Do Short Duration Exposures Work to Help Extinguish My Fear/Anxiety?

The purpose of exposing a client to a feared situation is to help teach the client that their feared obsession is likely not to happen and that they can tolerate some anxiety. We do this by presenting graded exposures. This means that we start with situations or thoughts that bring on some anxiety and learn the skills necessary to tolerate the anxiety in the feared situation. The purpose is to help the client develop confidence in recognizing that they can tolerate some anxiety and that whatever they fear is likely not going to happen. Of course, if it does we prepare our clients with the necessary coping skills to help manage with the situation (remember, there is no certainty in anything!). When completing exposure work, many people often leave the exposure exercise early. This unfortunately, doesn’t allow for enough time for the body to habituate to the experience. In other words, there needs to be enough time for your body to recognize that the experience is generally safe and that it can be tolerated. According to a study completed by Chaplin & Levine, research participants who were treated with brief (short session) exposures reported more anxiety after the exposure sessions than those who were in the group that participated in timed exposures that were longer in duration (Tollin & Springer 2020). Evident in the research is that longer continuous exposures are more likely to positively influence anxiety symptom reduction.

According to the text, Avoiding Treatment Failures in the Anxiety Disorders, “Stern and Marks compared 2-h sessions with 4.5-hour sessions of in vivo exposure for panic disorder with agoraphobia and found that the longer sessions yielded higher response rates. Foa et al. (1980) conducted a cross-over study with agoraphobics and found the massed exposure (10 daily sessions) was superior to spaced exposure (10 weekly sessions), particularly in reducing avoidance. Foa and Kozak (1986) also suggested that a long (90 min) exposure outperformed nine brief exposures (30s) with a long interval (10 mins) among participants with OCD.” How often the exposures are completed are also an important variable to consider in your treatment. Completing the exposures every so often or spacing them far apart could increase the risk of treatment failure. Many clinicians are aware of how difficult it is to make time to complete homework tasks, but spacing your exposures strategically can make a significant difference in treatment gains going forward. Massed exposures can be done by implementing exposures within your life. Many clients have chosen to put post-it’s of their feared thoughts around their home, asked their loved ones to send text messages to them that could raise their anxiety regarding their fears, and have played anxiety provoking videos in the background as they continue with their workday. The is of course no substitute for the dedicated time needed to complete exposures daily with attention and without disruption.

Springer & Tollin, 2020, The Big Book of Exposures.
Hoffman & Otto, 2010, Avoiding Treatment Failures in the Anxiety Disorders.