in front of people gives me so much anxiety because I know I'm bad at it.

It's not like, oh my God, . I don't wanna saying like, no, I'm bad, like your ears will bleed. So I'm like, avoiding, we're avoiding, I need to do exposure therapy on that. So we would do karaoke, we'd do this educational piece, we would do vulnerability group, and then we would also do this thing where we, it was almost like a game where you would draw tasks.

It wasn't out of a hat, but you would choose a task. Out of a bag or something. They were cut up on little ships of paper and it would be tasks that would typically provoke some [00:04:00] sort of anxiety. And so we would go to the cafeteria at McClain and we would try and barter with people. So we'd go to these poor people that were probably visiting a family member or doing something on campus, getting a test done.

But can we trade you our, food that we bought at the cafeteria for your food at the cafeteria? Cause people were probably like, who let these patients out? What the heck is going on? But it was really great for social anxiety. So there was other things. I'd go up and start a conversation with someone, ask for someone's phone number, random things like that that cause social anxiety if you're socially anxious.

And so you would go into the community, this little, little campus at McClain Hospital do these tasks to provoke some anxiety, but then cope with it, work through it, and increase your emotional resilience to social anxiety and anxiety in general. So that was my introduction to Exposure Therapy, and we're gonna do a little mini version of those learnings that I gained during my time at McLean.

And then we're gonna talk about ways that I have applied it in my own life. If you are [00:05:00] like, I am someone that's anxious, I don't know where to start, those are some good ways. Practice being vulnerable with someone. Practice doing something like karaoke where you have to go out of your way to do something that's uncomfortable.

Like again, I have to go back to how much anxiety this gave me. Like I would almost refuse to sing Happy Birthday. I made one of my friends stand up with me. There was a full YouTube thing. I think I lip synced, like I hated this with every ounce of my being. But you gotta overcome that. And then the other one, doing things in a social situation that you wouldn't normally do, especially when you're never gonna see those people again, is a really great way to overcome that social anxiety.

Okay, so the first thing we've talked about is what you can use exposure therapy for. I am someone that likes to do this holistic approach to emotion. So whenever I explain anxiety and depression to people that haven't experienced it before, and like imagine you are fearful, but it's on an extreme overwhelming scale that is impacting your everyday functioning.

So it's on the same spectrum like fear and anxiety. Can be explained in terms of these [00:06:00] basic emotions that we all experience, like fear and apprehension. So the same thing is true for exposure therapy. It has been clinically proven to be really effective for OC D, social anxiety, generalized anxiety disorder.

These really extreme, overwhelming versions of rumination, intrusive thoughts. Extreme emotional intensity and it also works for these smaller scale instances of anxiety, overwhelm, apprehension, et cetera. So it's on a spectrum and if you're like, well, have some anxiety, but like, I definitely don't need O C D treatment.

If that is a barrier for you trying this, whenever that kind of emotional resistance comes up, I always like to say all that that means is that there's a greater chance that this will work for you. There's a greater chance this will be effective because if it's clinically proven to work with in populations that are debilitated by their OCD or social anxiety, it's also gonna work for that fear you have about giving that big presentation coming up or making new friends so basically exposure [00:07:00] therapy is used for phobias. It's used for generalized anxiety, social anxiety avoidance, OC D, all of these different things. And the idea with all of those diagnoses is that there's some amount of fear and that fear is leading to avoidance. And so whether that's a situation, an object, an activity, a thought, an emotion, et cetera. There's fear there and then there's avoidance. And when we avoid things that make us anxious, they get exponentially worse.

The anxiety, the fear, the avoidance builds over time and then it's even more challenging to overcome that anxiety. So again, just like I mentioned where if you're like, I have some anxiety, but it's not debilitating, go use exposure therapy right now because you're going to avoid all of the pain suffering that comes when we avoid our emotions and they amplify an intensity.

What's also really cool is that the most effective treatment for Ooc D is exposure and response prevention therapy. So what we're gonna talk about with this, this key principle of exposure therapy is what is used in clinical settings to treat OCDs. We know it works, we know it's [00:08:00] effective For this C B T cycle of our thoughts, influence our emotions, influence our behaviors, and then it all repeats. And so that shows up in phobias. It shows up in anxiety, it shows up in O C D, and so exposure therapy works across the board.

