Exposure to Difficult Situations
 

The more fears I look at in the face, the more they leave without a
trace.

Over time, people with anxiety can develop agoraphobia and begin limiting
daily activities to avoid experiencing panic when they are not in a “safe”
place. People who appear to have mastered anxiety attacks, only to have
them return later, never fully recovered in the first place. When panic
decreases, do not become complacent! Use the following Exposure Chart
to see if you are avoiding difficult situations. Then, choose a circumstance
that causes you minimal distress. Practice exposing yourself to it with one of
the methods below until you are comfortable. Let your symptoms know you
intend to wait for them to pass.

• Refocus on a spot, safe-place image, details around you, your
  breathing, or a pleasant activity, or tap acupressure points if
  symptoms of panic start during a practice period.

• Flood by focusing on sensations of anxiety and talking yourself
  through them—“Oh good, this is just what I wanted to happen. The
  more times I float through symptoms of panic (without adding a
  second fear), the more quickly I will become desensitized to them.”

• Retreat/repeat by walking or driving away from a place of safety. At
  the first sign of tension, retreat. Calmly turn around and go toward
  safety. When you start to feel comfortable, repeat. Walk or drive
  away again. Continue this procedure throughout the practice
  session. Do not walk or drive in a random fashion. Plan your route in
  advance and work on it regularly until you are comfortable.

POINTERS FOR EXPOSURE

• Intentionally expose yourself for a practice period of 10–45 minutes
  without other obligations or distractions. Do not wait until you have to
  deal with a difficult situation.

• Practice for the designated time period even if panic passes quickly.
  Often, people have one or two waves of panic and then feel
  surprisingly comfortable.

• Practice even when you are stressed. Set your goals lower but
  practice regularly. The sense of accomplishment from practicing for
  10 minutes may help you feel better.

• Take a moment to relax before starting. Doing this even when you
  are not tense will review calming techniques that you can use with
  any anxiety that does come.

• In public places, be sure to look at your surroundings and other
  people. When you avoid looking at people, you may imagine that
  they are staring at you.

• You may become bored and “get in your head” as situations become
  more comfortable. If you notice you are thinking too much, switch
  back to noticing your surroundings.

• Do not rush if symptoms of anxiety start! This only pumps adrenaline
  into your system.

• Progress will not always be even. Do not get discouraged if you have
  plateaus. Practicing the same activity over and over will build a
  platform for later growth.

• You may regress after making steady progress. This is to be
  expected. Success can be frightening. Review a previous
  accomplishment until it becomes comfortable again to gain
  confidence that setbacks can be overcome with practice.

• Identify new challenges that involve greater levels of distress after
  mastering one situation. This gives you opportunities to continue
  practicing until you are confident in your ability to “float through”
  symptoms of panic in any situation.

EXPOSURE CHART

Directions: Begin to eradicate panic attacks from your life by identifying
situations that you avoid. Rate the degree to which you avoid each item (0
= not at all, 10 = completely). Add any other situations not listed.

Systematically expose yourself to situations with a rating of 5 points or less
until they are no longer a problem. Then continue to decrease anxiety in
other difficult situations through exposure.

Situations I Avoid

Home       
     •        Taking showers or baths without anyone nearby
     •        Remaining at home alone
     •        Being in my yard by myself
     •        Walking away from my home _____blocks
     •        Other:

Travel
     •        Driving in and out of my driveway
     •        Driving in my neighborhood
     •        Driving where there are traffic lights
     •        Driving in traffic
     •        Driving on interstate highways
     •        Traveling over bridges or through tunnels
     •        Traveling on buses
     •        Traveling on trains, subways, or trams
     •        Traveling on planes
     •        Other:

Public places
     •        Supermarkets
     •        Restaurants
     •        Parties, social gatherings
     •        Theaters
     •        Churches
     •        Malls
     •        Amusement parks
     •        Football games/stadiums
     •        Other:

Confinement
     •        Lines in stores
     •        Elevators
     •        Prolonged conversations
     •        Barber’s/hairdresser’s chair
     •        Dentist’s chair
     •        Other:

 

References

The retreat/repeat method of exposure is further described in Simple,
Effective Treatment of Agoraphobia by Claire Weekes (Bantam, 1979).

Some of the items for this exposure chart were taken from Don’t Panic by R.
Reid Wilson (Harper & Row, 1986) p.30