Exposure Basics
What is exposure therapy?
A skill that involves intentionally facing feared situations, sensations, or reminders instead of automatically avoiding them.
What is a fear hierarchy?
A list of situations related to a fear, arranged by how anxiety-provoking each one feels.
Jordan fears being judged and skips a club meeting. What anxiety-maintaining behavior is Jordan using?
Avoidance
Myth or fact: Feeling anxious means you are in danger.
Myth. Anxiety is an alarm response; it does not always mean a situation is dangerous.
What is avoidance?
Staying away from something that causes anxiety, which can provide short-term relief but maintain fear over time.
What does SUDS stand for?
Subjective Units of Distress Scale.
Sam fears eating in front of peers. What could be one small, planned exposure step?
For example, eating a snack with a trusted peer in an appropriate setting.
Myth or fact: Exposure means forcing yourself into your worst fear immediately.
Myth. Exposure is planned collaboratively and tailored to the person and treatment goals.
What is the goal of exposure?
To learn that you can face anxiety and that feared outcomes may not happen as expected, or may be more manageable than you thought.
On a 0–10 SUDS scale, what might a 0 and a 10 represent?
0 means no anxiety; 10 means the worst anxiety the person has experienced.
Riley fears making a mistake during a presentation and practices once but never presents. Which exposure ingredient is missing?
The practice may be missing repetition and/or a step that involves actually approaching the feared situation.
Myth or fact: You can feel anxious and still be successful at an exposure.
Fact!
True or false: You must feel completely calm before an exposure is successful.
False. Success is practicing the approach and learning from the experience, even when anxiety is present.
A teen fears talking to new people. Name one lower-anxiety and one higher-anxiety practice step.
Lower: say hello to a familiar classmate. Higher: start a conversation with someone new. Ratings depend on the teen.
Alex speaks to a classmate but texts a friend the whole time for reassurance that nothing awkward happened. What might be a safety behavior Alex is using?
Repeated reassurance-seeking through the friend.
Myth or fact: If anxiety rises during exposure, the practice has failed.
Myth. Anxiety can rise and fall; the learning and approach matter, not simply the anxiety rating.
A teen avoids answering questions in class because they fear embarrassment. What pattern might be keeping the fear going?
Avoidance prevents the teen from learning what might happen if they participate, which can maintain the anxiety.
Why should a teen list several different versions of a feared situation instead of only one?
To identify different levels of difficulty and create a more individualized, flexible fear hierarchy.
Taylor fears asking a teacher for help. Create a three-step fear hierarchy, from lower to higher anxiety.
Example: write down a question; ask the teacher privately after class; ask a question during class. Taylor should rate each step personally.
Myth or fact: Exposure should involve genuine danger to prove you can handle fear.
Myth. Exposure targets safe situations or manageable uncertainty, not actual danger.