How to face your fears effectively: The main principles of exposure therapy.

Fish facing fears by jumping to a bigger fish tank

Psychologists and psychotherapists often promote the idea of facing your fears. The exposure method is designed to help you confront your feared objects or situations so that you do not fear them in the future. Research suggests that exposure can be very effective, but how exactly does it work? In this article, you will find everything you need to know about the concept of exposure and how to face your fears effectively.

Why are you scared of things?

Every person in the world is scared of something, but some people are more fearful than others. Think about fear of heights, fear of snakes, or even fear of spiders. They are very natural and exist because of your in-built desire to live and the fundamental fear of dying. Your body’s reaction helps you stay away from objects or situations that might be dangerous. The experienced symptoms such as sweating and a pounding heart are commonly known as a “fight or flight” response. They provide you with additional assistance in difficult situations.

For example, your heart is pumping oxygen to your muscles so that you can be ready for action. Such a response could be beneficial when facing a physical threat. Being scared while running away from a predator could help you run much faster! Likewise, the additional strength and energy would be useful if you were to fight or confront that predator. Ultimately, if your body provides the additional resources, you are much more likely to survive.

When your fear response becomes irrational

Not everything you perceive as threatful is physically dangerous. Sometimes your fears might be exaggerated or irrational. For example, suppose you nearly choked on a banana. In that case, you might experience some level of anxiety when being asked to eat a banana again. Even though most people with no hesitation consume bananas daily, your instinct tells you to avoid them.

Your body will react in many such situations. For example: giving a speech in front of a bigger audience, attending a job interview, going on a rollercoaster ride, going on your first date, or seeing your friends after a lockdown. If you choose to avoid it, these symptoms will quickly disappear, and you will feel better. It makes sense why people avoid. Avoidance works! It helps you successfully get out of a difficult situation. However, how are you going to feel next time when facing the same problem? The relief you get from avoiding something makes you more likely to avoid it again. When you do, you teach yourself that the thing you are avoiding is indeed dangerous.

Should you face your fears and stop avoiding altogether?

Avoiding your fears can make things worse, but it doesn’t mean you should always face your fears. There are many situations in life where it’s better to play safe. The symptoms of the “fight or flight” response warn you that the situation you placed yourself in might be dangerous. Suppose you see a suspicious person walking towards you in a dark alley. Your body will give you a signal: “Be careful here”. When that person reaches to their coat pocket, and you notice a knife in their hand, your body will do anything it can to convince you it’s not safe to be there. Before you know it, you will be running in the opposite direction. You just avoided something dangerous, and that’s a good thing! What’s more, the next time you walk through the same dark alley, your body might create a similar response, just in case.

How do you know whether to avoid or face your fears?

We usually learn from our life experiences and then judge whether something is dangerous or safe. Still, this response is more biased towards survival (better safe than sorry!). This means that sometimes we will experience anxiety in situations that might not be dangerous, or the level of fear is disproportionate to the situation. If somebody is scared of leaving home or has a fear of dogs, avoidance might create additional problems. Both of these situations can be dangerous, but avoiding them altogether is not helpful because it often affects your other life goals.

The above examples demonstrate that sometimes it is better to confront your fears, but at other times it’s better to avoid them. In a nutshell, avoidance can be a good option when the thing you fear is a real “threat”. However, when you believe your fear is excessive and unrealistic, it is worth considering exposure.

It is difficult to know whether something is dangerous as this is very subjective. You are the person who is in control of your life, and it is your personal choice if you decide to face your fears. It is possible to live a happy and successful life with fears and phobias. Nevertheless, if avoidance interferes with your important life goals, it can be a good idea to choose to face your fears.

Is there a right way to face your fears?

You might be familiar with a TV show known as “I’m a Celebrity, Get Me Out of Here”. Celebrity contestants spend a few weeks in a camp where they face various challenges. For example, they are trapped in a small space with snakes, eat disgusting items, or have thousands of insects thrown over them. Here you can watch a video of two contestants taking part in a trial with snakes. Many contestants describe participation in the show as a positively life-changing experience, but others have found it traumatising. One previous contestant, Dom Joly, compared his experience to being held hostage (see his interview here). Yet, he also concluded that he “loved it”! The idea of facing your fears can be weirdly conflicting, but it is worth pursuing.

