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Exposures For Fear Of Uncertainty
The Exposures For Fear Of Uncertainty 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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Overview
Fear of uncertainty is commonly associated with many psychological difficulties, including generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), depression, and eating disorders. Exposure is an effective treatment for fear or ‘intolerance’ of uncertainty, typically preceded by the development of a fear ladder or exposure hierarchy. Clients sometimes find it difficult to develop appropriate exposure tasks or identify manageable ‘steps’ between behavioral experiments.
The Exposures For Fear Of Uncertainty 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.
Why Use This Resource?
Exposure is one of the most effective interventions for overcoming fear. It involves individuals repeatedly facing their fears to reduce their fearful responses and reverse the patterns of avoidance that perpetuate them.
- Provides examples of exposure exercises for addressing fear of uncertainty.
- 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?
Generalized Anxiety Disorder (GAD)
Clients often struggle with chronic worry and find it difficult to tolerate uncertain outcomes, leading to excessive reassurance-seeking, overpreparation, or avoidance of ambiguous situations.
Obsessive Compulsive Disorder (OCD)
Fear of uncertainty drives compulsions and checking behaviours, such as needing to be absolutely sure something bad won’t happen before stopping a ritual.
Depression
Uncertainty about the future can exacerbate hopelessness and passivity, and exposure to uncertain or ambiguous situations can support behavioural activation.
Eating Disorders
Individuals may rigidly control food intake to manage anxiety about health, weight, or performance, often linked to an intolerance of unpredictability or loss of control.
Social Anxiety Disorder
Fear of not knowing how social situations will unfold or how others will respond often underpins avoidance; structured exposure can help develop tolerance to this uncertainty.
Integrating it into your practice
01
Assess
Ensure the client experiences fear of uncertainty.
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.
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 list of exposure exercises.
- 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.
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 helps clients:
- Develop targeted exposure exercises and behavioral experiments.
- Plan ways to face and overcome their fears.
- Ensure exposure is helpful and effective.
Clinicians Who Use This Resource Also Use
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, https://doi.org/10.1037/0033-2909.99.1.20
- 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.
- McEvoy, P . M., Hyett, M. P ., Shihata, S., Price, J. E., & Strachan, L. (2019). The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: A meta-analysis. Clinical Psychology Review, 73, 101778. DOI: 10.1016/j.cpr.2019.101778.
- Shihata, S., McEvoy, P . M., Mullan, B. A., & Carleton, R. N. (2016). Intolerance of uncertainty in emotional disorders: What uncertainties remain? Journal of Anxiety Disorders, 41, 115-124. DOI: 10.1016/j.janxdis.2016.05.001.
- 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.
- Tolin, D. F. (2016). Doing CBT: A comprehensive guide to working with behaviors, thoughts, and emotions. Guilford Press.
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