Exposures For Fear Of Appearing Anxious

The Exposures For Fear Of Appearing Anxious handout helps clients and therapists identify feared stimuli, create exposure hierarchies, and plan exposure exercises and experiments to overcome this fear.
 

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Professional version

Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Overview

Concerns about appearing anxious in front of others plays a central role in social anxiety. Exposure is an effective treatment for tackling these fears. Clients sometimes find it difficult to develop appropriate exposure tasks or identify manageable ‘steps’ between behavioral experiments.
 

Why Use This Resource?

The Exposures For Fear of Appearing Anxious information handout is designed to help clients and therapists identify feared stimuli, develop exposure hierarchies, and plan appropriate exposure exercises and behavioral experiments. It also contains information about safety-seeking behaviors which may need to be addressed during exposure.
 

  • Provides examples of exposure exercises for addressing fear of appearing anxious to others.
  • Helps clients and therapists identify feared stimuli and develop exposure hierarchies.
  • Assists in planning effective exposure exercises and behavioral experiments.

Key Benefits

Identify

Helps pinpoint the specific fears that clients experience.

Personalize

Guides therapists in developing tailored exposure hierarchies.

Plan

Assists in organizing suitable exposure exercises and behavioral experiments.

Maximize

Describes how to enhance the effectiveness of exposure.

Who is this for?

Social Anxiety Disorder (SAD)

Concerns about negative social evaluation.

Performance Anxiety

Fear of appearing anxious during presentations or performance situations.

Integrating it into your practice

01

Assess

Ensure the client relates to the fear described in the handout.

02

Review

Go over the list of exposures for facing this fear.

03

Identify

Pinpoint specific items that would make the client feel anxious or afraid.

04

Expand

Explore additional scenarios that would make the client fearful.

05

Clarify

Specify the safety behaviors the client might use to cope with their fear.

06

Check

Ensure that the process of exposure is clear and makes sense to the client.

07

Plan

Discuss how the client might begin exposing themselves to their fears.

Theoretical Background & Therapist Guidance

Exposure is one of the most effective strategies for overcoming fear (Hofmann & Smits, 2008). It involves individuals repeatedly confronting their fears in order to reduce their fearful responses and break the patterns of avoidance that maintain those fears (Springer & Tolin, 2020).

Exposure-based interventions have been integrated into several therapeutic approaches, most notably cognitive behavioral therapy (CBT). These interventions can take several forms, including in-vivo exposure, where clients confront their fears in real life; imaginal exposure, where they face their fears through imagination or narrative; and virtual reality exposure.

Different theoretical frameworks for understanding exposure-based treatments have emerged, including emotional processing theory and inhibitory learning theory. While there is ongoing debate about the mechanisms behind exposure, the general stages of exposure tend to be consistent: (1.) identifying a fear stimulus, (2). articulating expectations about facing the stimulus, (3). prolonged exposure to the stimulus without distraction, (4). monitoring changes in fear levels, (5). reflecting on insights gained from the exposure, and (6). repeating the exposure.

Before beginning exposure, clients typically develop a fear ladder or “exposure hierarchy” (Beck et al., 1985). This is an individualized list of stimuli - such as activities, situations, or sensations - that provoke fear in the client and are therefore avoided. Once the list is created, the items are ranked and ordered according to the level of fear they induce.

What's inside

  • Comprehensive overview of exposure and theoretical accounts of exposure-based therapies.
  • Detailed exposure strategies for addressing clients' fears.
  • Instructions for developing client-specific exposure hierarchies.
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FAQs

Review the provided list and help the client identify additional idiosyncratic fears.
Identify these coping strategies beforehand and encourage the client to refrain from them during exposure exercise to maximise results.

How This Resource Improves Clinical Outcomes

This resource can help clients:

  • Develop targeted exposure exercises and behavioral experiments.
  • Plan ways to face their fears.
  • Ensure exposure is as useful and effective as possible.

References And Further Reading

  • Beck, A. T., Emery, G., & Greenberg, R. L. (1985). *Anxiety disorders and phobias: A cognitive perspective.* Basic Books.
  • Craske, M. (2015). Optimizing exposure therapy for anxiety disorders: an inhibitory learning and inhibitory regulation approach. *Verhaltenstherapie, 25*, 134-143. DOI: 10.1159/000381574.
  • Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. *Psychological Bulletin, 99*, 20–35.
  • Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. *The Journal of Clinical Psychiatry, 69*(4), 621.
  • Kessler, R. C., Berglund, P ., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. *Archives of General Psychiatry, 62*, 593-602. DOI: 10.1001/archpsyc.62.6.593.
  • Springer, K. S., & Tolin, D. F. (2020). *The Big Book of Exposures: Innovative, Creative and Effective CBT-Based Exposures for Treating Anxiety-Related Disorders.* New Harbinger Publications.
  • Tolin, D. F. (2012). *Face Your Fears: A Proven Plan to Beat Anxiety, Panic, Phobias, and Obsessions.* John Wiley and Sons.
  • Turner, S. M., Johnson, M. R., Beidel, D. C., Heiser, N. A., & Lydiard, R. B. (2003). The Social Thoughts and Beliefs Scale: a new inventory for assessing cognitions in social phobia. *Psychological Assessment, 15,* 384-391. DOI: 10.1037/1040-3590.15.3.384.
  • Wolpe, J. (1990). *The practice of behavior therapy* (4th ed.). Plenum.

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