However, if your aim is to face your fears effectively and make a long-lasting change, there are many safer and more controlled ways of doing so. The aim of the process of facing fears is to reduce your fear response. Not at any stage of the above trial did a person experience a reduction in their fear of snakes. The satisfaction experienced at the end is likely a result of having escaped the traumatic experience. The method of exposure could help to address this issue.

Face your fears using exposure

What is exposure?

A traditional exposure approach has its roots in behaviourist theories from the beginning of the 20th century. Many aspects of this therapeutic approach have changed over the years due to therapists and researchers gaining a better understanding of how fear works. By definition, the main aim of exposure is to confront the object or situation associated with an irrational fear response in order to reduce the intensity of that response. Below you will find the main principles of exposure, but please be aware this article does not replace professional advice. Do not hesitate to contact a therapist or your doctor to seek further advice.

Being in control of the process

The sense of being in control when facing fears is already significantly affected by the feared object or situation. It is important that you are at least in control of the pace and difficulty of the task. Emerging research in the field suggests that a sense of control might be one of the most critical aspects of exposure. Being forced to confront your feared objects/situations might not necessarily have the best effects. In the above study, the participants who were given full control over the distance from a spider (compared to a group with low control) ended up getting closer to the spider during the task. They also experienced less spider avoidance 2-3 weeks later. Whether you are working with a therapist or facing fears on your own, ensure you are in control of the process.

How much planning do you need?

The traditional therapeutic approach to facing fears includes a process of planning. In this process, you arrange the tasks in order of difficulty. For example, if you wanted to face your fear of dogs, the hierarchy might include firstly looking at a picture or a video of a dog. Then you might feel ready to spend some time in a park where there are dogs. In further stages, you might choose to be in the same room with a dog or hold the dog in your arms. However, this approach might feel a bit “controlling”, especially if these steps were suggested by a therapist or other professional.

Creating a hierarchy will only be helpful if you indeed want one. Please ensure you are making your own choices about what goes on the list. Nobody, but you, knows what level of difficulty is manageable. Sometimes phobias are so specific that it’s impossible to make the process more gradual.  You can take part in exposure on your own, use your friend or family member as a helper or get professional support from your therapist. Either way, ensure you are the one making decisions about the subsequent steps.

Taking your time

One of the factors to consider when doing exposure is ensuring that it is prolonged. In most cases, your mind and your body need some time to adapt. Leaving the situation too early could result in the maintenance of your problem. You would need to ensure that you stay in the situation long enough until your anxiety levels reduce. If the reason you decided to do exposure is that you know your fear is irrational, it means that you’d need to prove to yourself that you can indeed cope with the given situation or object.

Treatment protocols usually advise continuing with exposure long enough for your anxiety levels to go down at least by half. Still, in reality, it will be your decision. Nobody should force you to stay longer than you want to. If you choose to stay for a prolonged time, your anxiety will go down. The length of time it takes will depend on the type of fear and difficulty level. Sometimes it might take 3 minutes, but at other times it could be 45 minutes. However, if you stay in the situation, your mind and body will have no other choice but to give in. Being scared costs your body a lot of energy. There is no point in maintaining this response if it’s not needed, so your mind and body will react appropriately.

Full exposure

Facing your fears directly without any distractions usually produces better results. Any coping strategies you typically use could stand in the way. For example, you might be listening to music to distract yourself, asking your partner for reassurance, or using your phone as a safety object. It would be ideal if you could refrain from using these methods. Exposure helps you face your fears, but most coping strategies end up helping you avoid them. You might even be giving yourself a further signal that the situation is unmanageable because you could not face it on your own. This includes not using practical coping strategies such as looking away or checking your phone or any mental strategies such as counting or thinking about a “happy place”.

Therefore, where possible, try to make your confrontation with the object or the situation as direct as possible. Ideally, the aim would be to place yourself in front of the feared object or situation and do nothing about it. Your anxiety is likely to get worse, but your aim is to stay in the situation and allow yourself to be fully exposed to it. Choosing to tolerate all the unpleasant anxiety symptoms is very difficult but can be extremely powerful. However, remembering the importance of personal control, if using coping strategies is necessary for you to make a start, that is totally fine.

Face your fears again and again

After a successful attempt, it can be helpful to repeat the task multiple times. This could help you see whether your reaction is changing. When repeating the task, you might notice your anxiety response is lowering or that you habituate significantly faster. If possible, you could also try increasing the task’s difficulty and then repeating it as well.

