Confronting Your Fears Through Exposure (Ch 7)

Confronting Your Fears Through Exposure (Ch 7)

1. Introduction

   • Nothing important enough to note.

2. Eliminating Behaviors that Contribute to Social Anxiety

   • Intro
     • In essence, it's about breaking bad habits that make you feel anxious.
   • Avoidance of Social Situations
     • Don't avoid
     • Don't leave early
   • Avoidance of Feared Sensations
     • Doesn't sound like I do this
   • Subtle Avoidance Strategies
     • In essence, this is a way to partially avoid the feared situation.
     • Overprotective Behaviors
       • Avoiding having to face them when talking them?
       • Overthinking what I wear?
         • Should I go out with greasy hair or no makeup?
     • Distraction
       • Does sitting off by myself and playing games on my computer count?
     • Overcompensating for perceived deficits
       • Trying to convince everybody I'm competent?
       • Trying to convince that I'm one of them?
       • Acting too friendly?
       • Trying not to eat in my usual messy way?
     • Excessive Checking and Reassurance Seeking
       • Checking to see if there is food on my face?
       • Remember not to ask for this too much.

3. Exposure Exercises Overview

   • Initial Assessment (1)
     • Basically just Review Ch 3
   • Planning Appropriate Practices (2)
     • Exposure Hierachy
       • Is list of feared situations
       • Ranked in order of difficulty
       • From least fearful to greatest.
       • Most feared is on top.
       • Ch 9 has more info
     • The point of this is that it gets you to start with easier exercises first.
     • Make a master list of fears you want to work on.
       • With sublists of ways you can exposure yourself to each fear.
       • Refer to this when making your weekly exposure plan.
   • Carrying Out the Practices (3)
     • Review the Subtle Avoidance Strategies before going out.
     • Should be planned in advance.
     • Keep doing this frequently.
     • Can increase your fear if not done properly.
       • The brown, yellow, and green nodes help you make sure you're doing it right.
     • Remember to use cognitive strategies whenever faced with an anxious thought.
   • Maintaining Your Improvements (4)
     • More info in Ch 11.
   • These apply to any exposure-based treatment program.

4. Dimensions of Exposure

   • Exposure to Social Situations vs Feared Sensations
     • I only need the social situation exposure.
   • Imagined vs Live Exposure
     • Both can reduce fear.
     • But live exposure is better.
       • Sometimes, it's hard to imagine a situation in a way that induces fear.
         • Exposure doesn't work if you don't feel fear.
       • There is some evidence that being in the real situation is more effective.
     • Ideally, the imagined situation is only a stepping stone to the real one.
     • Role-play is considered a compromise between these two.
       • I could go into an interiview role-play with a mock set of skills and resume so I can focus on interview skills.
         • Rather then focus on how I am not yet a competitive applicant.
   • Gradual vs Rapid Exposure
     • With Rapid you might...
       • Skip steps
       • Try more difficult situations first
     • With Gradual you might...
       • Spend a good amount of time on each step
     • Similarities
       • Both equally effective.
     • Differences
       • Rapid brings quicker results.
       • but rapid is more uncomfortable
     • Do your exposures as rapid as you can deal with.

5. How Exposure Works

   • It's the testing ground for your anxious thoughts.
   • Sometimes exposure increases fear because...
     • You don't stay in situation long enough to start tolerating it better.
     • The way you decrease your anxiety is leaving the situation.
     • You aren't countering your anxious thoughts with realistic ones.
     • You aren't exposed often enough.
     • You're partially avoiding the situation while you're in it.

6. Things that Keep People from Practicing Exposure

   • Exposures are never planned well enough that you know what to do.
     • Brainstorm them throughly on paper
       • At the beginning of each week.
     • Plan the whole week's exposures in advance.
   • Other things keep screwing up your plans.
     • Don't plan last minute.
     • Have backup plans.
   • You always forget to practice or you're too busy.
     • Schedule blocks of time like you would a doctor's appointment.
   • I'm too scared to work on particular (or all) fears.
     • You need to find a less challenging way to approach the exposure.
       • Like starting out just imagining being in the situation.
   • I am having trouble re-creating my feared situation(s).
     • See Chapter 8 for suggestions.

7. How to Conduct Exposure Practices

   • Preparing for Exposure Practices
     • Remember to plan your exposures at the beginning of each week.
       • And to have backup plans.
     • Work on situations that help you achieve your current goals.
     • Identify any present anxious thoughts.
       • Use cognitive strategies on them.
   • Predictability and Control
     • Sometimes you can't control what will happen.
       • Try to predict every possible outcome.
     • Control the situation as much as possible.
       • So the fear inducing intensity is likely to stay at the level I want it to be at.
   • Duration of Exposure
     • Stay for a couple hours, if possible.
       • Not feasible for situations that usually don't last long.
         • In this case, find ind a way to make the situation happen over and over.
         • Like asking store staff where something is.
         • Or a half hour lunch.
       • Find a way to prolong the situation.
   • Frequency of Exposure
     • In the beginning, the higher, the better.
       • Once a week > once a month
       • Once a day > once a week
       • Ideally, start out at least an hour a day.
       • Until you start getting pretty confident.
         • Then you just need maintaince.
           • Switch to once a week.
           • Or Once a month
           • Make sure you don't go back to avoiding the situation.
   • Practice the same Exposure in Different Situations
     • Your confidence will generalize more.
   • Measuring A Successful Exposure
     • You felt uncomfortable.
     • But it was manageable.
     • You completed the encounter.
     • Okay if anxiety didn't lessen.
   • Remember To Keep It Low Risk
     • Don't put yourself in a situation where your feared outcome is likely to happen.
     • Unless you think you're ready to deal with that outcome.
   • Track Your Improvement
     • Periodically reassess yourself with the forms in ch 3.
   • Get a Helper
     • A friend could go on forum with me and back me up if I get attacked.
   • Realistic Expecations
     • This is gonna take weeks or months.
     • Exact time varies with the fear.
     • Expect to have setbacks.
     • And periods of no improvement.
   • Accept Your Anxious Feelings
     • Fighting them makes them worse.
     • Focus on something else.
       • Like what your goal is for this particular exposure.
       • Make sure you aren't using it to partially escape the situation.
   • Use Exposure Records and Diaries
     • More on this in ch 8 and 9
   • Aftermath of an Exposure
     • Don't beat yourself up.
     • List all the things that went right.
     • Remember that perfection will never be the goal.
     • Analyze what's bothering you.
       • Identify the type of anxious thinking they are.
       • Choose cognitive strategies and use them against the thoughts.

8. Fear SOS (Troubleshooting)

   • Something Terrible Happens During an Exposure
     • Objectively analyze what happened.
     • Possibly back off on the intensity for your next exposure.
       • DOn't feel bad no matter how much you have to back off.
   • Exposure is Increasing My Fear
     • You're probably approaching it wrong. See yellow nodes.