Live Exposure

Elaboration of the Exposure Hierarchy

Live exposure requires meticulous planning through a hierarchy of anxiogenic situations.

Together with the patient, feared situations are listed (e.g. returning a product, speaking at a meeting, eating in public) and rated from 0 to 100 according to the level of anxiety they provoke.

We start with situations that generate moderate anxiety (e.g. 40-50%) to ensure initial successful experiences that motivate the patient to face higher steps.

The order is subjective and personal; what is easy for one may be terrifying for another.

Planning and Elimination of Protective Behaviors

It is not enough to "be" in the situation; one must be without "crutches." Prior to exposure, identify and eliminate safety behaviors that the patient uses to reduce anxiety (e.g., avoiding eye contact, talking fast, holding a cell phone).

The instruction is to expose oneself to the feared stimulus (the social situation) by experiencing the anxiety fully, without trying to distract or protect oneself.

Only in this way does the brain learn that the situation itself is not dangerous and that anxiety decreases naturally by habituation.

Anxiety Recording and Processing

During exposure, it is essential to monitor anxiety levels at three times: before (anticipatory), during (peak and decline) and after. The patient records these levels numerically.

The goal is for him or her to observe how anxiety, although it rises initially, eventually falls if one stays in the situation long enough.

After exposure, the experience is processed: "Did what you feared happen?", "Was the anxiety as intolerable as you thought?". This post-exposure analysis consolidates corrective learning.

Summary

A hierarchy of anxiogenic situations is designed, ordered by difficulty. We start with moderate levels to ensure successful experiences that motivate the patient to keep moving forward.

It is essential to eliminate safety behaviors before exposure. The patient should face the situation without "crutches" to learn that anxiety decreases naturally by habituation.

During practice, anxiety levels are recorded at three times. Subsequent processing allows verifying that fear has decreased and consolidating the learning of safety.