So I do wanna give the caveat and the disclaimer that if your anxiety. It's becoming debilitating. It's interfering with your quality of life, it's interfering with your relationships, your ability to show up for work, school, et cetera. And it's been going on for a long time. It can be really emotionally unsafe to do exposure therapy, and that's why people go to therapy.

They get support. I did a lot of exposure therapy with help of therapists for a long period of time. I still will write exposure hierarchies with a therapist. So if you are like, this feels really overwhelming, the thought of even thinking about this thing I'm avoiding is debilitating. Work with a therapist, have them help you out with the exposure therapy process, and there are therapists that specialize specifically in anxiety, ooc D and exposure.

So go find a clinician that specializes in that area and they will help walk you through this step by step. This is more for if [00:09:00] you are feeling anxiety avoidance, et cetera. And you think you can overcome it, but you're not exactly sure how. Or there are smaller levels of anxiety that you'd like to work through.

This is for you. But if it's completely debilitating, overwhelming, impacting every aspect of your life, definitely work with a clinician. Because if you are not able to successfully cope with the emotions that come up or the thoughts are too overwhelming or it leads you to avoid more, again, the anxiety just amplifies.

And then it's even more challenging to work through those emotions. So we don't want to try exposure therapy than get cold feet back out, and then we're even more anxious than we were when we started. That would be really, um, productive. If you think that might happen, work with a therapist that will help you through it.

They'll help you make the most amazing exposure hierarchy and support you through it. But if you're like, I think I got this, I just need help understanding how this works, this is for you. So the first thing I wanna talk about is the C B T cycle. In C B T, there is this amazing triangle, circle, however you wanna describe it, where we understand that our [00:10:00] thoughts impact our feelings and they impact our behaviors and just keeps going in a cycle.

So if you. Wake up and you're like, I am feeling depressed. And then you don't get outta bed, and then your thoughts are like, I have nothing going for me. I'm so unmotivated. I hate everything about life. And then you feel worse about yourself, and then you don't get out of bed for longer. Then you avoid your responsibilities.

You can see how that cycle continues to go in a loop and make the situation worse. If you interject at one point, whether it's your behavior, your thoughts, or your feelings, you were able to adjust the rest of the cycle. So one skill that we've talked about a lot on the podcast is opposite actions. The idea is that you took the opposite of what you're feeling.

And so if you are feeling depressed and you would like to avoid all of your friends and family members, you don't wanna do anything. You wanna stay in bed, you wanna avoid your responsibilities, you're gonna do the exact opposite. So when you go to coffee with a friend, maybe you go to class,

maybe you call someone and say, I'm really not feeling great today. Can we go hang out, spend time together? I really just need to get out of my own head. That behavior is then going to impact your thoughts, which are [00:11:00] probably on a loop, like, I have nothing going for me. Everything sucks. This is terrible, this is overwhelming.

And of course, the feelings and feeling depressed, unmotivated, overwhelmed, et cetera. So exposure therapy. Is building off of that idea where when we adjust the behavior or we adjust the thought, or we adjust the feeling, and we'll get through that. When we talk about an exposure hierarchy, which one of those you are kind of inserting yourself into, you are able to break the cycle of the really intense anxiety, the overwhelming thoughts, and the behavior of avoidance.

So what is exposure therapy? The basic idea of exposure therapy is that you are exposing yourself to the thing that is causing anxiety, fear, et cetera. In a small, safe, doable way, you are slowly building yourself up to the thing that makes you so anxious and so overwhelmed, and as you build mastery over those thoughts, those behaviors, those things that are making you anxious, as you get more effective with your ability to cope with the emotions that arise, to [00:12:00] shift the thoughts you're having, you're able to overcome the anxiety, the phobia, the thought pattern, et cetera.

There are four types of exposure therapy. I originally learned three, but we're getting a little technologically savvy nowadays. So the first is in vivo exposure. So you are directly immersing yourself in the thing that is making you anxious. So if you are scared of being in public, you are struggling with leaving your home, you are struggling with going out, socializing with others.

In vivo exposure would be leaving your home and going outside into the. Imaginable exposure is when you are mentally going through the process of doing the thing that makes you anxious. So even though you're still in your house, you are closing your eyes, you're almost meditating, and you are visualizing yourself leaving the front door, locking the door, getting in the car, driving to a coffee shop.

