Graded Exposure Therapy: How To Overcome Your Fears

Graded Exposure Therapy

Is your daily life affected by fears that are difficult to overcome or confront and wish to get rid of it and live more freely? Some of us may be born and accompanied by many fears of varying levels and influence; some may think that these fears do not affect the individual’s self-condition and are easy to get rid of, but many others see them as more complex and challenging. Graded Exposure or Graded Exposure Therapy can help you to overcome your fears. Read further to know what they are.

How Does Exposure Therapy Work?

You might wonder how exposure to the same elements you fear would help you overcome your fear. Graded Exposure therapy is an evidence-based psychological treatment developed to help people overcome fear or anxiety caused by objects, activities, or situations by facing them using some techniques. The term ‘graded exposure’ explains that you will gradually be exposed to those fear-causing factors.

When people are scared of something- a situation or activity, they tend to avoid it, thinking either it can make it worse if they try to get over it or there’s no hope of trying. Therefore, as long as we avoid such elements, each time we go into a feared situation, we experience the same level of anxiety time after time. Although this may be helpful in lowering our distress in the short term, avoidance can help maintain this pattern of fear and anxiety indefinitely.

The anxiety we usually have experienced is part of the fight or flight response. This is the in-built biological system in our body that prepares us to act in response to dangerous or frightening situations. However, physiologically we cannot stay at this high level of anxiety. Our anxiety naturally reduces by exposing ourselves to the situation and remaining in it, and this process is called habituation.

Install CareClinic App

Graded exposure works out by gradually exposing ourselves to the dreaded situation, beginning only with those we feel we can tolerate. Exposing us to the causative factors allows the progression of habituation to occur in order to ease our fear and decrease our anxiety response in the long term.

What are the Types of Exposure Therapy?

There are several unique types of exposure therapy examples, as the treatment is not one size fits all and will depend on various factors of each case:

In Vivo Exposure Therapy

During in-vivo exposure therapy, a person will encounter a phobia or situation that causes fear or anxiety in real life. For example, someone with social anxiety might be instructed to give a speech in front of an audience, or someone has a phobia of needles; they may gradually work toward handling an actual needle.

Try the CareClinic app

Imaginary Exposure Therapy

They vividly imagine the object, situation, or activity they fear the most. For example, an individual with post-traumatic stress disorder (PTSD) might be asked to call in and describe their traumatic experience to reduce feelings of fear. Imagining their source of fear or anxiety in a safe setting, combined with talking therapy, can help reduce feelings of distress.

Virtual Reality Exposure Therapy

Virtual reality technology is a new entry into healthcare that can be used when in-vivo exposure is not feasible. For example, if you get a fear of flying, you might take a virtual flight in the psychologist’s office, using equipment that provides an airplane’s sights, sounds, and smells. This uncovers you to a realistic and similar experience to help reduce the fear associated with flying while in a safe environment.

Interoceptive Exposure Therapy

Interoceptive exposure therapy focuses on generating physical responses that individuals associate with panic or distress. For example, if an individual has panic disorder, they may increase heart rate with a sense of terror or danger. For example, the therapist might tell a person to run on the spot in a safe setting to stimulate similar physical sensations without any sense of danger.

The therapist may also work with clients to establish a hierarchy of their fears or anxieties, which means placing scenarios in the level of intensity the person finds the most challenging. Then the therapist may choose to expose the person either to their lowest or greatest fear first. These two approaches are referred to as graded exposure and flooding.

Graded exposure means that people face their most little intimidating fears first before gradually building up to more tough situations with time. This gradual exposure can help people build confidence to overcome a more significant fear. For example, if an individual gets fear of snakes, they may start by looking at pictures of snakes, which might then progress to having a snake in the room behind glass and eventually carrying the snake.

In contrast to starting exposure with less intimidating fear, people might begin with exposure to the most challenging fear; this is called flooding. This may help them faceless impactful fears more easily. Some people may require just one or two sessions to resolve an issue or need a longer course of ongoing therapy sessions.

