Confronting Your Fears Through Exposure (Ch 7)

Introduction
1. Nothing important enough to note.
Eliminating Behaviors that Contribute to Social Anxiety
1. Intro
  1. In essence, it's about breaking bad habits that make you feel anxious.
2. Avoidance of Social Situations
  1. Don't avoid
  2. Don't leave early
3. Avoidance of Feared Sensations
  1. Doesn't sound like I do this
4. Subtle Avoidance Strategies
  1. In essence, this is a way to partially avoid the feared situation.
  2. Overprotective Behaviors
    1. Avoiding having to face them when talking them?
    2. Overthinking what I wear?
      1. Should I go out with greasy hair or no makeup?
  3. Distraction
    1. Does sitting off by myself and playing games on my computer count?
  4. Overcompensating for perceived deficits
    1. Trying to convince everybody I'm competent?
    2. Trying to convince that I'm one of them?
    3. Acting too friendly?
    4. Trying not to eat in my usual messy way?
  5. Excessive Checking and Reassurance Seeking
    1. Checking to see if there is food on my face?
    2. Remember not to ask for this too much.
Exposure Exercises Overview
1. Initial Assessment (1)
  1. Basically just Review Ch 3
2. Planning Appropriate Practices (2)
  1. Exposure Hierachy
    1. Is list of feared situations
    2. Ranked in order of difficulty
    3. From least fearful to greatest.
    4. Most feared is on top.
    5. Ch 9 has more info
  2. The point of this is that it gets you to start with easier exercises first.
  3. Make a master list of fears you want to work on.
    1. With sublists of ways you can exposure yourself to each fear.
    2. Refer to this when making your weekly exposure plan.
3. Carrying Out the Practices (3)
  1. Review the Subtle Avoidance Strategies before going out.
  2. Should be planned in advance.
  3. Keep doing this frequently.
  4. Can increase your fear if not done properly.
    1. The brown, yellow, and green nodes help you make sure you're doing it right.
  5. Remember to use cognitive strategies whenever faced with an anxious thought.
4. Maintaining Your Improvements (4)
  1. More info in Ch 11.
5. These apply to any exposure-based treatment program.
Dimensions of Exposure
1. Exposure to Social Situations vs Feared Sensations
  1. I only need the social situation exposure.
2. Imagined vs Live Exposure
  1. Both can reduce fear.
  2. But live exposure is better.
    1. Sometimes, it's hard to imagine a situation in a way that induces fear.
      1. Exposure doesn't work if you don't feel fear.
    2. There is some evidence that being in the real situation is more effective.
  3. Ideally, the imagined situation is only a stepping stone to the real one.
  4. Role-play is considered a compromise between these two.
    1. I could go into an interiview role-play with a mock set of skills and resume so I can focus on interview skills.
      1. Rather then focus on how I am not yet a competitive applicant.
3. Gradual vs Rapid Exposure
  1. With Rapid you might...
    1. Skip steps
    2. Try more difficult situations first
  2. With Gradual you might...
    1. Spend a good amount of time on each step
  3. Similarities
    1. Both equally effective.
  4. Differences
    1. Rapid brings quicker results.
    2. but rapid is more uncomfortable
  5. Do your exposures as rapid as you can deal with.
How Exposure Works
1. It's the testing ground for your anxious thoughts.
2. Sometimes exposure increases fear because...
  1. You don't stay in situation long enough to start tolerating it better.
  2. The way you decrease your anxiety is leaving the situation.
  3. You aren't countering your anxious thoughts with realistic ones.
  4. You aren't exposed often enough.
  5. You're partially avoiding the situation while you're in it.
Things that Keep People from Practicing Exposure
1. Exposures are never planned well enough that you know what to do.
  1. Brainstorm them throughly on paper
    1. At the beginning of each week.
  2. Plan the whole week's exposures in advance.
2. Other things keep screwing up your plans.
  1. Don't plan last minute.
  2. Have backup plans.
3. You always forget to practice or you're too busy.
  1. Schedule blocks of time like you would a doctor's appointment.
4. I'm too scared to work on particular (or all) fears.
  1. You need to find a less challenging way to approach the exposure.
    1. Like starting out just imagining being in the situation.
5. I am having trouble re-creating my feared situation(s).
  1. See Chapter 8 for suggestions.
How to Conduct Exposure Practices
1. Preparing for Exposure Practices
  1. Remember to plan your exposures at the beginning of each week.
    1. And to have backup plans.
  2. Work on situations that help you achieve your current goals.
  3. Identify any present anxious thoughts.
    1. Use cognitive strategies on them.
2. Predictability and Control
  1. Sometimes you can't control what will happen.
    1. Try to predict every possible outcome.
  2. Control the situation as much as possible.
    1. So the fear inducing intensity is likely to stay at the level I want it to be at.
3. Duration of Exposure
  1. Stay for a couple hours, if possible.
    1. Not feasible for situations that usually don't last long.
      1. In this case, find ind a way to make the situation happen over and over.
      2. Like asking store staff where something is.
      3. Or a half hour lunch.
    2. Find a way to prolong the situation.
4. Frequency of Exposure
  1. In the beginning, the higher, the better.
    1. Once a week > once a month
    2. Once a day > once a week
    3. Ideally, start out at least an hour a day.
    4. Until you start getting pretty confident.
      1. Then you just need maintaince.
        Switch to once a week.
        Or Once a month
        Make sure you don't go back to avoiding the situation.
5. Practice the same Exposure in Different Situations
  1. Your confidence will generalize more.
6. Measuring A Successful Exposure
  1. You felt uncomfortable.
  2. But it was manageable.
  3. You completed the encounter.
  4. Okay if anxiety didn't lessen.
7. Remember To Keep It Low Risk
  1. Don't put yourself in a situation where your feared outcome is likely to happen.
  2. Unless you think you're ready to deal with that outcome.
8. Track Your Improvement
  1. Periodically reassess yourself with the forms in ch 3.
9. Get a Helper
  1. A friend could go on forum with me and back me up if I get attacked.
10. Realistic Expecations
  1. This is gonna take weeks or months.
  2. Exact time varies with the fear.
  3. Expect to have setbacks.
  4. And periods of no improvement.
11. Accept Your Anxious Feelings
  1. Fighting them makes them worse.
  2. Focus on something else.
    1. Like what your goal is for this particular exposure.
    2. Make sure you aren't using it to partially escape the situation.
12. Use Exposure Records and Diaries
  1. More on this in ch 8 and 9
13. Aftermath of an Exposure
  1. Don't beat yourself up.
  2. List all the things that went right.
  3. Remember that perfection will never be the goal.
  4. Analyze what's bothering you.
    1. Identify the type of anxious thinking they are.
    2. Choose cognitive strategies and use them against the thoughts.
Fear SOS (Troubleshooting)
1. Something Terrible Happens During an Exposure
  1. Objectively analyze what happened.
  2. Possibly back off on the intensity for your next exposure.
    1. DOn't feel bad no matter how much you have to back off.
2. Exposure is Increasing My Fear
  1. You're probably approaching it wrong. See yellow nodes.

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Confronting Your Fears Through Exposure (Ch 7)

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