Placing your order, talking to someone, getting your coffee, sitting there for 30 minutes, and if you really, truly are very anxious about something, going through that mental process will bring up anxiety. [00:13:00] Your heart rate will probably increase. You'll be breathing a bit more rapidly. It is an overwhelming experience too.

Expose yourself even mentally to that thing that is making you anxious. This is also used with people that struggle with PTSD or had a traumatic experience. Doing that imaginable exposure to the thing that is causing all of those intense emotions is also something that is done, in a clinical setting.

The second to last one is called inter interceptive exposure. I'm sure I'm saying that wrong, but the idea here is that you are exposing yourself to the physiological experience. Of anxiety because if you've ever had a panic attack, you know that one of the most overwhelming parts of that experience is you're like, I can't breathe.

My thoughts are going insanely fast. My heart rate is going so quickly. Like, am I physically okay? Is something wrong? What's going on? And so, That can sometimes almost become a trigger in itself for more anxiety because you're like, I don't wanna have another panic attack. This is my worst nightmare to be this anxious.

And so once your heart rate starts increasing, once your breathing is more rapid, you get more anxious because of those physical symptoms. when we're doing [00:14:00] a interceptive exposure, you are kind of getting yourself in the physiological. Space of a panic attack. So maybe you're doing some, some sprints and you are sitting with the increased heart rate.

The increased breathing rate, that's similar to what you experience when you have anxiety. Maybe you're breathing through a straw so you know what it feels like to have shallow breath and not fully be able to catch your breath. Maybe you are going through the similar thought patterns that sometimes come up when you are having social anxiety or worried about leaving the house.

Right? So that's in interceptive expose, you're, you're exposing yourself to the experience of being anxious. As we talk about how an exposure hierarchy and going through that exposure process worked, you are again building mastery over your ability to cope with the situation. The last, I think this is the newest version of exposure therapy is you can use virtual reality.

So if you're like fancy schmancy, you have a whole VR headset, maybe you're like, okay, I'm scared of leaving the house. I'm going to have someone else film a VR experience of me leaving the house, and then I'm gonna watch that. And of course, [00:15:00] that's gonna make you anxious because it feels like you're really going through that experience.

But a great example here is if you are afraid of flying, maybe you are going to watch a vlog of someone going to the airport and going through security and boarding the plane and on the plane, that will probably bring up some anxiety. So to work through that, in that safe environment and that less intense version of anxiety can be super effective.

So those are the four types of exposure therapy, and again, The underlying theme there is that you are exposing yourself to the thing that's making you anxious in a small, manageable way that is still slightly pushing you outside of your comfort zone. You are effectively coping with the emotions and thoughts that arise, and you are working your way through it, and you are doing the opposite of what you want to do, which is avoid and run away.

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So if you are doing exposure therapy, the way that I would approach this, and the way that I've approached this in the past is I would do an exposure hierarchy. So what I would do is I would write down the thing that I am most afraid of and most scared of. So if it is public speaking, you're gonna say, my biggest fear that I.

I am going to have to navigate as I have to give a speech at the end of the semester and I'm absolutely terrified. I have so much anxiety. The idea of doing that makes me wanna like throw a faint run away, drop out of college. If that's your fear, that is going to be at the top of the hierarchy. That's what we're working up towards.

And you're gonna work yourself backwards. You could say like, what is one step below giving a speech? Maybe it. Being in the room, watching other people give their presentations, and knowing that you probably are gonna be next. So maybe you go in, sit in on another lecture where people are giving presentations and you mentally are like, okay, I'm ready to give my presentation.

Let me pull [00:18:00] up my slides. Let me emotionally deal with this overwhelming experience. And maybe below that is practicing giving a presentation to a friend or two. You're going through the process, you are saying everything that needs to happen, et cetera. And then below that, maybe you're giving the presentation in an empty classroom.

Before that, maybe you're prepping for the presentation, you're creating your slides, you're preparing your speaker notes. Before that maybe you are watching someone else's presentation. You are not mentally like, okay, my presentation is next. But even just watching someone else do it can kind of bring up that anxiety.

So you're doing that in person. Then maybe it's watching a video of someone that is giving a presentation and the very lowest. freebie almost, if you will, is mentally going through the process of giving the presentation. Again, this will be different for everyone. It's so subjective, but you're gonna make this hierarchy that feels very doable to move from one step to the next. You don't wanna be like, okay, one day I'm imagining I'm giving a presentation.

