According to the ABC's of Anxiety, your alarms, beliefs, and coping behaviors work together to make you anxious. And up until now, you may have been avoiding situations that trigger your ABC's. Or you have been using other more subtle coping strategies to deal with it. For example, you were talking to yourself, trying to calm yourself down, and trying to reassure yourself that nothing bad will happen. But by doing so, you also avoid your anxiety. However, physical or mental avoidance and other similar coping strategies aren't good. Simply staying away keeps you from experiencing parts of life that could be making you happy. Take for example the following avoidance behavior:
You're afraid of cars on freeways.
You've seen some gory wrecks on TV that have you believing:
- You, or whoever is driving on a freeway, will lose control of the car and crash
- Quality assurance failed to notice how your engine is malfunctioning
- Drivers are too busy on their phones to see you crossing the street. Even though you made it on the freeway, the chance of crashing is increasing and you need to pull over.
With this fear of being in the car on freeways, you cope by staying off the freeway. You limit yourself to activities that don't require traveling any significant distances from your home. This restricts you from going anywhere that would be too far without the freeway. But do you realize what you're missing out on? Your travel and work possibilities are limited.
The goal of the exposure plan is to help you overcome the fears that interfere with the functionality of everyday life. Understand that exposure therapy doesn't immediately throw you into the worst-case scenario and make you deal with it. Rather, you start by confronting small degrees high anxiety situations, and then gradually build up to facing your biggest fear. This gives you a chance to slowly get used to being in your dreaded situations. Individuals also have the opportunity to examine their beliefs and come to realize that bad things don't always happen. The goal is to learn how not to be afraid, and understand that some situations may not be so bad after all.
How to Make a Fear Ladder or Fear Hierarchy
First, identify the situation that gives you the worst anxiety. This is at the top of the fear ladder, and you're going to slowly climb the ladder until you reach the top of it. To make a fear ladder, write down 10 real-life situations similar to your top anxiety that you can find yourself in. Then rank them on a scale of 1 to 10—10 being the scariest scenario. If you can't think of 10, don't worry. The situations should progressively build up in how scary they are up until your biggest fear. Here's an example:
Sarah has an immense fear of heights. You won't find her at the top of the Seattle Tower, let alone the second story of her grandparents' house. And although her case of vertigo doesn't affect her everyday life, tall places have control over Sarah because, for the most part, Sarah avoids heights at all costs instead of learning to tolerate them. Take a look at Sarah's fear ladder.
Goal: Be able to look over the ledge of the tallest building
- Stand on a chair with a friend nearby
- Stand on a chair by yourself
- Go upstairs, and look out the window
- Go upstairs, look out the window, and peer down
- Stand next to a tall building and look up
- Go inside the building and take the elevator up 2 floors
- On that floor, look out the window, and peer down
- Take the elevator up another floor, repeat.
- Take the elevator to the rooftop, then look around
- On the rooftop, peer over the edge
How to Climb to the Top
At the bottom of the ladder, Sarah exposes herself to small degrees of heights. When she's standing on the chair, she's a little scared, but she knows that she won't die from that height—maybe she'll get a little rug burn from the fall. On the next step of Sarah's fear ladder, she takes a bigger step out of her comfort zone. And the next step, bigger. She gets farther and farther out of her comfort zone until she gets to the rooftop. And by that time, she has been exposed to so many height situations, that she's grown used to them. When she looks over the edge, Sarah may feel some anxiety still, but she also knows that she survived all those other times.
This is All Happening so Quickly
The example has Sarah going 0 to 100 mph in 7 seconds. However with this type of therapy, individuals decide how fast they want to go. You may find that within an accelerated ladder like Sarah's, there might be steps in-between steps. Every step needs to be repeated several times until you are ready to take the next one. This could mean that your anxiety has sufficiently lowered, or that you've reached a point where you can consider believing that your anxiety trigger is not dangerous, and will not hurt you.
If direct confrontation is too much right now, consider adjusting the time and space of a situation.
- Time: How long you expose yourself to the fear object. Start with spending 30 seconds, to 1 minute, to 5 minutes, and so on with your fear object. In the beginning, those 30 seconds feel like an eternity because you have been avoiding every split second of possible exposure to your fear. But time will get faster. You could possibly even lose track of time spent with your worst fear.
- Space: How far you are from the fear object. You can start with being 10ft away, then 5ft, then 3ft, then right next to the object. You can also be across the street, from your window, or wherever. Prior to approaching your anxieties, you have been avoiding the situation. Modifying the distance between you and your fear object helps you stop avoiding, and slowly start confronting.
However way you choose to structure your fear ladder is up to you. But remember that persistence will make your exposure therapy successful.
How to Conquer
You have to want it. There will be times in which you can't take the step, or you go back one. But be determined. Seeing the greater potential in accepting your fears is hard to understand. Remember to:
- Keep trying even when the going gets rough.
- Ask for help and support from a professional if you don't understand something.
- Monitor your ABC's.
Through the course of exposure treatment, patients learn to think and act differently in response to their fears. Ultimately, individuals learn to tolerate their anxieties instead of avoiding situations. You're going to be challenged to leave your comfort zone. Prepare yourself for some uneasiness, but be open-minded in the process.
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Date of original publication: April 15, 2014
Updated: October 23, 2015