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Dealing with Avoidance-Motivated Behavior: Exposure Therapy

Mark Dombeck, Ph.D.

If you are an avoidant person, one method you can use to promote your experiential learning is known as exposure therapy. Exposure is appropriate when avoided dangers are not really as objectively dangerous as they appear to be.

Exposure therapy is simple in principle. You convince yourself to not avoid your fears, but rather to face them directly. You help yourself endure your fear experience, face your fears and remain in the feared situation. The goal is to help yourself remain in contact with your fear experience until you realize that what you thought was dangerous is not actually so bad after all. Maybe not wonderful, but really not so bad as you thought.

The success of exposure therapy depends on the occurrence of a phenomena called habituation. Habituation is a natural human and animal neurologically based tendency to get used to whatever you are exposed to for a long time. Habituation is what allows you to not notice common loud noises in your home environment (street noise, barking dogs, etc.) that would keep a visitor up all night. Just like people can get used to noises that initially upset their sleep, they can also get used to fear feelings, so long as they remain exposed to those fear feelings for a long enough time.

Habituation is a sort of relaxation process. Like any relaxation, it doesn't occur immediately, but rather takes some time to develop. It occurs as people remain in the midst of their fear, and come to realize that nothing actually dangerous is occurring. Habituation promotes new learning of safety, toleration for fear feelings, and extinction of the fear avoidance urge.

Systematic Desensitization is a common form of exposure therapy in which relaxation exercises are paired with exposure in a graduated manner, to help people become more relaxed about the things they fear in a gentle, gradual manner (rather than all at once). To perform a systematic desensitization:

  • Teach yourself how to relax deeply using one of the relaxation methods described below. Progressive Muscle Relaxation is generally used.
  • Pick something you're afraid of, and then list 10 or so situations concerning that thing that make you anxious. Rank order them from the least fearful situation to the most fear inducing situation.
  • Starting with the least fearful situation, imagine that situation as fully as you can, while practicing your relaxation technique. Do what you can to provoke the normal uncomfortableness you'd feel while contemplating that feared situation, but remain relaxed through this period. Do this several times, over several days, until it is relatively easy for you to remain relaxed while intensely focused on the fearful situation.
  • When you have mastered the first situation, move up step-wise to the next most fearful situation, and repeat the process of thinking about that situation while remaining relaxed.
  • Continue this process until you have mastered the ability to remain relaxed and calm even though you are contemplating the most feared situation on your list.

In systematic desensitization you imagine the feared threat, rather than actually exposing yourself to it. Imagined threats are known as "in vitro" threats (which is Latin or something on that order literally meaning "in glass", and figuratively meaning "artificial"), while actual threats are known as "in vivo" threats (real live threats). It is often easier to work with in vivo threats than it is to work with in vitro threats, and in many cases, the resulting de-conditioning effect is good enough. If you perform a systematic desensitization procedure using in vivo (live) threats rather than in vitro (imagined) ones, it is called Graduated Exposure.