Learn to live with it

Well done if you experienced a positive reduction in your anxiety! The next helpful step usually is to try and incorporate this newly learned skill into your daily life. This might be more or less possible, depending on the nature of your fear. You may naturally encounter your feared situation in your everyday life. For example, if you were working on exposure to any of the following: spiders, dogs, confined spaces, open spaces, escalators, lifts, crowds, germs, being alone, phone calls, or trains, you might be able to incorporate them into your daily life easily. It could be helpful to place yourself in these situations whenever an opportunity arises.

Keeping record

Keeping a record of your progress can be helpful, but it is not necessary for exposure to work. If you are not a big fan of writing or keeping a diary, that is fine. You will still experience the benefits of exposure. On the other hand, if you enjoy keeping notes and tracking your work, think about what might be helpful to monitor. Among others, you could keep a record of the intensity of your fear response (e.g. from 1-10) or the length of time it took for your anxiety to go down. You could also note the level of difficulty or even write down your thoughts or observations. Looking back at your record can help you realise how much positive progress you have made. Comparing your notes from various days can also help with additional reflections.

What about short or unpredictable situations?

Many fears cannot be faced using all of the above principles. Suppose your aim is to face your fear of going on a first date, fear of driving, or meeting your friends after lockdown. In these cases, it would be impossible to stay in the situation without any distractions or changes to the intensity of the situation. However, trying to stick to most of the above principles would still be helpful.

For example, when you see your friends for the first time after lockdown, you might experience some social anxiety.  It would be best to face your fears and refrain from using additional coping strategies.  Avoiding expressing your opinion, avoiding eye contact, or holding a phone in your hand, they would all make you feel safer. However, they would also have the opposite effect in the long term. On the other hand, the more you face your fears, the more experienced and confident you will get. Over time, your anxiety will reduce appropriately.

Do you need a therapist to help you face your fears?

In some cases, it might be better to seek professional help. Some phobias require a specialist’s knowledge. Experiences such as intense panic attacks, dissociation, intrusive thoughts or flashbacks, are difficult to face on your own. In these cases, do not hesitate to seek professional help. A therapist could help you understand these symptoms and face your fears in a safe and manageable way. Sometimes it is crucial to get to the bottom of your problem. Your therapist could help you explore and understand what the sources are before taking part in any practical work such as exposure.

Can I have exposure therapy remotely?

Traditionally, you and your therapist would meet in the same room, make a plan together, and then take part in a real-life scenario exposure. However, since the start of the COVID-19 pandemic, many therapy services operate remotely. Do not worry, it is still possible to take part in effective exposure. In fact, exposure is the primary underlying mechanism behind various psychological interventions. In many cases, such work would not differ remotely as compared to face-to-face.

Many people find it easier to talk about their problems when they are in a comfortable home environment. Other exposure tasks might require some creative methods. For example, facing some of your fears through a screen might be necessary to prepare you to take part in further stages independently. Having the guidance of your therapist could help you familiarise yourself with the process until you feel ready to continue on your own. It is also possible to take your therapist with you to an exposure session by having a video connection on your phone or wearing earphones. Such methods would depend on your circumstances.

Additionally, remote sessions (similarly to face-to-face therapy) could also help you explore any other issues you might be facing. For example, they could help you cope with managing panic attacks or coming to terms with any past traumatic experiences. Finally, your therapist could participate in a real-life exposure session with you. Of course, this would depend on the level of local restrictions. It might be worth discussing your circumstances with your therapist to reflect on your options.

Summary – how to face your fears effectively

To summarise, whether you are scared of a specific situation, object, memory, vision, or circumstance, the method of exposure can bring many positive changes to your life. In some cases, you might be able to take part in it on your own, but at other times it might be better to seek professional help. The main aim of exposure is to stay in the situation long enough for your fear response to go down while facing the situation or object. To ensure the best possible results:

  • Be in full control of the process
  • Fully expose yourself to your fear
  • Do not use any avoidance strategies
  • Take your time
  • Make it gradual
  • Repeat the task or incorporate it into your everyday life.
  • Do not hesitate to seek professional help.

Restore Control is a psychotherapy service offering evidence-based treatment for mental health problems using Exposure Therapy, Method of Levels Therapy, and Cognitive-Behavioural Therapy. If you would like to book a session, you can do so online using the online booking system or get in touch to discuss your circumstances.