Exposures: What to Do if Your Clients Say "I Can't Do It"

Exposures: What to Do if Your Clients Say "I Can't Do It"

Patricia Zurita Ona, PsyD

Zurita Ona

Patricia E. Zurita Ona, Psy.D., Dr. Z. is a clinical psychologist who specializes in working with children, adolescents, and adults struggling with OCD, anxiety, and emotion regulation problems. Dr. Z is the founder of East Bay Behavior Therapy Center, a boutique therapy practice, where she runs an intensive outpatient program integrating Acceptance and Commitment Therapy and Exposure Response Prevention. Dr. Z is the creator of the online class “ACT beyond OCD,” an online resource for people that want to augment their ACT and ERP skills.  

Dr. Z is the author of the following books:  

  • ACT beyond OCD: An Acceptance and Commitment Therapy Workbook for Adults
  • The ACT Workbook for Teens with OCD: Unhook Yourself and Live Life to the Full
  • Parenting a troubled teen: using acceptance and commitment therapy
  • Escaping the emotional roller coaster: ACT for the emotionally sensitive

​​​​​​​Dr. Z is the co-author of the book Mind and emotions: a universal protocol for emotional disorders” that has received a “Self-help seal of merit” from the Association for Behavior and Cognitive Therapists (ABCT).”

Dr. Z. is also a Fellow of the Association of Contextual Behavioral Science, a member of the OCD San Francisco Bay Area, board member of Made of Millions, and a chair of the committee for the Anxiety and Depression American Association.

Exposures: What to Do if Your Clients Say "I Can't Do It"

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Have your clients faced those situations where, in getting ready to make values-based exposure exercises, their minds come up with thoughts along the lines of, “It will be too much; I won’t be able to handle it; It will be a disaster; how do I know it’s going to work; Do I really have to do it?” And next thing they know, they’re in a battle with those thoughts, sometimes trying to prove them wrong, other times giving up and going along.

It makes perfect sense to feel concerned and afraid of doing exposure exercises because they involve facing all those obsessions that our clients are hooked on and take too seriously. So, here are some suggestions to handle those sticky moments.

Suggestions:

Normalize their fear about doing values-based exposure exercises
E.g.  “It’s not your fault, it makes sense to be scared when approaching the things that you care about. This is what shows up when making bold moves toward your values.”

Introduce a metaphor that clarifies that behind their fears about doing values-based exposure exercises there is the stuff they care about
E.g. Let’s think for a moment that you have a coin. On one side you have the stuff you care about, and on the other, there is the yucky stuff that comes with those pesky obsessions. 

Normalize the protective function of our  mind
If we pay close attention to our minds, we will notice that it’s always trying to convince us to do something, to act, even if the action is taking a nap. And sometimes, our mind tries its best to convince us to stop pursuing what…CLICK TO TWEET

Do some experience exercises to distinguish that thinking is not the same as taking action
Invite clients to participate in two exercises:

  1. For a moment, think to yourself “I cannot lift my right arm,” and as you hold onto that thought, extend your right arm above your body as if you’re touching the sky and hold it there for a couple of moments
  2. Tell yourself, “I can’t swallow,” and as you do so, swallow slowly and then fast.
    As simple and silly as these exercises look on the surface, they do show you that thoughts, even the most sophisticated reason-giving thoughts, don’t have to control, lead, or monitor what you do, how you do it, and when you do it.

Check the workability of going along with those reason-giving thoughts
You use the following questions as guidance for discussing with your clients what happens if they go along with those reason-giving thoughts:

  1. When thinking about values-based exposures, your mind comes up with reason-giving thoughts like…
  2. If you take those reason-giving thoughts as the absolute truth, then what are the actions you do?
  3. What are the short-term results of those actions?
  4. What’s the long-term outcome of those actions?
  5. Do you get closer or further away from your values?

Nerdy comment:
Reason-giving thoughts are no different from any other type of thinking the mind does, and it certainly doesn’t have any magical powers. It’s only our behavior, our public, and private actions, that give them power and make them…


This article was originally published at Dr. Zurita Ona's website. Reprinted with permission from the author.

Patricia Zurita Ona, PsyD

Zurita Ona

Patricia E. Zurita Ona, Psy.D., Dr. Z. is a clinical psychologist who specializes in working with children, adolescents, and adults struggling with OCD, anxiety, and emotion regulation problems. Dr. Z is the founder of East Bay Behavior Therapy Center, a boutique therapy practice, where she runs an intensive outpatient program integrating Acceptance and Commitment Therapy and Exposure Response Prevention. Dr. Z is the creator of the online class “ACT beyond OCD,” an online resource for people that want to augment their ACT and ERP skills.  

Dr. Z is the author of the following books:  

  • ACT beyond OCD: An Acceptance and Commitment Therapy Workbook for Adults
  • The ACT Workbook for Teens with OCD: Unhook Yourself and Live Life to the Full
  • Parenting a troubled teen: using acceptance and commitment therapy
  • Escaping the emotional roller coaster: ACT for the emotionally sensitive

​​​​​​​Dr. Z is the co-author of the book Mind and emotions: a universal protocol for emotional disorders” that has received a “Self-help seal of merit” from the Association for Behavior and Cognitive Therapists (ABCT).”

Dr. Z. is also a Fellow of the Association of Contextual Behavioral Science, a member of the OCD San Francisco Bay Area, board member of Made of Millions, and a chair of the committee for the Anxiety and Depression American Association.

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