In today's day and age, most of us are no strangers to anxiety. Whether it's social events, work-life balance, drama in the friend group, or anything that just makes you uneasy and worry a bit too much, anxiety is pervasive and can come up a lot in our everyday lives. Anxiety symptoms can range in severity, and with that comes a spectrum of how much the anxiety affects daily and overall functioning. Maybe anxiety for you means that you get nervous before a social event and need to excite and talk yourself up beforehand, but anxiety can also look like isolating yourself by sitting out a party or hangout due to excessive worry of saying something silly that you could regret later, or out of fear of doing the 'wrong' thing.
This is where avoidance comes in. Let’s be real, anxiety is a lot easier to deal with when we're not dealing with it. Attempting to push it down, out of our “field of vision” and out of consciousness sounds a lot more pleasant and is a lot more tempting than feeling the depths of our anxiety. It is a natural human instinct to not want to experience pain, making it completely understandable that we don't want to experience what makes us anxious, and that we would avoid that object or event. But as therapists, we recognize that, whether it’s our emotions or anxiety, the more we push it down in attempts to get it away from us, the harder we're going to be hit with it when we stop pushing or forget to keep pushing. This is best explained by the boiling pot explanation, which talks about how if you were to put a lid on a pot with boiling water, the water will boil even more with the new pressure of the lid, and will eventually spill over. The same can be said about all of our emotions, but can be especially seen with our anxiety. If we push our anxiety further and further down in attempts to avoid it, the anxiety will come back even harder with momentum from the pressure of the lid.
Which begs the question: If avoidance doesn't work, what does?
The boiling pot method is perfect in showcasing that while engaging in avoidance may feel good in the short term, it is going to lead to heightened anxiety in the long term when it finally boils over and can no longer be contained by the lid. Instead of engaging in avoidance, one method to overcoming anxiety may be doing the exact opposite, which is exposing yourself to the stressful and anxiety provoking idea, event, object, etc. This, in a nutshell, is what exposure therapy is.
Exposure therapy has become a go-to modality for anxiety treatment as it is evidenced-based treatment, having been proven effective, and is highly collaborative. A core component of exposure therapy is the hierarchy of fear, where a client and therapist work together to create a list of scenarios for the client to rate least anxiety-provoking, to most anxiety-provoking. The therapist guides the client in a safe and controlled manner to being exposed to the increasingly severe anxiety-provoking events. This is to illuminate to the client their actual ability to tolerate these events, and their anxiety.
To put the hierarchy of fear into practice, a person experiencing excessive worry surrounding social interactions and events may create a hierarchy of fear, as well as rate them with how anxiety-provoking he believes the situation to be:
- saying hello to a neighbor = 10% anxiety
- making a phone call for a food order = 20%
- talking to friends of friends = 30%
- going to a social event not knowing many people = 40%
- being in a group of unfamiliar people = 50%
- being in an unfamiliar group that expects participation from you = 60%
- speaking in front of a group of unfamiliar people = 70%
The therapist will then guide the client through acquiring the skills needed to tolerate and effectively experience those scenarios, and will gradually expose the client to versions of these scenarios. In this mock hierarchy of fear, the therapist would likely work with the client to identify what times of day he can see his neighbor naturally, as well as utilize his new internal resources to deal with the anxiety while facilitating a small conversation or a “hello.” The therapist and client would go over how distressing that actually was for him after completing the task, and expose him to a sense of flexibility within himself, that he likely was not as distressed as he imagined he would be with his initial rating of 10%. Understanding that what he previously thought would be 10% distressing was actually only 5% distressing is thought to help him get through the event with it being less anxiety in the future.
Exposure therapy is daunting and difficult to engage in at times, but is extremely effective in helping cope with future instances of experiencing that anxiety-provoking scenario. Through experiencing it and tolerating it, we create the confidence to be able to face that scenario again with less anxiety and fear. The ability to face the anxiety-provoking scenario has always been and is currently in all of us, and exposure therapy helps bring that part of us to light.