Exposure Therapy

We were talking with a patient who had taken a jump into what seemed like a potentially difficult situation, by joining an online support group.   She had hesitated to join the group for a long time, sharing that she had created a list of “things that could go wrong” about the group.  When she joined the group, she initially got to know some people that she thought would support her.  However, her negative expectations seemed to be fulfilled when she emailed some exciting (to her) news to the group and got no response. 

A few days later she got supportive emails from two members of the group who had, themselves, experienced unrelated barriers to communication earlier. Realizing that it was just “bad luck” that had prevented her friends from reaching out, but that they were, in fact, very happy for her accomplishment gave her a boost, and made her realize that you can’t predict ahead of time what the outcomes of any action are going to be.

This got us thinking about how difficult it is to analyze any action we may be considering taking.  We think and think about what might happen, but, in the end, when we truly engage, we find outcomes depending on information we couldn’t have known ahead of time.  That, we believe, is the main value of exposure therapy: it gets us out into the world and experiencing things we could not have predicted, which causes us to develop coping skills we couldn’t have expected to have.

Often, when we expect to be entering some new experience, we start by thinking up all the negative outcomes that could arise, and may give the possible negatives more weight than the possible positive outcomes of taking action.  We suggest an exercise of actually writing down all the expectations we can think of before trying something new, and then afterwards, going back to the list and comparing actual outcomes with expected outcomes.  What we often learn is that you simply cannot predict what may happen before you try something, and that you probably don’t give yourself enough credit for having the ability to cope with any negatives that may arise.

Exposure Therapy is a way of facing situations that seem anxiety-inducing or fearsome by deliberately seeking out opportunities to experience the challenge.  Gradually, we become habituated to the situation we feared and the fear and anxiety become less.  As we note above, it doesn’t necessarily help to just imagine the challenge because we don’t really know what may happen once we are in a situation we view as negative.  Prior analysis and even planning can only go so far, but the experience itself is where the habituation and coping skills develop.