Anxiety, Fear Avoidance, and Exposure Therapy
We all know the feeling that comes AFTER doing something we have actively avoided because of our fears, that lovely ah-ha moment of understanding that, “Wow, this really wasn’t so bad, it was actually OK!” Enough of these exposure experiences can allow us to make a cognitive shift from, for example, “Hey it isn’t the place that is so bad, it was the feelings and thoughts about it that I was stuck on.” Through the doing and living to tell the story, our anticipatory anxiety gets challenged, and in time proven wrong. Repeatedly exposing ourself to the feared thing allows a metacognitive shift to occur, and over time that lessens the potency of our fear. In short, our original beliefs, that either we could never do it, or the cost of doing the “it” would be too great, embarrassing, incredibly scary, or even dangerous, shrinks the more we experience exposure to that thing.
Generally speaking, when one seeks therapeutic help around avoidance, we’ve gotten to the point where we feel like it is inhibiting the quality of our life. As mentioned, exposure work in therapy is a method of supporting a client in moving towards a shift in their thoughts, feelings, sensations and imagination about what they are avoiding. We work towards changing the individual’s relationship with the experience, and that is done through engaging in what makes us fearful. This isn’t to suggest the goal being that if you are scared of snakes you sit in a pit with them, but perhaps you don’t have a panic attack when you encounter one near you in the woods. Understanding the “why” of what scares us into avoidance is helpful, but really the process of a metacognitive wheel turning in relationship to what is fearful to a person is the focus., This mental movement that helps one manage the fear, allows our mind to shift from thinking, for example, “I am so fragile!” to “I’m not fragile, I just think I am.”
Is it truly progress if you fear driving over bridges, and drive over the Golden Gate Bridge 50 times just to say, “Yes, I can do it, but each time it is a horrible ordeal”? Another approach that accomplishes both a metacognitive re-alignment and attitudinal shift about doing it might be achieve if you drive over the bridge, and listen to a podcast, then you’ve gotten through the feared experience without it being an ordeal. This is accomplished by using another part of your brain. The result hopefully will reduce one’s obsessive doubts about your capability, and develop a healthier curiosity about that previous fearful thinking; “My anticipatory anxiety is lying to me, I don’t need it to be a predictor anymore,” or, “Thoughts aren’t facts, I have done this several times now and it was fine.”
I have found that these cognitive shifts can be successfully brought forward utilizing Exposure Therapy, and also can be combined with EMDR and Internal Family Systems effectively. I’ve seen client’s create these shifts in their thinking and overcome anxiety and fear in a way that exhibits the best of who they are.
Kathleen Byrne, MA, EdS, MEd, PCLC
Resources
Benito, K., Pittig, A., Abramowitz, J., Arch, J. J., Chavira, D., de Kleine, R., De Nadai, A. S., Hermans, D., Hofmann, S. G., Hoyer, J., Huppert, J. D., Kircanski, K., McEvoy, P. M., Meyer, H., Monfils, M.-H., Papini, S., Rief, W., Rosenfield, D., Storch, E. A., … Smits, J. A. J. (2024). Mechanisms of Change in Exposure Therapy for Anxiety and Related Disorders: A Research Agenda. Clinical Psychological Science, 13(4), 687-719. https://doi.org/10.1177/21677026241240727 (Original work published 2025)
Gallagher, T., Hembree, E., Gillihan, S., & Foa, E. (2025). Exposure Therapy for Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder. The Art and Science of Brief Psychotherapies. doi.org/10.1176/appi.books.9781615372072.md08