Although exposure-based treatments can be highly effective for helping clients overcome problems with anxiety, you can enhance treatment outcomes by paying attention to the way that you conduct exposure therapy. Successful exposure therapy follows these guidelines:
Clients may become anxious and experience other somatic symptoms (e.g., rapid breathing and sweating) when discussing events they perceive as threatening. Remember that this is the basic fight or flight response and it can be a signal that the client perceives great threat.
Notice and describe these symptoms as they emerge in session. For example, “I’m noticing that as we discuss this topic you’ve started to breathe rapidly and are visibly very anxious.”
Your client reads that exposure and response prevention (ERP) is the gold standard for treatment of OCD. She tells you, “I’m willing to try ERP, but I’m only willing to do some exposures and not others!”
One of the most common fears socially anxious clients have is of making mistakes. Social perfectionists do not allow themselves to make the sort of common human errors the rest of us do, and this both causes and maintains their anxiety. By trying to live up to a perfect standard in social situations, these clients have unrealistic expectations of themselves.
The social perfectionist has a tough time asking questions because he is afraid he may sound stupid. Exposures designed to test whether he really does sound stupid often fail because no matter what he says, or what others tell him, it sounds stupid to him. It is often more effective to expose this client to his core fears. I call this exposure “asking stupid questions.”