# Exposure Therapy



## Lithium4 (Nov 23, 2007)

Excuse me if this has been dicussed before.

I've come across this concept a few times in my reading, the idea that if you gradually expose yourself to a feared situation you can eventually become comfortable with it.

I'm convinced that this type of approach is exactly what I need, but I have one major concern: what happens when I'm "exposing" myself to a feared situation and I have a panic attack? Generally, when I have a panic attack (or whatever you want to call it, a bad experience) I become even more anxious about that given situation. My fear is that if I try to expose myself to things I've been avoiding, it won't go well and I'll become even more worried about it than I curently am.

Has anyone ever tried this kind of approach with success? Any insight on how to avoid making the situation even worse?


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## Anachiel (Oct 21, 2007)

When you do CBT with a psychologist you'll get to do Exposure Therapy in the form of a scale where you start to face your least feared social situations, over and over again and then when you feel like you are comfortable with the least feared situation you can then move up the scale, until you reach the most feared situation, you just don't jump in the deep end straight away and have a full blown panic attack. This takes a lot of time and effort on your own behalf. My treatment was pretty rushed and I think that's what spoilt it for me. It's good when you can take your time with your therapist but then this may cost a lot too, just depending on who you see. You have to be prepared for some failures from time to time but that's OK as long as you are making progress and progress won't come without a bit of failure here and there, but you learn from that too, where you went wrong and how you can improve. I even got video taped whilst I was attempting my fears and then the video was played back to me. I then got to judge myself and although I knew at what moments I was feeling very nervous it didn't show up as bad on video as what I thought it would, I actually embraced the person I am in the form of self love and acceptance. I won't deny though that I was still self critical when watching myself on the screen, I picked on myself over the most smallest little things but that's all a part of the whole SA package - being self critical. 

The other thing to remember is that fear reaches a peak. It's not going to stay up on that peak because there's no where else for it to go so it will eventually subside, it will pass (just like a wave). I remember being at school and having to give some sort of speech and suffered the worst panic attack ever that words would not even come out of my mouth, the hyperventilation got so bad everyone looked at me like I was a strange alien but then after I reached that peak it subsided and I kept going along with my speech, I felt like a real failure after that but I was not giving myself the proper credit I deserved, at that point it's crucial you don't give up, don't let one failure stop you, keep going with it until you feel comfortable that your getting better.
Also, Toastmasters is a good start also, may be get some hints from Tomcoldaba, he seems to be going great with Toastmasters.
Good luck.


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## tomcoldaba (Jul 1, 2007)

Lithium4 said:


> I'm convinced that this type of approach is exactly what I need, but I have one major concern: what happens when I'm "exposing" myself to a feared situation and I have a panic attack? Generally, when I have a panic attack (or whatever you want to call it, a bad experience) I become even more anxious about that given situation. My fear is that if I try to expose myself to things I've been avoiding, it won't go well and I'll become even more worried about it than I curently am.


I took the flooding approach to exposure therapy. I would expose myself again and again to the feared situation. In Oct I joined 3 toastmaster clubs. My first meeting, I was sweating buckets after I spoke for 15 seconds, my heart was pounding, my mouth dry and my voice shaky and my feet felt like rubber. I attended 6 meetings in October. In November, I gave 4 speeches of average length of 6 minutes and attended a total of 12 meetings. My anxiety is a memory. I volunteered to facilitate meetings at work. Ten minutes later I was stunned by what I had done.



Anachiel said:


> The other thing to remember is that fear reaches a peak. It's not going to stay up on that peak because there's no where else for it to go so it will eventually subside, it will pass (just like a wave).


This is an excellent analogy. Fear will reach a peak and then it will subside.

If you live in the DC area, there is a Survival Stagefright school run by a physician. He will give you beta blockers only if you need it. Here you do public speaking exposure therapy under the watchful eye of a doctor. Then he recommends that you join toastmaster to maintain your exposure. See if there is such a program in your city.

Good Luck


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## hhbecks (Jan 2, 2008)

I have also heard a lot about exposure therapy. Just thinking about it makes me anxious! All my life, I have put myself in situations that scared the hell out of me, and I have all those bad memories of when it didn't go well. If you do it, let us know how it goes. I hope I will be brave enough to try it if that is what my therapist suggests.


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## sprinter (Nov 22, 2003)

I think normally exposure therapy is done in conjunction with cognitive therapy,the C in CBT. Exposure being part of the behavioral therapy. Exposure by itself may end up being a waste of effort. 

