When treating an anxiety problem with exposure the trick is to remain in the presence of the fear-evoking stimulus, to maintain the anxiety caused by that stimulus and to do this effectively you need to follow three cardinal rules, Exposure tasks must be:
1. Graded that is at a level, which is distressing but not so distressing that you are not able to endure use subjective units of distress as a measure for this step (0=no anxiety up to 8=the highest level of anxiety you can imagine) .
2. Prolonged that is you must stay in the presence of the fear-evoking stimulus until such time that your level of anxiety has fallen by at least 50% of the initial rating without the use of any safety behaviours or distraction whatsoever. This, basically, means that you must be prepared to remain in the exposure task for up to one hour.
3. Repeated that is once is not enough to habituate to the fear evoking stimulus you must repeat each and every graded step until you can honestly say that the level of anxiety is reduced by at least 50% on your approach to the fear-evoking stimulus as compared to the first time you approached the fear-evoking stimulus. First steps are to compile a list of every situation that causes the anxiety response, no matter how trivial this appears. Then to compile a list of what you do and what you avoid doing to help you cope with the fear.
The next thing to do is to create an exposure hierarchy; this is achieved by rating the fear-evoking situations in order of severity and putting them in order from least difficult situations to cope with to the most difficult.
Following that you then undergo the exposure task (aim for an initial rating of approximately 5 out of 8 subjective units of distress or S.U.D.). Remain in situ until you experience at least a 50% drop in anxiety (for up to one hour) without your usual safety behaviours and distractions. Repeat this task several times until your S.U.D. rating is at least 50% lower on initial contact with the fear-evoking stimulus than it was the first time you attempted this graded step.
Then move onto the next graded step in your exposure hierarchy.
Habituation occurs when you no longer feel anxious in the presence of the fear-evoking situation.
Adrian Soden originally qualified as a Registered Nurse (Mental Health) in August 1995 and has worked in a variety of mental health settings, including Acute Admissions, Forensic and continuing care. He commenced Specialist Psychotherapy training (incorporating ENB650) in September 2000 at the Sheffield Hallam University and graduated with honours as an Adult Behavioural Psychotherapist. http://www.astconsultancy.co.uk/index.html
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