The Range Of Results You May Get From Gradually Facing Your Fears With Exposure Therapy
One method to tackle your fears, and any connected insecurities, is to slowly face them and learn firsthand you can handle what they throw at you. It's one of the key pieces of Cognitive Behavioral Therapy (CBT). The clinical term for it is Exposure Therapy.
No treatment method is always effective. Sometimes when people try a popular therapy like CBT and it doesn't do the job, they can conclude they're beyond hope. I wrote this article to give you a more realistic idea of what you can broadly expect if you try gradually facing your fears, and to reassure you you're not a lost cause if it doesn't instantly fix all your problems.
I find the results of exposure therapy vary on a fear by fear basis. It's not that it totally cures all of someone's fears, or doesn't touch any of them. This is because different fears have different mental processes propping them up. Some of these supports can be affected by real life exposure, while others are resistant to it.
This range of possible results is based on my personal experience and observations. It's assuming someone uses the approach properly. Of course, they may not accomplish much if they make a mistake in executing the program.
You have a fear. For example, you're really nervous around snakes. As you're planning your step-by-step fear facing hierarchy you get a sense you don't have to start with super-easy steps like looking at videos of snakes. You can jump right to holding one.
You know someone with a pet corn snake. You're a bit on edge beforehand, but go to their place and they take their snake out of its enclosure and put it in your hands. You hold it, it doesn't do much, your fear quickly drops, and you truly, deeply internalize that many snakes are harmless. Your fear dissolves and never comes back. You still have a healthy, sensible respect for rattlesnakes and cobras and whatnot, like anyone would, but you're no longer excessively fearful around every last snake.
It's hard to predict ahead of time, but on occasion fears can quickly collapse due to a real world encounter. First, your fear has to be mild enough that you're willing to do a higher-intensity exposure right away. Second, what's likely happening under the hood is that the, often unspoken, belief holding up your fear is amenable to being disrupted and disproven by a single exposure. For example, you've always been afraid of snakes, and have never interacted with one. You've always unconsciously assumed if you were close to a snake it would viciously attack you. Holding a placid, indifferent pet snake drives home that they're not a threat. Your previous, faulty assumption crashes against reality and is eliminated. The old belief is overwritten by a new one.
This is the same scenario as before, but it takes longer for the lesson to sink in. You're uncomfortable around snakes, and create a hierarchy of how you'll slowly get used to them.
- You start by watching some videos of snakes. It makes you a bit squeamish, but it's nothing you can't handle. It doesn't take long before you can watch clips of them without any discomfort.
- Next, you go to a reptile store and watch some snakes in their terrariums. It's more nerve racking to be this close to live snakes, even if they're behind glass, but you also truly get used to that.
- Next you hold your friend's pet snake. That makes you quite anxious, but you manage to go through with it. At first you can only hold it for a minute or so, but you work your way up to a longer time.
- Finally, you let your friend drape the snake around your neck, and you let it hang out there for a while. That step actually isn't that bad. You got over the worst of your fear just from learning to hold it.
You have to work through the whole hierarchy, and it's anxiety provoking at times, but you make steady progress. By the time you get to the end you've truly realized snakes are no big deal. Your fear goes away and doesn't come back. It took more time and work for the new mentality to stick, but you still got there in the end.
This outcome can occur when you have underlying beliefs that are open to being changed through real world experience, but they need more consistent evidence before they'll let go. One dramatic counterexample isn't enough. Your initial level of anxiety is also high enough that you can't jump right to a harder exposure, and have to work up to it.
You go through your gradual exposure steps, starting with watching videos of snakes, all the way up to having one draped on your shoulders. You're able to get through each step, but it doesn't feel as if your core fear of snakes is going away. It half feels like it's being challenged and lowered enough that you can move to the next step, but also that you're just getting better at tolerating your nerves and acting in spite of them.
In the end you still have some wariness of snakes. You're not crazy about the things, but you can now be around them without being crippled by anxiety. Your fear didn't totally go away, but it was reduced, and for practical purposes you can function much better. You're not going to skip any more camping or cottage trips for fear of seeing a snake. If you run into one you'll still be a bit tense, but you can manage. It's not a perfect outcome, but it will do.
For some fears this is the best many people can realistically expect from real world exposure. Most of us never totally get over a fear of situations like public speaking or chatting to attractive people we want to date, but if we can still do it with a bit of nerves that's way better than not being able to do it at all.
