In vivo exposure in the treatment of anxiety disorders

Avoiding situations of thoughts or feelings that cause discomfort is a common reaction in most of us. In the short run, this solution will help you feel better and stop being afraid. In the long run, however, it reinforces anxiety reactions and prevents you from overcoming anxiety difficulties.

Exposure to an anxiety-inducing object or situation is commonly seen as a healing component of behavioral therapy for fears and phobias. The therapeutic way of facing long-term anxiety, will be effective when assisted by a psychologist who will oversee the entire course. In cognitive-behavioral therapy, effective exposure can be done gradually or intensively, in imagination or in vivo, individually or in groups. Although there is some evidence that in vivo exposure is better than imaginal exposure, especially for certain problems, such as agoraphobia, obsessive-compulsive disorder, and difficulties with social anxiety. An exception may be prolonged exposure, which is used in PTSD (post-traumatic stress disorder).

Types of exposure

Imaginal exposure- confronting difficult experiences (imaginal exposure).

Exposure with response refraining – confronting fearful situations and stimuli while refraining from compulsive behavior. A method of work recommended when working with obsessive-compulsive disorder or self-harm.

Exposure in vivo-confrontation with real-life situations and anxiety-provoking stimuli.

Exposure therapy-benefits

• The habit of relieving anxiety and fear through avoidance doesn’t help with anxiety. Unfortunately, every time you withdraw from an activity, your avoidance habit becomes stronger and more difficult to overcome. Repeated and systematic in vivo exposure, i.e. scheduled confrontation with the situations you are running away from, will help you stop avoiding daily activities and thus minimize anxiety.
• Once you’ve confronted the situations you’re avoiding repeatedly, you’ll realize that nothing bad is happening and you simply don’t need to wall yourself off from these situations. However, if you don’t confront them, continue to consider them dangerous, you won’t stop running away from them.
• Many people suffering from anxiety disorders believe that if they withdraw from a fearful situation, the anxiety will never stop and will become more and more severe until they lose their minds. However, if you stay in the situation long enough, you will find that your anxiety will diminish. Such a process is called habituation. It is what promotes a decrease in the symptoms that are bothering you now.
• Confronting scary situations and overcoming your fear will strengthen your self-esteem. You will feel like a more empowered person who has a say in your life. You will return to activities that you used to enjoy and that you avoided because of your anxiety symptoms.

Example of in vivo exposure

A little girl was sitting on the beach with her mother when they were suddenly covered by a powerful wave. The girl became very frightened and, crying, announced that she wanted to go home. The next day, when it was time to go to the beach, the girl cried and protested. She repeated: “The water is bad and wants to take me away.” To help her get rid of her fear of water, her mother took her on walks on the beach for the next few days. She held her hand and guided her so that she gradually approached the shore. By the end of the week, the girl was no longer afraid to be near water. Her fear had subsided, thanks to her gradual familiarization with the water and getting used to it again.

Factors determine the effectiveness of in vivo exposure

Duration. Successful exposure-based therapy is prolonged. That is, the patient remains in the anxiety-inducing situation until there is a significant reduction in anxiety levels.

Frequency. Effective exposure is constant. Most patients quickly understand that repeated exposure to the anxiety-inducing situation leads to a reduction in anxiety.

Comprehensiveness. Proper exposure is comprehensive, meaning it is carried out on all aspects of the anxiety-producing situation. For exposure to be effective, it is important to be aware of all emotional, cognitive and behavioral components of anxiety.

Subjective Discomfort Units Scale (SUDS)

The scale of subjective units of discomfort (abbreviated as SUDS) will help us determine how severe the discomfort or anxiety is caused by a given situation. It ranges on a scale of 0 to 100. One hundred indicates extreme nervousness, the most you have ever experienced, while zero means that the discomfort is not felt at all and you feel completely relaxed and relaxed. Everyone feels emotions differently and the severity of discomfort according to the SUDS scale; in one person, it doesn’t necessarily mean the same discomfort as in another. This is why we refer to this scale as subjective.

Creating a hierarchy of situations for in vivo exposure during psychotherapy

In exposure therapy, your therapist will ask you to give specific examples of situations, people and places that you avoid because of difficult experiences. You will then jointly make a list of situations you avoid and determine the corresponding SUDS index.

Gradual exposure will begin by confronting situations that cause moderate anxiety (i.e. 40 or 50 on the SUDS scale), after which you will gradually move to situations that cause more discomfort (i.e. up to 100 on the SUDS scale). When using the stimulus exposure technique, you should stay in the situation for 30-45 minutes or until your anxiety decreases significantly. Remember that the exposure should be conducted in such a way that when you leave the situation, you are not accompanied by a feeling of too much relief. The psychologist will assist you and ensure that the exposure tasks and therapy plan are carried out correctly.

The situations in which you will conduct in vivo exposures should be readily available, in the course of subsequent exercises. For example, if something requires a three-hour car ride back and forth, you need to consider it an unrealistic exercise to repeat frequently. What’s more, situations should be made specific rather than pointed out in general terms. Based on the in vivo exposure hierarchy, you and your therapist will determine which situations you can practice on your own as a homework assignment.

Exposure therapy will help you eliminate the negative symptoms you are experiencing. In vivo exposure is repetitive in nature. Exposure helps you practice the ability to be and stay in situations that remind you of difficult situations without anxiety interfering with your life. Exposure exercises require facing situations that you normally avoid. If you do this, anxiety reduction will appear faster than you think and your life will be fuller and richer with new experiences.

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