The next one, I am doing a live [00:19:00] podcast. Like that would be the worst way to structure your exposure hierarchy. Because you're gonna get too anxious about the idea of giving a whole live podcast to an audience. You're going to avoid the situation and the anxiety is going to amplify. So what I would do is make this really comprehensive list, and you wanna have these be things that you can check off, yes, I did this, or no, I didn't.

We don't wanna be vague, like I'm gonna expose myself to the feeling of being anxious. No, you wanna be really specific. Are you exposing yourself to the physiological sensation of being like short of breath? Are you mentally going through the thought process that might come up when you're giving your presentation?

Are you imagining the worst possible scenario that could happen and coping through that worst case scenario in your head? We're being very specific and we, again, it's a comprehensive list of like freebie. I can do that. It'll make me a little bit anxious, but I got this too. Oh my gosh.

This is the end goal and I'm very anxious about navigating this experience. So once you have your exposure hierarchy is what that's called, [00:20:00] you are going to begin the process of doing these small exposure therapy steps. And this is why it's great to work with a therapist because I full accountability here, have made multiple exposure therapies for myself this year.

Whether it's like making new friends or talking to people or doing things that make me anxious, they're in my bold journal. They're written down. Have I done? Nope. I go back home and I see my therapist. She's like, how's the exposure therapy going? I'm like, haven't really done that. So this is why it's great to work with a clinician or someone that can hold you accountable and also be there to support you throughout the process, but it's totally possible to do by yourself, especially if it feels emotionally safe to do so.

And you can do things like having a friend hold you accountable. So maybe the thought of going to the gym is like so anxiety provoking for. So you ask a friend, Hey, do you wanna go walk on the treadmill with me? It's a pretty low ball, like easier item. Or you're like, oh, can you go to this gym with me and get a smoothie?

Don't even work out. Just go and get a smoothie. , or maybe you're walking past the gym and you're like to a friend, hi, do you wanna go on a walk? We can go wherever. And then [00:21:00] you strategically walk past the gym, but you're going with a friend. So they're there to hold you accountable and you're not backing out and avoiding the situ.

So there's some ways to hold yourself accountable. But it can be a very personal thing and you almost need to like expose yourself to the idea of being vulnerable and telling people that you're anxious and you're trying to overcome this anxiety. That in itself you are exposing yourself to those anxiety, shame, whatever emotions come up can be intense and so that also you're doing a little bit of exposure.

But now getting into the details. So we have our exposure therapy, we have our first item.

What you're gonna do before is we're gonna really go above and beyond with coping ahead. This is a D B T scale within the a ABC scale. So it's from the emotion regulation module. We're working to long-term overcome and maintain our emotional stability. So with the Cope Ahead scale,

We are planning exactly how we're gonna cope with the situation. When you're coping ahead, you are describing the situation in as much detail as possible. We're not even doing the imaginable part of it, but on a piece of paper, you're like, I'm [00:22:00] going to be imagining what it's like to expose myself to this anxiety.

So if we use the example of going to the gym with a friend, that's what's making you anxious. But your like big, long-term goal is to work out three days a week.

So like going to the gym with a friend is maybe in the middle of the hierarchy, like maybe first third. So it's not quite like I'm just walking by the gym or I'm just getting a smoothie. We've already done those things. We've conquered them, we've overcome the anxiety. We didn't avoid them. We did it amazing.

This is maybe third or fourth on the list. So you're like, my friend and I are gonna go to the gym. I have someone there to support me. We're just walking on the treadmill. We're not gonna do anything crazy. We're not gonna try to lifting weights or asking someone what workout are you doing?

Like none of that. You're just gonna walk on the treadmill for 30 minutes and then you're leaving. So you're gonna describe the situation. You're texting your friend to make the appointment, to go to the gym. You are walking to the gym with your friend, you're probably feeling some anxiety. You then get to the gym At Penn, we have to swipe our cards in.

So you're swiping your card in, maybe you're filling up your water bottle, you're [00:23:00] getting to the treadmill, you're putting the treadmill on. What are you gonna do on the treadmill? Are you listening to music? Are you watching a show? Are you talking to your friend? What are you doing?