The theoretical explanation for this kind of result is that instead of the old belief ("Snakes are dangerous") being overwritten and erased, it still remains, but is being counteracted by a new, competing belief ("Snakes are harmless"). The original belief feels dulled, and the new one seems fairly plausible. There may be moments where the old belief flares up a bit, but for the most part it's suppressed by the new one.
Something about the exposures wasn't enough to totally disprove the old belief, only shore up the alternative. Maybe further, better targeted exposures could finish the job. Maybe the original fear is tied to an unprocessed traumatic memory, and won't totally go away until the emotions from that early experience are worked through. If someone was bitten or scared by a snake as a kid, the terror they felt at the time can be "frozen" in their mind. When they see a snake again as an adult they get sucked back into that old Frightened Kid mindset, and their adult logic has a hard time getting through.
People can also have unconscious reasons for keeping a fear around. I read about one case where a woman's fear of snakes was really a way to avoid going on camping trips with her unpleasant, outdoorsy husband, so she'd have an excuse to get a break from him.
Okay, but inconsistent result
You complete your hierarchy. With difficulty you're able to get through it. You're still fairly nervous about snakes. In your gut you still think they're quite risky. But if you're in the right mood you're able to force yourself to be around one. The problem is, sometimes you're not in the right mood, and you can't do it. The intensity of your fear goes up and down.
All in all you're still much better than before. Maybe you skip the odd hike, but for the most part you can say yes if your friend asks if you want to go on one. If you absolutely had to be around a snake you're sure you could find some way to psych yourself up to get through it. It may drain and frustrate you that knowing you've got a hike planned still takes a fair bit out of you mentally, but at least you're not as bad as you used to be.
Explanation: The exposures have strengthened the competing "Snakes are harmless" belief, but it's barely holding on against the original "Snakes are dangerous" one. The two beliefs take turns in the driver's seat. Depending on various factors, like how stressed you are about other things in life, sometimes the original belief takes hold again.
There are a couple ways this can play out, but in the end your fear isn't reduced very much. Maybe you slowly gut your way through the whole hierarchy, after a lot of false starts, but you're still pretty nervous, and never really come to believe snakes are safe. Or you may get partway through the hierarchy, but be too afraid to do the final steps. Maybe something didn't go totally according to plan and helped reinforce your fear, like when you tried holding a pet snake it got startled and made a bluff strike. You couldn't accept your friend's explanation that it felt scared for a second and made an empty defensive gesture.
In terms of practical, functional results, your anxiety is a bit lower, but not enough to make a huge difference in your life. Maybe you can put up with it if you're watching a nature documentary and there's a segment on snakes, but you're still too scared to go hiking or camping.
The explanation here is that the new "Snakes are harmless" belief wasn't built up enough to make a meaningful dent in the old one. You're not as scared as you used to be, but still enough that it limits you.
You start the hierarchy, but it isn't long before you hit a wall. Even the earlier steps feel too anxiety inducing. Your fear of snakes feels deeply true on an emotional level. Logic doesn't make a dent in it (e.g., telling yourself, "I'm going to look at snakes in their secure enclosures. They can't hurt me" doesn't calm you). You either know in theory you shouldn't be scared, but can't help it, or you reject the rational reassurance ("They may still be able to get out of their tank and bite me on the neck"). Maybe you make a few attempts to rejig your initial exposure steps, but nothing seems to work. You give up.
If you can't even begin to face a fear, even with an easier early step, it's likely very emotionally intense. As I mentioned earlier, it may be sustained by an unprocessed trauma or an unconscious motivation against changing.
You have your doubts, but reluctantly start the hierarchy. Even this supposedly mild variation of your fear is too much for you. It's extremely scary. You feel retraumatized. Your anxiety is reinforced, and may even become stronger than ever.
Here's another version: You get through the early steps of the hierarchy, but at a later stage something goes horribly wrong. Your friend's pet snake acts totally out of character and bites your hand. That totally supports your case that snakes are bad news, and you close the book on trying to get used to them. Your friend tries explaining her snake isn't venomous, and that while bites are rare from that species, they sometimes happen, and are just minor flesh wounds. You're not hearing any of it.
Exposure therapy has backfired on you and made your fear worse. With better preparation you may have been able to avoid it, but it's not always possible to account for everything ahead of time. If you knew your fear was intense you could have learned more coping techniques beforehand. You could have gotten more education on how snake bites are not fun, but harmless. You could have worn gloves. You could have done some trauma work first, to take the edge off your fear. But if you've already had things go wrong, that's cold comfort. Hopefully you can find another treatment method that's a better fit, or regroup and try a better prepared version of exposure down the road.