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Authored by: Gianna LaLota, LMHC-D, LPC
Imagine wanting to go out with friends, travel, or speak up at work, but anxiety holds you back. Avoidance helps you feel safe in the short term but slowly shrinks your world over time.
How Anxiety Narrows Life
Clients often remark to me that anxiety has completely narrowed their lives through avoidance. Anxiety’s function is to keep us safe, and it has a way of convincing us that the best way to ensure we are safe and protected is by avoiding our anxiety triggers altogether.
For someone with social anxiety, that might look like staying home instead of going to a networking event, never speaking up at work and missing out on career advancement opportunities, or never trying out that new restaurant you want to check out for fear of interacting with the waiter. For someone with panic disorder, that might look like avoiding the crowded train on their commute to work, not traveling far from home in case a panic attack strikes, or avoiding exercise or any activity that might elevate their heart rate. Slowly but surely, by avoiding your anxiety triggers over time, your life shrinks.
Avoidance is tempting because it provides short-term relief in the moment. What many people do not realize is what avoidance teaches your brain over time. It sends the message that whatever you avoided was dangerous, which increases your fear the next time you face that trigger.
The Role of Exposure Therapy
Exposure therapy is a therapeutic technique that involves gradually facing your anxiety triggers and feared outcomes over time. It is one of the most effective ways to overcome anxiety and begin getting your life back.
The goal of exposure therapy is to increase your confidence in your ability to cope with anxiety triggers and face them head-on. When done correctly, it can be incredibly empowering and help you feel more capable and confident in yourself. That said, it does require a willingness to tolerate discomfort. The first few times you practice an exposure, it will likely feel uncomfortable. This is a normal part of the process.
Over time, tolerating that discomfort teaches your brain: I may feel uncomfortable, but I am safe. I can tolerate this feeling. I do not have to avoid it. Many of the feared outcomes driven by anxiety are unlikely to happen, and even when they do not go perfectly, you are still able to cope.
What the Process Looks Like
The process of exposure therapy typically includes the following steps:
- You write out a list of your anxiety triggers and feared situations that you typically avoid.
- You create an exposure hierarchy by assigning a level of difficulty to each situation. In CBT, we call this the SUDS level, or Subjective Units of Distress. A 0 on the SUDS scale means no anxiety at all, whereas a 100 represents the highest anxiety you can imagine.
- You begin with more manageable exposures and practice those until you build enough confidence to work your way up the hierarchy.
- A therapist who specializes in exposure therapy can guide you in setting predictions before exposures, reducing safety behaviours during exposures, and debriefing what you learned afterward.
Examples of Exposure Exercises
Examples of exposure exercises for different anxiety disorders include:
- Generalized Anxiety: leave a work email unfinished for a day; call someone without rehearsing what to say; plan an outing without having every detail figured out.
- Social Anxiety: have a conversation with a coworker you do not usually talk to; ask a stranger for directions; speak up in a small group meeting.
- Panic Disorder: jog in place to raise your heart rate; ride the subway during rush hour; walk through a crowded shopping area.
- Health Anxiety: read an article about a common illness without checking your symptoms afterward; skip checking your pulse or temperature after a minor worry; watch a health documentary without seeking reassurance.
- Specific Phobia: look at a photo of the feared object; sit in the same room as the feared object; touch or handle the feared object.
The Importance of Targeting Safety Behaviors
Targeting safety behaviors is a key element of successful exposure therapy. The hard truth is that if you are not addressing safety behaviors, you are not doing true exposure work.
Avoidance means not entering a feared situation at all. Safety behaviors are more subtle. They are behaviors you engage in during a feared situation to reduce anxiety in the moment. In the short term, they decrease anxiety and provide relief. In the long term, they keep you stuck in the cycle of anxiety.
For example, if you struggle with social anxiety and attend a party to work on avoidance, but once there you stay glued to someone you know, limit your conversation topics, and rehearse what you are going to say before speaking, you are unintentionally teaching your brain that you were only able to get through the party because of those behaviors. You do not get the opportunity to learn that you could have managed without them.
The only way to truly overcome anxiety in the long term and build confidence in yourself is to gradually let go of those safety behaviors so you can see that you do not need them to cope.
Examples of safety behaviors include:
- Generalized Anxiety: repeatedly checking or rewriting emails before sending them; excessive list-making or over-planning to prevent mistakes; seeking reassurance about everyday decisions.
- Social Anxiety: rehearsing sentences in your head before speaking; avoiding eye contact; using your phone to avoid or escape interactions.
- Panic Disorder: carrying water, medication, or other just-in-case items at all times; sitting near exits; constantly monitoring your heart rate or breathing.
- Health Anxiety: frequently checking your body for signs of illness; Googling symptoms for reassurance; scheduling repeated medical appointments despite reassurance.
- Specific Phobia: always having someone accompany you near the feared object; scanning for exits; distracting yourself to avoid fully experiencing the situation.
Practical Mechanisms Behind Change
Exposure therapy helps you approach the things anxiety once convinced you to avoid, giving you your life back. Through exposures, you test the predictions rooted in anxiety and see whether the outcome is as catastrophic as you anticipated.
For example, if you fear public speaking, you might predict that your face will turn red, you will lose your train of thought, and others will judge or laugh at you. Exposure allows you to put that prediction to the test. Did it turn out exactly as you imagined, or was there another possible outcome?
Importantly, even if some of your feared outcomes do happen, what did you learn about yourself in the process? Are you able to tolerate discomfort? Are you able to recover? Over time, you build confidence in your ability to cope and become better able to assess the true level of threat in a situation.
Signs Exposure Therapy Is Helping
Exposure work takes time, repetition, and a willingness to tolerate discomfort, but the reward is worth the effort. In my work, I have seen clients with social anxiety who once feared making small talk develop meaningful friendships at work. I have seen clients with panic disorder board flights to visit family they had not seen in years. I have seen clients with health anxiety begin to trust their bodies again.
Clear signs that exposure therapy is working include feeling capable in situations you once avoided, living a fuller life, and making decisions based on your values rather than letting anxiety drive your choices.
Conclusion
Ultimately, exposure therapy allows people to move from avoidance to engagement. It helps you reclaim meaningful activities, build confidence, and experience life more fully.
Overcoming anxiety does not mean eliminating it entirely. It means learning that you can live a full and meaningful life even when anxiety shows up.
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