As a Calgary psychologist and a Cochrane psychologist, I often work with clients who experience uncomfortably high levels of anxiety in specific situations. Early on in anxiety counselling, I inform these clients that a key step in addressing their issues is exposing themselves to these situations rather than avoiding them. Overcoming avoidance through exposure is the fundamental way to help clients achieve their goal of experiencing lasting reductions in anxiety to a more comfortable and manageable level.
After I have informed clients of the benefits of exposure, some of them give me a response which may appear to be puzzling. Their response is that they have tried exposure and it has not helped them to achieve their anxiety-reduction goals. The puzzle involves what to make of this claim which some clients have made. Is there accuracy in these clients’ claims of having exposed themselves to anxiety-provoking situations and that this has not led to a reduction in their anxiety? If it were so, this would seem to fly in the face of my recommendation that exposure is the key to addressing anxiety issues. In turn, this would not speak well of my ability as a psychologist to give helpful advice to my clients.
Fortunately, there is a solution to this puzzle which allows for my clients’ claims to be accurate while leaving the soundness of my therapeutic advice intact. This focus of this solution is on exposure needing to be of a particular kind in order to be effective. That is, not all exposure is effective in achieving lasting reductions in anxiety.
To elaborate on this point, in the following sections I will discuss the keys to effective exposure. In doing so, I will indicate how adhering to certain exposure principles results in it being effective while not adhering to these principles leads it to be ineffective.
The keys to effective exposure: Duration and repetition
Whether exposure is effective in addressing anxiety issues depends on two key factors:
(1) Duration. This refers to how long a person remains in the anxiety-provoking situation while they are exposing themselves to it. Exposures which are longer in duration are more likely to result in anxiety issues being addressed than are shorter-duration exposures. Research suggests that remaining in the situation for 30 to 40 minutes will usually be beneficial while exposures shorter than this duration are less likely to achieve desired anxiety-reduction results;
(2) Repetition. Repeatedly exposing yourself to the anxiety-provoking situation is more likely to lead to lasting reductions in anxiety compared with one-shot or infrequent exposures.
Why greater duration and repetition facilitate the benefits of exposure
Greater duration and repetition lead to two key processes which address anxiety issues: (1) Habituation. This refers to a reduction in the intensity of anxiety occurring with longer and more frequent exposures; (2) Inhibitory learning. This refers to a person learning that they can function effectively with their anxiety when they engage in longer and more frequent exposures. Brief and infrequent exposures do not typically allow enough exposure in order for habituation and inhibitory learning to occur.
How to use duration and repetition to make exposure effective
The best way to ensure exposure is effective is to make it deliberate and planned. This entails scheduling regular exposure to anxiety-provoking situations in which each exposure is of sufficient duration and exposure to each situation is repeated one or more times.
Exposure is best done in a gradual manner in which the person begins their exposure with situations which lead them to experience low-to-moderate levels of anxiety. When the person has experienced lasting reductions in anxiety through exposure to these initial situations, they can then expose themselves to situations involving progressively higher levels of anxiety.
A psychologist who specializes in cognitive behavioural therapy (CBT) can guide you in the implementation of the strategies discussed in this article.
May you use the right kind of exposure when addressing your anxiety issues,