Exposure Therapy Examples

  • Graded Exposure Therapy: The psychologist assists the client to construct a fear hierarchy, in which the client ranks feared objects, activities or situations according to difficulty. They begin with mildly or moderately complex exposures and progress to the harder ones.
  • Systematic Desensitization Therapy: exposure can be combined with relaxation exercises. In some cases, to make you feel more manageable and associate the feared objects, activities, or situations with relaxation.
  • Flooding Therapy: Applying the exposure fear hierarchy to begin orientation with the most challenging tasks.
  • Habituation Therapy
  • Extinction Therapy
  • Emotional Processing Therapy
  • Self-Efficacy Therapy

Effectiveness of Exposure Therapy

Exposure therapy could be an efficient treatment for a wide array of anxiety disorders. Facts show that around 60–90% of people have either no symptoms or very mild symptoms of their original condition upon completion of their course of exposure therapy.

Exposure therapy is a demonstrated treatment component for a range of problems, including:

  • Panic Disorder: A study found that a therapist-guided, three-session exposure treatment effectively treated panic attacks in a small group of people.
  • Phobias: A research review indicated that in vivo exposure seems to be the most effective treatment for a wide range of phobias. Some studies stated that 80 to 90 percent of participants trusted responded positively to treatment.
  • Social Anxiety Disorder: Another study found significant reductions in social anxiety in a group of six participants who stutter. The improvements were mainly maintained after six months.
  • Obsessive-Compulsive Disorder (OCD): A study supported the use of exposure therapy as a treatment for OCD. Exposure and response prevention, i.e. graded exposure, is one of the treatments for OCD. In short, this treatment exposes a person with OCD to their obsessive element and has them refrain from acting on them.
  • Post-traumatic Stress Disorder: A study revealed that exposure therapy is one of the most research-supported treatments for PTSD.
  • Generalized Anxiety Disorder: A study found a reduction of anxiety in older adults when exposure therapy was included in their treatment.
  • Chronic Pain
  • Trauma
  • Other Fears

Exposed Therapy Techniques

If you have mild social anxiety, you might feel anxious around crowds of people or parties. You can try to force yourself to spend time in progressively more crowded places. The graded exposure therapy includes the following steps as a guide for successful execution.

Identifying Anxiety-Provoking SituationsExposure Therapy for PTSD

The first important step of graded exposure is identifying all the elements that cause anxiety, and you are either avoiding or distracting yourself from such elements. You have different situations, activities or objects. It is essential to distinguish them into various lists. By classifying them, you can select and tackle one specific fear at a time.

Dodging or dropping a situation are just two things we might do to make ourselves feel safer and reduce our anxiety. There are often more subtle ways to avoid fully experiencing anxiety in situations. For example, you can track your anxiety activities using the CareClinic platform and manage it to help identify the slight behaviours we use to minimize distress.

Be specific to the fear-causing elements that make us choose distraction or avoidance as a solution. Try to raise what, where, when and who questions and answer them when making a list. You would be able to identify the real fear-causing factor by asking those questions. Even minor differences might cause different anxiety levels; hence, these questions would help you find the exact reason.

Build an Exposure Hierarchy

While you identify the fears, remember the next step is to sort the situations specified in the order of the level of anxiety you experience. Ranking anxiety-provoking activities would help you to execute the graded exposure to be carried out gradually without experiencing overwhelming levels of stress.Exposure Therapy for Anxiety Activities should be ranked from those that provoke the highest level of anxiety to those that generate less intense feelings. It is helpful to think about the situation that would be easiest to remain in first.

Hence, the easiest way to write down the list of fear-causing activities is by identifying the most straightforward and most difficult situations to be in, comparing other fearful conditions with these two, and listing them in between. Using the situations specified in the CareClinic platform by writing a diary in the order of the level of anxiety you experience would be helpful. Sometimes it can be not easy to think of what would be more or less anxiety-provoking,

It can be helpful to mark a scale of 0-100% next to each situation, indicating the level of anxiety it would provoke. This will make placing the conditions or activities in a hierarchy easier, from the lowest to the highest percentage. It would be best to remember that this process can seem overwhelming but developing an order is crucial to proceed with graded exposure.

