Tool 1: Real Life Exposures

Real-life exposure means gradually but repeatedly facing real situations that you have been avoiding.

These should be things that most people would consider safe, but you find anxiety-provoking. Examples include driving, going shopping, using public transportation, watching certain TV shows, or leaving your baby for a short time with someone trustworthy.

For example:

Ellen, who had a very traumatic birth of her second child, avoids going out a great deal, especially to the neighbourhood of the hospital where she gave birth. She also avoids watching birth stories on television, because they remind her of her own birth experience.

Jennifer avoids being left alone with her baby, because she is afraid she might harm the baby.

Salima avoids leaving the baby with her sister, in case her sister won’t do things exactly how Salima would do them.  


How to do real-life exposures

STEP 1: Make a list
Make a list of situations, places, or objects that you fear. For example, if you are afraid of going out on your own with the baby while you are a new mother, the list may include: walking around the block; walking to a convenience store; driving or taking transit a short distance to a familiar community centre; and driving or taking transit to an unfamiliar shopping mall. It might be helpful to look at your list with a family member of an experienced mother whose judgment you trust.

STEP 2: Build a Fear Ladder
Once you have made a list, order your feared situations from the least scary to the most scary. You can do this by rating how much fear you have for each situation on the list, from 0 (no fear) to 10 (extreme fear). Once you have rated each situation, use the Fear Ladder form to make a final list.

If you have several different kinds of situations you avoid, make a separate Fear Ladder for each one.


Sample Fear Ladders

Fear Ladder for Salima’s fear of leaving the baby with a trusted relative

Step   Fear Rating (0-10)
1 Walking around my own neighbourhood while he naps at home with my sister. 2
2 Walking down to the coffee shop while he naps at home with my neighbour, a sensible woman with three grown children. 3
3 Walking down to the coffee shop, leaving Arman awake at home with my sister. 5
4 Leaving Arman for an hour with my sister while I go grocery shopping at the mall 2 km away. 6
5 Leaving Arman for an hour with my sister at her house while I go to lunch with a friend. 7
6 Leaving Arman with my sister for two hours while I go to the dentist across town. 9

 

Fear Ladder for Ellen’s fear of the area of the hospital where she gave birth

Step   Fear Rating (0-10)
1 Drive to a park 6 blocks from the hospital. 3
2 Drive a loop around the hospital neighbourhood, keeping about 1 block away from the hospital at all times. 4
3 Drive to within a block of the hospital, so I can just barely see it, and park there for 20 minutes. 5
4 Drive to the farthest part of the hospital parking lot, and park there for an hour. 6
5 Park at the hospital and walk to the door. Walk around the hospital to various entrances, without going in. 7
6 Go into the hospital, browse the gift shop, and have a cup of coffee in the foyer. 8
7 Call the maternity ward and ask for a tour. Explain that I had a difficult birth there and wants to see it again for myself, to help with the memories. 10
8 Visit the maternity ward again, this time bringing the baby. 10


STEP 3: Face fears (exposure)
Starting with the least anxiety-provoking activity, repeat it until you start to feel less anxious doing it.

Try remain in the situation for a prolonged period of time (e.g., going for a walk in your neighbourhood) – stay in it long enough for your anxiety to lessen noticeably.

Try “looping” it, if the situation is short in duration. This means doing the same thing over and over again for a set number of times (e.g., making consecutive phone calls until you feel more comfortable doing it).

Your anxiety will start to go down if you stay in a situation long enough (or continue engaging in a specific activity). Anxiety takes a lot of energy and at some point it “runs out of gas.” The longer you face something, the more you get used to it, and the less anxious you feel when you face it again.


STEP 4: Practise
Practise regularly. Some steps can be practised daily (such as driving over a bridge, taking an elevator, saying “hi” to a stranger, touching doorknobs), while other steps can only be done once in a while (such as attending a class or having lunch with friends). However, the more often you practise the faster the fear will fade.

Don’t forget to maintain the gains you have made. Even when you have become comfortable doing something, keep exposing yourself to it from time to time, so your fears don’t creep back. For example, if you have overcome a fear of needles, schedule routine blood tests or donate blood every six months so that your fear of needles does not return.

 

Beware of unhelpful advice that family members may give.

Well-meaning loved ones naturally want to protect us from distress, and might inadvertently say or do things that enable us to avoid the things we fear. They may say things like, “Why are you doing these things that are upsetting? Just stay home and relax.” It can be helpful to let them know what you are working on, and that it’s important for you to take it at a slow but steady pace. Loved ones can become your supporters and encouragers, rather than just your protectors.

 

For more information, see the following AnxietyBC resources:
Facing Your Fears: Exposure
Fear Ladder Template (PDF)