And you're also gonna describe what potential. Anxiety might come up for you. Are you anxious when you're on the treadmill? Are you anxious before you enter the building? Like what are the pain points? You're being super specific and you're also using the check the facts skill here. So if you're like, what's gonna make me most anxious is when I fall off the treadmill on my face in front of everyone and the whole dim laughs at me and kicks me out and tells me that I'm never again allowed to go to the gym.

We gotta check the facts there. That's probably not gonna happen. Yes, you could fall off the treadmill, but the most. Course of events. If that happens, people like, oh my gosh, are you okay? Like, can I help you? You're gonna get back on the treadmill. You're gonna keep doing your thing. No one is gonna ban you from the gym for the rest of your life.

we're checking the facts. We are writing down the possible situations that might happen, but we're also being realistic. You are also, [00:24:00] again, listing the emotions and the thoughts that might come up that would lead to the anxiety and that typically cause avoidance or are you having like a thought pattern about not feeling like you are active enough to be at the gym or is not going to the gym for you associated with maybe body image.

Like what body image thoughts are coming up for you and how would you cope with. So we're describing the situation, we're naming the events, we're naming the emotions, we're naming the thoughts, and then you're gonna decide what coping skills you're going to use when. So if I was going to the gym, I would really lean on distraction. I'd be like, okay, I know that I really have a lot of time to be in my head and get overwhelmed once I'm on the treadmill. So I'm gonna scroll on TikTok because that's super engaging and it's really hard to ruminate in your head when you're watching TOS and people are dancing.

The sounds are going. The trend is happening, so I know the second I get on the treadmill, I'm going to scroll on TikTok, and that's what I'm gonna do. And at least in the short term, that will distract me. I'm also gonna practice deep breathing. I don't wanna be totally out of breath while I'm walking on the [00:25:00] treadmill.

So I'm gonna pace my breathing with my walking. These are some examples of skills you would use. So go through, see what the most overwhelming things that would happen in this anxiety provoking situation are. And you're gonna plan what coping skills you are going to use. And this, you're even gonna mentally go through it.

So again, this is a little bit more challenging with imaginable exposure because you're planning it and then the anxiety provoking situation is imagining it. But if you're doing something in person, you're physically going somewhere and doing this activity that provokes anxiety.

You're going to imagine yourself doing it again. Even exposure therapy is built into the D P T Scale, cope ahead, so you're imagining yourself doing it. You're imagining yourself coping with the skills you're imagining, rewiring the thoughts that are coming up.

You're imagining doing your distraction, doing your deep breathing, getting through the situation effectively. And then you always wanna make sure that after these really intense emotional situations, you're recharging, you are doing some self-care, you're gonna be like, okay, next week is my next item on the exposure therapy hierarchy.

You're not like, let me bang out [00:26:00] all 10 of these exposures right at once. We always wanna get back to our baseline after being in this situation that is making us. So that's an example of how we would use the COPA head skill. And then we actually go through the motions. We actually do the thing. So we do the skills that we planned we were gonna use, we problem solve in the moment if we need to.

We're gonna lean on distress tolerant skills, if this is something that makes you super anxious, but if you really do take the time to properly do a cope ahead and plan how you're gonna cope with this situation. What might come up, what exact coping skills I'm gonna use. Even write yourself a list, put on your notes app.

If I have a thought spiral about body image, I am going to distract with this thought. Instead, I'm gonna say these affirmations. If I start breathing really quickly because I'm getting anxious, I'm going to pace my breathing to my walking. If my thoughts are just going crazy, I'm an open TikTok and scroll for five minutes.

So if you truly do that process of outlining what skills you're going to use and what triggers might come up, I don't necessarily think you will have to do as much problem [00:27:00] solving in the moment because you've done that in advance. You've made it pretty easy for yourself. You just have to do the thing.

we can't avoid. Avoidance is easy, but again, it amplifies the anxiety long term. So once we have gone through the motions, we've done the thing that makes it sanction anxious. We've used our skills, we've overcome that anxiety in a way that is safe, that is not overwhelming, that's not causing us to avoid more.

We can check that item off the exposure therapy. As we keep moving up this hierarchy over time, our level of fear, our level of avoidance, our level of anxiety will decrease. This is the beauty of exposure therapy. Every single time you check off this thing on your hierarchy, you are getting better at using your coping skills. You are getting better at navigating anxiety, thought patterns, avoidance, whatever it is. And it gets easier with time.