I think I understand what some experts are saying about exposure by itself. If I go back to when I was in school and doing the public speaking in front of class stuff I remember one year I had to do two presentations and I worried about them for a month or so before hand but they turned out surprisingly well. I was really nervous when I started them but quickly calmed right down after I got started and did way better than I ever dreamed I would do. You would think that would put an end to my stage fright but next year all it took was time in between with summer break and a different class with different people, a less friendly teacher and I had my worst experience in front of class ever. It was a real setback that sent my SAD on the road to being worse than it ever was or has been since. The problem of course was nothing really changed, there was no real change in thought patterns, which is what cognitive therapy is supposed to do.


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## tomcoldaba (Jul 1, 2007)

sprinter said:


> If I go back to when I was in school and doing the public speaking in front of class stuff I remember one year I had to do two presentations and I worried about them for a month or so before hand but they turned out surprisingly well. I was really nervous when I started them but quickly calmed right down after I got started and did way better than I ever dreamed I would do. You would think that would put an end to my stage fright but next year all it took was time in between with summer break and a different class with different people, a less friendly teacher and I had my worst experience in front of class ever. It was a real setback that sent my SAD on the road to being worse than it ever was or has been since. The problem of course was nothing really changed, there was no real change in thought patterns, which is what cognitive therapy is supposed to do.


Exposure therapy requires consistency. It is like exercise. You have to do it regularly for it to be effective. Your example shows why it failed. If you had continued with your public speaking exercise during the summer, you would may not have had the experience you are talking about. The fear peaks and after a while it disappears.

That is why I belong to 3 toastmaster clubs. I gave the same speech 3 times in a span of two weeks. My performace anxiety has been reduced greatly. Btw, I am not an accomplished speaker but now I speak up at meetings and am able to present my views to my audience at work.


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## sprinter (Nov 22, 2003)

tomcoldaba said:


> Exposure therapy requires consistency. It is like exercise. You have to do it regularly for it to be effective. Your example shows why it failed. If you had continued with your public speaking exercise during the summer, you would may not have had the experience you are talking about. The fear peaks and after a while it disappears.
> 
> That is why I belong to 3 toastmaster clubs. I gave the same speech 3 times in a span of two weeks. My performace anxiety has been reduced greatly. Btw, I am not an accomplished speaker but now I speak up at meetings and am able to present my views to my audience at work.


I agree consistency is important. Are you doing cognitive therapy along with, or before you started the exposures? I know with the 20 tape/cd series Overcoming Social Anxiety step by step you spend several weeks just doing the cognitive things before you are supposed to start doing the behavioral exposure type things. But that's if you have that luxury as some people are forced to do presentations etc. because of work or school.


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## Anachiel (Oct 21, 2007)

sprinter said:


> I agree consistency is important. Are you doing cognitive therapy along with, or before you started the exposures? I know with the 20 tape/cd series Overcoming Social Anxiety step by step you spend several weeks just doing the cognitive things before you are supposed to start doing the behavioral exposure type things. But that's if you have that luxury as some people are forced to do presentations etc. because of work or school.


Hi sprinter, could you tell me where you can get cd's like that and how much they cost. It's great to have constant reminders of CBT techniques on a daily basis and I think if you listen to CD's before bedtime or early in the morning, it would be a good idea. It's great to do the therapy, but after a while if you don't consistently keep up with what you've been taught you go back to your old ways as you can't have a therapist with you forever, but having CD's as a constant reminder I think could also help to remind you of the techniques taught so you don't forget. It's easy to forget if you don't have it drummed into your ears everyday. And I think for any of us to succeed with any improvement of our SA we have to be consistently reminded of the new thought patterns taught during CBT and constantly exposing ourselves to the feared situation on a least feared to most feared scale.
Have a nice day.


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## sprinter (Nov 22, 2003)

Anachiel said:


> sprinter said:
> 
> 
> > I agree consistency is important. Are you doing cognitive therapy along with, or before you started the exposures? I know with the 20 tape/cd series Overcoming Social Anxiety step by step you spend several weeks just doing the cognitive things before you are supposed to start doing the behavioral exposure type things. But that's if you have that luxury as some people are forced to do presentations etc. because of work or school.
> ...


With the series you are supposed to spend at least 30 minutes a day, reading the handouts etc. Just listening to the tapes or Cd's by itself is not enough to make a real difference. Also, to really improve after a while you are supposed to get involved with group therapy. The problem though is that is not available most places. That's not just any group therapy it's supposed to be a social anxiety group where everyone is working with the series. As far as the cognitive information you can get a lot of the same information from a good book. The series is expensive..
http://www.socialanxietyinstitute.com/audioseries.html


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## Anachiel (Oct 21, 2007)

thanks for the reply sprinter, there's always a catch with these things isn't there.


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## winnipegjets (Oct 1, 2007)

tomcoldaba said:


> Exposure therapy requires consistency. It is like exercise. You have to do it regularly for it to be effective. Your example shows why it failed. If you had continued with your public speaking exercise during the summer, you would may not have had the experience you are talking about. The fear peaks and after a while it disappears.
> 
> That is why I belong to 3 toastmaster clubs. I gave the same speech 3 times in a span of two weeks. My performace anxiety has been reduced greatly. Btw, I am not an accomplished speaker but now I speak up at meetings and am able to present my views to my audience at work.


