Identification of feared situations for exposure

A crucial initial step in exposure therapy is the detailed and specific identification of the situations, objects, or internal sensations that generate fear or anxiety in the person.

This process allows us to understand the nature of the problem and establish goals for gradual exposure.

Exhaustive Exploration of Fears

Together with the therapist, the person explores exactly which stimuli or contexts cause discomfort.

A general description such as "I am afraid of heights" or "I have anxiety about public speaking" is not enough.

These statements need to be broken down into concrete, observable situations.

For example, for someone with a fear of heights, feared situations might include leaning out of a high-rise balcony, climbing a ladder, crossing an overhead pedestrian bridge, or standing at an observation deck.

For someone with social anxiety, these might include starting a conversation with a stranger or giving an opinion in a meeting or eating in front of others.

Specificity and Context

It is important to be as specific as possible when identifying these situations, as fear can vary considerably depending on the details of the context.

For example, a person with a fear of dogs may feel much more anxious around a large, loose dog than around a small, leashed puppy.

Factors such as the location, the people present, the time of day, and any other elements that may influence the intensity of the anxiety experienced should be considered.

Hierarchizing Situations

Once the feared situations have been identified, the next step is to arrange them into an exposure hierarchy, from those that provoke a low or moderate level of anxiety to those that generate very intense fear.

This hierarchy will serve as a guide for gradual exposure.

This identification process not only provides the "raw material" for exposure therapy, but also helps the person become aware of the the breadth and specifics of their fears, which is an important first step toward self-knowledge and change.

The person's active collaboration in this process is essential to ensure that the therapy is tailored to their specific needs and fears.