Yes, you are continuing to expose yourself to things that make you more anxious, but you also have more practice using your skills in the moment and coping with the thing that's making you [00:28:00] anxious. And so we just went through like an extreme, really comprehensive way to cope with something that makes you super anxious.

Would probably be like a big phobia or a big sense of avoidance. But you can also do this for smaller things. So if you're like, I get super anxious being in a new situation, I never am the first one to introduce myself. I'm always like kind of hanging back and letting other people do the talking. You're like, it's a long term goal for me to become more comfortable in those situations, maybe that doesn't have a lot of anxiety for you, but you know that the easier option is to avoid.

So you've just always done that in the past, so maybe you would. Two or three items on your exposure hierarchy. Like I am going to go ahead and make conversation when I order my coffee at the coffee shop. Next time I'm gonna pretend to ask someone for a phone charger. Pretend like, oh my gosh, my phone just died.

What time is it? Something like that. And then you work yourself up to being like, oh, hi, I am Sadie. Nice to meet you. So you don't have to do this like 12 step plan. You're just doing that. When there's extreme avoidance, there's a pattern of extreme anxiety and avoidance.[00:29:00]

So that is exposure therapy. And again, if you are feeling the urge to avoid, if you are feeling anxiety, your little like mental signals should be like, okay, we gotta do some exposure here. Because the more you lean into that anxiety and the more you avoid, the more it will build with time.

So whether that is anxiety, let's go back to the beginning of this episode where we talked about being vulnerable. Maybe it's social anxiety, maybe it is things like doing karaoke in front of other people. Maybe it's a phobia you have, maybe it's a general, something you wanna improve on, but you've been avoiding because it does bring up some anxiety.

There's this whole spectrum of things that cause anxiety and intensive emotions, and you can use exposure therapy across the board. So just like a quick little recap. Exposure therapy, in a nutshell, you are identifying the thing that makes you anxious, whether it's an activity, an interaction, a behavior, whatever it is you're identifying that.

You are deciding whether you're gonna do in vivo, which is when you're actually going and doing an action related to the thing that's make you anxious.

Whether you're imagining [00:30:00] yourself doing that thing or when you are doing interceptive, which is when you are exposing yourself to the feelings of. You're gonna make a hierarchy of each step is like, okay, a little bit outta my comfort zone, but I can do this. You're starting with an easy item, let's make things easy for yourself.

Give yourself a freebie that you're like, yep, I can do that. Let's get some momentum going. And the last thing is the thing that you are most anxious about. And again, when you're choosing your biggest thing, check the facts. Like if we go to the gym example, you're like, I am most anxious, I have the biggest phobia falling off the treadmill.

Your biggest thing that you're working up to is not gonna be falling off the treadmill and dealing with that anxiety. It's probably not gonna happen. Sure. We like to be prepared for every worst case scenario, but you don't really have to fall off the treadmill and be like, I'm so glad I have the coping skills to deal with this in case this ever actually happens in my life.

But like going to the gym consistently and using the treadmill would probably be your highest item on the exposure. So writing down the exposure hierarchy, it's manageable. It pushes out outside of our comfort zone, but it's still [00:31:00] doable. We're checking things off with each action item, with each part of the exposure therapy hierarchy.

We're coping ahead. We're planning what coping skills we're gonna use. We're building mastery over the thoughts, emotions, and behaviors. We are beginning to trust ourselves because we know I can cope with this. I've got this, I've done this before and I can get through this. And then you keep building yourself all the way up to the thing that makes you most anxious.

You overcome that anxiety, you stop avoiding, and it's amazing. It really just is so effective in so many areas of life because when we're not doing something, a lot of the times it's emotional resistance or anxiety and exposure therapy is a great way to combat that. So I know that was so much information.

I truly hope that made sense because it can be a little bit overwhelming. It can be a lot. I probably gave too much detail at some points and skied over some things at other points, but I'll leave links in the show notes about what is exposure therapy, how it works, all of the things. But it's been one of the greatest tools in my toolkit for me, mental health wise.

And so I [00:32:00] hope it helps you now as well. And again, if this feels really overwhelming and like too, Make sure to loop in a clinician, go to therapy, get support. That is totally a hundred percent okay. if you enjoyed this episode, if she persisted, as always, make sure to leave a review, share with a friend or family member.

If you share on social media and tag me, I'll make sure to repost, give you a little shout out. I really, really hope this was helpful and I'll see you next week.

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