Managing Phobias through Graded Exposure Therapy

Exposure therapies are designed to encourage the individual to confront their phobias and try to remain in the situation until they gradually desensitise, or overcome the phobia or anxiety disorder. There are many variations of exposure therapy that are successful in treating phobias, though the technique will depend on the nature of the phobia and the therapist and client approach. This may include a cognitive component to challenge distorted, negative irrational thoughts related to the phobia.

Managing Phobias through Graded Exposure Therapy / Mindful KeepingI recently supported one of my clients through the process of graded exposure therapy and she was happy for me to share her experience with you. Her phobia was in relation to managing her fear and anxiety around being home alone in her house after darkness set in.

In the case of my client, who I will name Beth for privacy and confidentiality purposes, I suggested she take the graded approach and repeat every night, or as many times as possible whilst her mother was away from the home. Beth’s mother was spending time in hospital and this was the first time that my client had ever had to stay in the house on her own, she had approximately one week to practice being alone before her mother returned home.

We discussed the best approach to take in such a short space of time. There were two components to her fear and this included taking her dog outside to do her business in the dark, which generally wasn’t a problem for Beth as her mother was normally inside the house when she took her dog out each evening. The second component to Beth’s phobia was staying in the house alone when it was dark outside. Beth stated that her fear escalated as the night progressed into the early hours of the morning and she found it difficult to go to bed and sleep at night.

Initially, I made a few suggestions to Beth that would help her to cope through the long hours of darkness, until our next appointment. These included leaving the front porch light on when she wasn’t home, so that she could see what she was doing when she returned home from visiting her mother in the hospital. This way, she would have light in the driveway when she parked the car, as well as when she walked up to the front door and inserted the key into the door. She could then turn out the light when she was safely inside the house. Beth stated that this was a good plan and that she would employ that idea.

The second thing I suggested she do was to leave a radio on in the house, whether it was music or talkback radio, it didn’t matter, as long as she had background noise so that she felt like she wasn’t alone in the house. I then suggested she leave it on all through the night, as Beth indicated that turning everything off and retiring for the night was the most fearful and anxiety-provoking part of the evening.

I also suggested that she invest in a night light, which she did, so she could leave it on in the hallway throughout the night, so that she wasn’t in total darkness. The final self-help tip I suggested to Beth was to keep her dog with her at all times, even when she retired for the night.

Both self-help strategies and therapy can be effective for treating phobias. Beth later stated that these ideas were very helpful for her in working through her fears.

Although Beth initially wanted to avoid being in the house altogether, she had enough trust in our therapeutic relationship to be guided by my knowledge and professionalism. I explained to Beth that in my experience, one of the most effective ways to overcome a phobia of this kind, is by gradually and repeatedly exposing yourself to what you fear, in a safe and controlled environment. Exposure therapy is often necessary if you are to overcome your anxiety disorder or phobia.

I had two ideas in mind that I encouraged Beth to try; one was taking her dog outside on her lead to do her business, before Beth retired for the night, keeping in mind that this is something that Beth would normally do with her dog every night anyway, the only difference now being that she was home alone. Beth was adamant that she couldn’t take her dog out to the front yard to do her business knowing that she was alone at the house. I asked Beth to keep the front porch light on, keep her dog on the lead and take her outside to the toilet just as she would normally do. I encouraged her to keep this routine going and then as she felt comfortable with it I then suggested that, rather than going back inside the house once her dog was finished doing her business, she stay outside and time herself for two minutes before returning back inside. This was keeping her outside in the dark for a longer than necessary time frame, giving her the opportunity to challenge her anxiety and fear.

During this exposure process, Beth has learned to ride out the anxiety and fear that she was experiencing until it inevitably passed. I did point out to Beth that I didn’t want her to stay out in the dark and have a full blown panic attack, so if she felt that it was becoming too intense, she could go back inside; she could always try again the next night.

What I was hoping Beth would see was that through repeated exposure, facing her fear of being outside alone in the dark would become manageable, with practice and time. This is also where she would apply her thinking strategies we had previously discussed, normalising her thought pattern, telling herself that she wasn’t going to die and that there was nobody watching her and she was safe.

