The work I did with Dr. Shikatani for my dog phobia changed my life! I am 58 years old and spent my entire life dealing with an irrational extreme phobia of dogs, which led to significant avoidance behaviors. I was able to make amazing progress in just a few months using a cognitive-behavioral approach. Almost one year after being discharged, I continue to use the tools she helped me develop and no longer avoid dog encounters. I even enjoy some of them!
-Lily
I received this heartwarming testimonial from a former client who overcame her severe fear of dogs through a treatment called cognitive behavioral therapy (CBT), with a focus on exposures. Exposures involve directly facing one’s fears head on, in a gradual and repeated way. Lily had challenged herself to slowly approach small friendly dogs from a distance, moving closer and closer, and then gradually worked up to spending time with bigger dogs. She learned that most dogs are not dangerous, and in fact may even be quite friendly! By the end of our work together, she was approaching dogs on the street, feeding them treats from her hand, and happily allowing them to lick her hands and face. Lily is living proof that exposures really work! Exposures are hard and will challenge you, AND they work. In fact, research has proven time and again that exposure therapy is a gold-standard treatment for anxiety disorders.
How do CBT exposures differ from everyday life exposures?
You may be saying to yourself, “But I have to talk to customers at my job, so I’m doing exposures, but I still feel anxious interacting with people. Exposures don’t work for me.” However, the way we practice exposures as part of CBT has important differences from our everyday experiences of going out into the world. In order to work, we want exposures to be predictable and controllable, prolonged or repeated, practiced frequently and spaced close together, and practiced without using any subtle avoidance strategies (e.g., distraction, avoiding eye contact). Importantly, we also make sure that the exposures are in line with your values, so that they take you closer to a meaningful and fulfilling life!
Why do exposures work?
Exposures work so well because they help us learn new information by approaching our fears instead of avoiding them. For example, clients often learn that what they fear does not come true, or that perhaps they can tolerate what happens much better than they had initially thought. Clients are often surprised that they can manage their feelings of anxiety, and that the emotion peaks and passes on its own, even when they don’t run away from the situation. In turn, clients feel much more confident that they can enter and stay in these situations. Although the main aim of exposures is to “feel anxious and do them anyways,” clients often find that their anxiety lessens with exposure practice, which is a nice bonus!
Figure 1 caption (Reference: Based on Wagner, 2002, 2011): When we avoid a situation or leave as soon as we feel anxious (e.g., we see a dog coming and we quickly cross the street), we do not learn anything that counters our anxious thoughts. In fact, we learn that we need to avoid or escape the situation to be safe and for our anxiety to reduce. However, when we approach a situation and stay in it during an exposure (e.g., we see a dog coming and we slowly go up to it), we learn all sorts of things, such as “anxiety is not dangerous,” “I can be anxious and still do things,” and “I don’t have to leave for my anxiety to go down.”
What kinds of fears can we treat with exposures?
Exposures are helpful for so many things! If someone is afraid of certain objects or situations such as driving, needles, crowds, enclosed spaces, or heights, exposures are the obvious go-to treatment. However, other fears can also be readily treated with exposures, such as fears of: contamination, health or safety, panic attacks, leaving the house, being judged by others, and much more!
How can I start working on my fears using exposures?
Of course, facing your fears through exposures is often much easier said than done. A specially trained cognitive behavioral therapist can be an invaluable source of expertise and support throughout this process. Exposure therapy can be provided on a weekly basis over a few months, or in a brief intensive format in which exposures are practiced for a few hours each day, such as in our 2-week Intensive CBT program. If you live in Massachusetts, our clinic has immediate openings and we would love to help you out!
Written by Beth Shikatani, PhD, a clinical psychologist at Cambridge Psychology Group who specializes in treating OCD and anxiety. She is the director of the Intensive CBT Program for Anxiety and OCD, a 2-week accelerated program that provides individual CBT and exposure therapy to adults and adolescents (age 16+) with difficulties with OCD, social anxiety, panic disorder, agoraphobia, and specific phobias. Dr. Shikatani is also available to give presentations to mental health professionals and the community on OCD, anxiety, perfectionism, cognitive behavioral therapy, and mental health skills.
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