The following are 8 tips for practicing exposure and response prevention therapy for agoraphobia, panic and anxiety disorders. The key lies in confronting your fears, embracing the discomfort, and realizing that anxiety is not insurmountable and that you have the power to tolerate the symptoms.

1. Embrace the anxiety and discomfort: Feeling anxious during an exposure is natural, it signifies that you are doing the exposure correctly by triggering your fear and it signifies progress.

2. Lean into the fear: What does that mean…lean into it. Rather than resisting the fear or trying to calm yourself to feel less anxious or distract yourself, you want to feel the anxiety and notice your symptoms. You are dropping your resistance all together.

3. Let go of all safety behaviors: Safety behaviors can include having other people with you, taking medication or using substances to calm you, bringing medication with you, bringing food or water, monitoring your symptoms, using distraction, practicing calming strategies like breathing methods or trying to relax yourself. Even the smallest safety behavior can negate the exposure and block the benefits. When you use safety behaviors, like having someone with you in the car while driving or going somewhere, your brain interprets that as being the only reason you could do the exposure and survive it. Some people can give up their safety behaviors cold turkey, while others work to gradually give these up.

4. Learn something new: Each exposure is like a little behavioral experiment. Remember the first time you learned to ride a bike. You had to confront your fear, let go of safety behaviors like someone running next to you, and trust yourself. It was scary. You may have even fallen a few times. I remember riding right into a line of picker bushes next to my parent’s driveway. But, somehow, I jumped on that bike again and learned to ride. That’s exactly what you do in exposure therapy. You are allowing your brain to learn that you can face your fear head on and survive. With practice, your brain creates a new neuro network that we refer to as safety learning. The fear then extinguishes or goes away. However, your goal is not to reduce your symptoms, your goal is to tolerate your symptoms.

5. Embrace Surprise: Surprises during exposures are golden moments. They strengthen your memory and help to extinguish fear. We surprise ourselves in exposures by planning an exposure where we expect the worse to happen and then learn that it doesn’t happen.

6. Vary Intensity: We used to say to create a hierarchy and slowly work your way up the hierarchy doing more and more challenging exposures. What inhibitory learning research has taught us is that our brains learn better by varying the intensity of our exposures. That means that one day you might want to do something very challenging, and another day choose an easier exposure. I do, however, recommend beginning exposure therapy doing exposures that you know that you can get through. This helps to build up your confidence.
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7. Change Settings: You want to change it up often when you do exposures. Fear generalizes and exposures do not. What that means is that fear can spread easily from one thing to another. However, exposures do not.

8. Daily Practice: Consistency in practice is the key. You will have good days and bad days and recovery is never linear. But practicing daily or as often as possible is the key to long term recovery.

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