I guess we should all stop what we are doing, and listen to what you suggest, right Tommy?


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## tomcoldaba (Jul 1, 2007)

winnipegjets said:


> I guess we should all stop what we are doing, and listen to what you suggest, right Tommy?


Let's take Nardil.

Btw, hope you had an enjoyable vacation. Missed your take on Coping with SA. Ok you took Nardil.


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## riboflavin (Jan 11, 2008)

I am new here, but thank you for your posts tomcoldaba! I have horrid social anxiety, particularly centered around public speaking. I have gone to a toastmasters meeting in the past to see what it was about, but haven't gone back(that was about a month ago). 

Your post has given me a lot of hope however. I am going to force myself to go to the toastmasters meeting next week and paying that $50 fee.

By the way, if I join multiple toastmasters clubs, do I have to pay the $50 for each club? I really enjoyed reading about your experience, and if you have anything else you can add, I'd love to hear it and it might serve as further encouragement. Thanks again!


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## tomcoldaba (Jul 1, 2007)

riboflavin said:


> Your post has given me a lot of hope however. I am going to force myself to go to the toastmasters meeting next week and paying that $50 fee.


Toastmasters International dues ($27) are for 6 months starting April and October of each year. If you join in the middle of the period it is pro rated at $4.50 a month. There is a one time fee of $20. Each club has its own dues.

I joined 3 clubs in October and each club meets twice a month. It appears your club meets weekly. So you are really joining two clubs.

The first club charged me $ 27 for TI dues, $4.50 for club dues and $ 20.00 for initiatiation fee. So I paid $ 51.50 for the first club. The second and third clubs charged me each $27.00 for TI dues and $10 for club fees. So I paid $37.00 each to the second and third club. So I paid $125.50 for 6 month membership for three clubs. Each club sets their own dues which is different from Toastmaster International dues.

These club are volunteer clubs. Each club has a different personality. In one of my clubs, I am very lucky, one member has appointed himself a mentor to the club. I told him about my fear of public speaking. (He does not understand SA - it is a foreign concept to the world). He gave me the timers role and a speech to give when I am the timer. I was the timer 3 times in 3 months at this club. He sent me emails about my performance and reassured me that I showed no anxiety. His emails are a great help. Whenever, I have maladaptive thoughts, I read his emails.

My other two clubs, the members are nice but do not offer this kind of service. Again, these folks are not mental health professionals but ordinary folks trying to overcome performance anxiety.

Please try to join one club. If your club meets every week, then you are really joining two clubs. Attend the meetings diligently for three months. If your anxiety is less then skip meeting where you dont have a role such as toastmaster of day, table topics master, speaker, evaluator etc.


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## ardrum (May 13, 2007)

tomcoldaba said:


> I took the flooding approach to exposure therapy.


Ballsy! 

I've noticed I tend to build up to a feared event when I'm planning a series of exposure. The flooding technique is often said to be the fastest method, but a lot of people (myself often included) don't go through with it. I refuse to say I "can't" do something that I factually CAN do though. So I say that I CAN do the feared event, but I'm just choosing to build up a to it a bit.

At the moment, I don't notice any particular fear that I want to target. I guess that means I'm doing rather well. Having a job at a place where I see a TON of people has really helped. It's like its own exposure therapy exercise, in addition to being a source of income.


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## tomcoldaba (Jul 1, 2007)

ardrum said:


> tomcoldaba said:
> 
> 
> > I took the flooding approach to exposure therapy.
> ...


I had actually attended 5 meetings as a guest before I went to the flooding approach. Not so gutsy.



ardrum said:


> I've noticed I tend to build up to a feared event when I'm planning a series of exposure. The flooding technique is often said to be the fastest method, but a lot of people (myself often included) don't go through with it. I refuse to say I "can't" do something that I factually CAN do though. So I say that I CAN do the feared event, but I'm just choosing to build up a to it a bit.
> 
> At the moment, I don't notice any particular fear that I want to target. I guess that means I'm doing rather well. Having a job at a place where I see a TON of people has really helped. It's like its own exposure therapy exercise, in addition to being a source of income.


Congratulations on your success and hard work. You set yourself some pretty high goals for Halloween.


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## X33 (Feb 13, 2005)

I have read of this drug, a common TB antibiotic - D-cycloserine - and its role in fear extinction. If I recall correctly, 2 exposure sessions while using this simple, minimal side effect drug equals 9 regular sessions. So it greatly accelerates the benefits of exposure therapy.

Only obstacle though is that D cycloserine is a prescription medicine.


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