Imaginary and Thought Exposure

Creation of Detailed Scripts

When live exposure is not possible (e.g. fear of a plane crash or rare situations) or is too intense, imaginary exposure is used.

A script is written in the present tense and first person describing the feared situation in full sensory (smells, sounds, physical sensations) and cognitive (catastrophic thoughts) detail.

The narrative should include the patient's worst fears to activate the fear network in a safe environment.

For example, describe step-by-step the turbulence of an airplane, the noise of the engines and the panic reaction itself.

Recording and Repeated Listening (Habituation)

The script is audio-recorded in the therapist's or patient's voice. The task is to listen to this recording repeatedly and daily (e.g. 30-45 minutes) without distractions.

At first, anxiety is triggered by listening to the story, but with constant repetition (habituation principle), the stimulus loses its emotional charge.

The story ceases to provoke terror and becomes a neutral or simply boring story, indicating that the brain has stopped processing it as an imminent threat.

Exposure to Intrusive Thoughts (Loop)

For obsessive or intrusive thoughts (e.g. "I could hurt someone", "I am a fraud"), the loop exposure technique is used.

The exact thought causing distress is identified and recorded or verbally repeated incessantly over a prolonged period.

Massive repetition of the phrase (e.g. "I am a fraud, I am a fraud...") causes a phenomenon of semantic satiation: the word loses its meaning and emotional power.

The patient learns to tolerate the presence of the thought without the need to neutralize or suppress it, accepting it as a simple mental event without real consequences.

Summary

Detailed present tense scripts are used for situations that are difficult to replicate. The narrative includes the worst fears and sensory details to activate the emotional fear network.

The recording is listened to repeatedly until habituation is achieved. With constant exposure, the story loses its affective charge and ceases to provoke terror, becoming a neutral narrative.

For obsessive thoughts, loop exposure is applied. The incessant repetition of the feared phrase causes semantic satiation, stripping the thought of its meaning and emotional power.