Managing Phobias through Graded Exposure Therapy / Mindful KeepingIt’s not uncommon to overrate how bad things will be if you’re exposed to a situation you fear and underrate your ability to cope. Following this process each night was giving Beth gradual exposure and building her confidence until eventually she indicated that her anxiety was decreasing in the situation of taking her dog outside into the darkness. Beth said she even started walking her dog down the street. Beth increased her ability to manage this very well over several nights until she felt that she was taking back control and the phobia was losing its power.

The second component of Beth’s phobia was being alone inside the house at night. Before we put this process into play, Beth said that she was adamant that she wasn’t going to be able to stay in the house during the night hours. My suggestion of the radio, the night light and keeping her dog by her side was in order to take the edge off her anxiety and fear of being alone. Again, I suggested to Beth that she apply the same thought pattern process that she utilised when taking her dog outside to the toilet at night. We had previously discussed how she would counteract those negative thoughts with positive thoughts and how useful this could be for her. By journaling her negative thoughts throughout the exposure therapy process, Beth began to challenge those unhelpful thoughts with something more realistic. This helped her to alleviate her fears and reduce the onset of panic. She managed to tell herself that she was in a safe space and that nothing was going to happen to her. We even discussed a plan for imminent danger, involving where she would exit the house if she needed to and how she would escape to her neighbour’s house if there was ever a problem; there wasn’t a need for this plan.

So for the final part of her graded exposure, I asked Beth to pick a room, any room in the house where she wouldn’t normally have a light on or make use of that room at night. Beth looked at me like I was going mad. She selected a room and I asked her if she could go into that room several times throughout the evening and just stand in the room for as long as she could without going into full blown panic. I asked Beth to do this first with the light on and then as she built her confidence, stay in the room with the light off and gradually increase her timing so that she was spending more time in the room. I suggested she utilise her skills and techniques that she had learnt so far and through repeated exposure of facing her fears, Beth began to realise that the situation, while uncomfortable at first, was not harmful to her and that she was safe.

I will be honest; I didn’t know how Beth was going to overcome this phobia in such a short space of time as her mother’s return home was imminent. We both knew that this was going to be her only opportunity to work on this phobia because it was rare, if ever that her mother was away from the home for an extended period of time.

With limited time, Beth worked through the graded process, repeating the exposure night after night, confronting her fears in a safe environment, staying in the feared situation until her anxiety symptoms subsided. For the times she felt she couldn’t stay any longer in the situation, she left and came back and repeated the process again later until she felt less discomfort. This type of therapy increased Beth’s self-efficacy and emotional process, giving her the confidence to manage the feelings of her anxiety and attach new, more realistic beliefs about the fear and the situations.

In conclusion, towards the end of the graded exposure therapy process, I received a text message from Beth one evening saying, “Guess what I’m doing right now?” Of course I was curious so I answered back, asking her what she was doing. The response was uplifting when Beth said that she was out in the laundry room doing the washing, in the dark of night, with the lights on, the doors and windows open and unlocked, alone in the house but for her dog and that she was feeling fine, with very little anxiety. I was pleased that the exposure therapy was working for her.

At our next appointment, with Beth’s mothers return home from hospital pending, we discussed whether Beth felt that she had had ample time to overcome the anxiety around this particular phobia. Beth stated that her confidence had increased and that she felt that she was now in control of her phobia, due to the work that she had done so far around the process of graded exposure therapy. She said that if she had any further difficulty with the phobia, she would return to repeating the process of graded exposure therapy, referring back to the skills and techniques that she has learnt through her therapy sessions.

Although the graded exposure therapy was successful for Beth, working with phobias requires an individual approach. If you want to work on your phobia, it may be in your best interest to see a counsellor and discuss the best approach that will work for you. In Beth’s case, the graded exposure therapy was successful.

You can contact me here to make a booking if you would like some support in working through your phobia.

106 George Street
East Maitland NSW 2323

6/88 John Street
Singleton NSW 2330

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