The Easiest First Exposure
Sometimes the prospect of doing your first exposure can be really daunting. You’ve spent months, even years trying to avoid feeling your distress or sitting with uncertainty. Sure, your clinician might try to comfort you by explaining how Exposure and Response Prevention (ERP) makes the distress weaker and easier to handle, but you haven’t yet experienced proof of that! It’s just the beginning of therapy and you already feel stuck, paralyzed in fear despite how badly you want the outcome.
Never fear! (Or rather, learn how to fear skillfully.) In these situations, there is a way to begin developing your response prevention skills without aggressively exposing yourself to a feared situation, premise, or image.
When I work with folks who are afraid to take the first step, it is nearly always the case that they live a life revolving around noise and stimulation. People who are completely intolerant and fearful of experiencing a distressing thought often fill up every waking minute with some sort of distraction to get themselves out of their head, for fear of what their brain would generate if there were a moment of silence.
And that’s exactly what the first exposure is: silence. Not for too long. Maybe for 20 seconds at a time before a check in, and slowly increasing the duration over time.
Mindfulness as an Exposure
Building up the ability to cease seeking constant distractions, give the brain permission to generate whatever thoughts and feelings it wants, and practice choosing to not engage with that content is the whole point of an exposure. Sometimes, we don’t need to say or do anything particularly scary to kick off that urge to distract or soothe. As long as one experiences the urge to do so and practices resisting that urge, the exposure is useful for building our skills. Essentially what we’re doing here is using mindfulness as an initial exposure.
When you build up confidence at being able to handle moment to moment fears or discomfort your brain throws at you, you can begin taking on more active exposures, like saying a scary phrase or putting themselves in a distressing (but rationally safe) situation. Some folks just need a gentler entry point into the process to help embolden them, and to practice these initial skills under a less threatening context. That’s totally fine! I often tell my patients “it doesn’t matter if you like to jump into a cold pool or take the steps, as long as you’re here to eventually learn to swim.”