Why do worry exposure?

There are several reasons why purposely exposing your self to your worries can be beneficial:

• Confronting your worries allows you to practice using the skills that you’ve learned, such as relaxation techniques or cognitive challenges to distorted thinking.
• Intentionally worrying allows you to practice focusing on one thought at a time so you can habituate to the specific worry.
• Because worry exposure decreases anxiety in response to specific thoughts, you’ll be less fearful when those same thoughts arise spontaneously.
• Avoiding thoughts, or using techniques like distraction, maintains fear and can even cause more anxiety and worry. Directly confronting your worries stops that negative cycle.

How to confront your worries

Effectively confronting your worries involves systematically and repeatedly facing the thoughts and images associated with specific worries. Here are the specific steps involved in worry expo sure (Lang 2004; Brown, O’Leary, and Barlow 2001):

1. Develop a list of your worries
2. Create a hierarchy in which you rank these worries in order of importance, or the amount of anxiety they cause
3. Practice your imagery skills
4. Choose a worry to con front and focus on it for an extended period of time

Step one: List your worries

Look back at your note book and review the self monitoring that you completed earlier. What worries did you identify? Do you worry about your family, your health, or your job? What do you worry might hap pen? If you haven’t done any self-monitoring, take out your note book now and list your most common worries. Be as specific as you can. You may need to spend a few days working on this task before moving on to the next step.

Step two: Create a hierarchy

Now take your list of worries and think about how much anxiety each causes you. Using a scale of 1 to 10, with 10 being the most anxiety and 1 being minimal anxiety, decide how anxious each worry makes you. Some people find rating their anxiety difficult, so don’t be too concerned about the accuracy of your ratings. Just do the best you can. You can always revise your ratings later if necessary. In your note book, make a new list of your worries, ranked from highest to lowest anxiety. As an example, Paula’s worry hierarchy might look like this:

Worry Anxiety Rating

• My kids will have unhappy lives. 10
• My husband may get into a car accident. 9
• My kids will fail out of college. 8
• I may have some illness that I don’t know about yet. 8
• I don’t spend enough time with my kids. 6
• My boss will notice the mistake I made yesterday. 5
• The bills won’t get paid on time. 5
• I’ll never finish all my housework. 4
• I’ll be late for work. 4

Step three: Practice your imagery skills

Imagining and holding a thought in your head for an extended period of time can be difficult, especially when the thought is anxiety provoking. Like any other skill, it may take time and practice to master. Many people find it easier to practice their imagery skills with scenes that are pleas ant or neutral before moving on to their worry scenarios. Practice with a pleas ant scene prior to beginning expo sure to your worries me thoughts and images.

Step four: Choose a worry and confront it

After you’ve created your worry hierarchy and have honed your visualization skills, it’s time to pick the first worry you’ll con front. To start, choose a worry that produces mild anxiety. Then write out the worst possible out come in as much detail as you can. For Paula, it would make sense to start with her worry that she’ll be late for work, since it’s low on her list. She would then consider all the feared negative consequences of being late and would write them out in detail. Her worry scenario may go some thing like this:

I show up late for work and everyone notices when I walk in. My boss is standing near my desk talking to a coworker and I see him look at his watch as I walk by. I can tell that he is not pleased. He calls me into his office later that day and tells me that he cannot tolerate this kind of behavior and that it isn’t fair to the other employees. He tells me that I’ll have until the end of the day to clear out my desk. I’m given no time to find another job, and we can’t pay our bills. We have to move out of our home and can barely afford the basic necessities of life.

After writing out this scene, Paula would imagine it as vividly as possible. Some people find this easier to do if they record the scenario on audio tape. That way you can close your eyes and really focus on the images. The thoughts and images should be kept in mind for twenty to thirty minutes. Concentrate on them as if the scenario was actually happening. It’s normal for anxiety to rise during this part of the exercise, but it should begin to decrease over the course of the exposure. Be sure to record your anxiety level in your notebook, both at the beginning of the exposure and at the end, using the 1 to 10 scale.

Step five: Apply your anxiety management strategies

After sticking with the exposure for twenty to thirty minutes, you can apply your anxiety management techniques. For instance, Paula could identify the cognitive errors in her worry that she’ll be fired for being late, she could list evidence against that belief, or she could come up with other, more likely possibilities. Relaxation techniques, such as diaphragmatic breathing, could be applied at this point as well. In your note book, rate your anxiety again after you have used your new skills.

excerpt from 10 Simple Solutions to Worry: How to Calm Your Mind, Relax Your Body, and Reclaim Your Life by Kevin L. Gyoerkoe Psy.D., ACT, Pamela S. Wiegartz Ph.D., ACT