Planning Exposure ExercisesIn Vivo Exposure Therapy

The last step of graded exposure is starting to expose yourself to feared situations. Sometimes it is not easy to come up with several different variations of the same situation. Since recalling feelings are so overwhelming, choose your way of thinking. For example, by thinking of what, where, when and with whom each situation occurs, we can break down the situations into many variations that cause different anxiety levels. some examples:

  • Different times of the day
  • Looking at a photograph
  • Watching a video
  • Larger or smaller locations
  • Alone or with a friend

When planning exposure, you can leverage the diary feature within the CareClinic platform. CareClinic is an all-in-one personal health platform, that provides numerous valuable features to help you maintain a personal health record. Create a self-care action plan and log all medications, supplements, diet, physical activities, and therapies you receive. You can even set up your own healthcare team that manages your health and pregnancy. Add your physician, obstetrician, registered nurse, and family members to keep them in the loop.

Beginning with the least anxiety-provoking fear, plan your exposure to follow the following four conditions of the graded exposure. Do not forget to note what, where, when and with whom you will perform the exposure. Always maintain a scale of either 1 – 10 or by percentage (0-100%) to rate your level of anxiety. Marking the levels before, during and after each exposure to observe changes or improvements in your anxiety levels. Record any reactions during each repeated exposure.

Graded Exposure Therapy

The term ‘graded’ would explain the ‘gradual’ increase of the exposure to fear-causing factors. Facing your fears could be a considerable challenge. Hence it is vital to start by exposing yourself to a situation that causes a certain level of anxiety that is not excessive. The hierarchy you have developed becomes a valuable tool to achieve this goal. By maintaining the diary with a scale measuring the level of anxiety, you can follow up on your anxiety levels. The diary will help you move up in the hierarchy when you are comfortable and confident to do so.

Prolonged Exposure Therapy

The time that we remain in the feared situation should be adequate. The word ‘adequate’ means that you stay until anxiety naturally reduces through the process of habituation. The length of exposure can vary from a few minutes to a few hours. It might be challenging to stay in the situation for such a length of time. However, if you decide to leave before feeling a decline in anxiety, you will continue to avoid the situation; it will be an unhelpful strategy in the future. The longer the exposure with lowering stress, the more the effectiveness of the graded exposure therapy.

Without Distraction Exposure Therapy

If you plan your exposure with the distraction in the backdrop, you will not experience the complete anxiety episode. Reducing the anxiety with other means such as distraction during the exposure will not help the process of habituation. Engaging in distraction and safety behaviours also maintains our fear of the situation long-term. Keeping this fact in mind, you should plan your exposure without any distractions set up.

To start with, it may be that it is too anxiety-provoking not to use any safety behaviours that you might have been using for a long time. In this case, you can begin exposing yourself to these behaviours and then gradually reducing them.

Repeated Exposure Therapy

The process of habituation requires repeated exposure to take place to be effective. The recommended repeated exposures to a situation are 4-5 times a week. Sometimes the condition is rare or involves others and multiple exposures are not possible. In such cases, you should be creative to reconstruct a similar situation to make the exposure count.

Digital Health App for Exposure Therapy

The natural human tendency is to avoid conditions and situations you are afraid of. Forcing yourself to stay with the exposure might help you step outside your comfort zone.

Graded exposure therapy is a practice therapists use to help you conquer fear. Multiple types of research have found that exposure therapy can be effective at treating a variety of kinds of anxiety disorders, including PTSD and phobias. It is always best to undergo gradual exposure therapy under the supervision of a trained professional. Exposure therapy is generally conducted under the supervision of a therapist or other medical expert. Research has evidenced that exposure therapy under a therapist was more effective than self-directed therapy, especially for treating OCD symptoms.

Attempting to execute exposure therapy without assistance or supervision from a trained professional may lead to additional trauma or fear. Especially if you are trying to treat PTSD, you should never try it yourself. As a part of graded exposure, you can include characteristics of exposure therapy into your daily life to help you defeat mild phobias.

Leveraging the CareClinic platform can assist you with the process of exposure therapy. An all-in-one platform like CareClinic can help you navigate exposure therapy by getting into the habit of tracking and sticking to the processes involved. Start using it now by tapping the banner below.

Download CareClinic Pill & Symptom Tracker App

Dr. Suleiman Furmli