Getting the most from exposure practice
A practical guide to making each exposure practice count: test a clear prediction, drop safety behaviours, stay until you learn something, name feelings, vary practice and write down what you learned. Based on Craske et al. (2014): adds a checklist for your next practice and a space for what to remember.
Written by Tarun Vermani, Trainee Clinical Psychologist Updated
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Getting the most from exposure practice
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What each practice is for
Exposure practice is a way of finding out. Each time you face something you fear, you have a chance to learn that what you dread does not happen, or not in the way you expected, and that you can cope with the feeling while you are there.
The aim is not to feel calm. Some practices will feel easier than you expected and some harder. A practice still counts if your anxiety stays high, as long as you stay with it and learn something new. Your therapist can share a sheet on why avoidance keeps fear going and how anxiety often rises and settles. This sheet is about how to make each practice count.
Before you start: name what you expect
Before each practice, write down exactly what you fear will happen. Make it specific enough to check, for example "I will faint in the queue" or "people will laugh at me if my voice shakes", rather than "it will go badly". Then rate how likely it feels, from 0 (it will not happen) to 100 (it will definitely happen).
Choose a practice that can really test that prediction. If you fear you will faint after ten minutes, a two-minute practice cannot tell you much. You learn most when what happens is different from what you expected.
Only practise steps you have agreed with your therapist, and leave out anything that would put your health or safety at real risk.
During: drop the extras
Safety behaviours are the small things we do to feel safer: holding on to something, keeping a phone in your hand, having someone with you, rushing, or saying something reassuring to yourself over and over. Distraction can work the same way. They can leave you thinking "I was only all right because I did that", so the fear never gets a fair test.
As you practise, drop them, all at once or one by one.
Choose which safety behaviours to drop with your therapist. Keep precautions that protect your real health or safety. Do not stop or change any prescribed medication on your own; talk to your prescriber first.
Stay until you have learned something
You do not need to wait for your anxiety to fall before you stop. A better question is: have I found out what I came to find out? If you were testing whether you would faint in the queue, stay until you have been in the queue as long as you feared it would take.
If you leave early because the feeling is too much, that is information too. Talk it over with your therapist and plan the next step. One hard practice does not undo what you have learned.
Name what you feel
While you are in the situation, try putting your feelings into words, out loud or in your head: "I feel scared. My heart is pounding. I am worried people are looking." You are not trying to argue with the feeling or make it go away, just to describe it. Many people find that naming a feeling makes it a little easier to stay with.
Mix it up and practise often
What you learn in practice can be tied to the place where you learned it. If you only ever practise in one place, at one time, with one person, the new learning may not come with you to other places. So vary things:
Practise in different places and at different times of day, alone and with other people.
Change how long you stay, and do not always climb your list in strict order. Sometimes try a step a little harder, or go back to an easier one in a new setting.
Practise often, several times a week if you can, rather than one long practice now and then.
Once single fears feel manageable, try putting two together. For example, if you fear lifts and you fear crowded places, you might take a lift in a busy shopping centre.
After: write down what you learned
Soon after each practice, ask yourself: did what I feared happen? What did happen? What surprised me? What did I learn about the situation, and about how I cope? Then rate again how likely your prediction feels now.
Write your answers down, so you can look back on them. Your therapist can share a record sheet for this. Keep it to what you found out: going over it again and again to feel sure is not part of the practice.
Things I will try
Tick the ideas you want to use in your next practice. You do not need to do all of them at once.
What I want to remember
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When to use ‘Getting the most from exposure practice’
‘Getting the most from exposure practice’ is a psychoeducation handout based on cognitive behavioural therapy (CBT). It draws on core CBT skills used right across the model, with presentations including depression, anxiety, OCD, trauma and low self-esteem, rather than being tied to a single diagnosis.
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 8 minutes. It moves through six short sections to read:
- What each practice is for: Exposure practice is a way of finding out. Each time you face something you fear, you have a chance to learn that what you dread does not…
- Before you start: name what you expect: Before each practice, write down exactly what you fear will happen. Make it specific enough to check, for example "I will faint in the…
- During: drop the extras: Safety behaviours are the small things we do to feel safer: holding on to something, keeping a phone in your hand, having someone with you,…
- Stay until you have learned something: You do not need to wait for your anxiety to fall before you stop. A better question is: have I found out what I came to find out? If you…
- Name what you feel: While you are in the situation, try putting your feelings into words, out loud or in your head: "I feel scared. My heart is pounding. I am…
- Mix it up and practise often: What you learn in practice can be tied to the place where you learned it. If you only ever practise in one place, at one time, with one…
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The CBT approach behind it
‘Getting the most from exposure practice’ introduces a CBT approach that involves gradually and safely facing avoided situations so anxiety can subside (exposure). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This handout is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Craske, M.G., Treanor, M., Conway, C.C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23. doi:10.1016/j.brat.2014.04.006
- Craske, M.G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46(1), 5-27. doi:10.1016/j.brat.2007.10.003
- Weisman, J.S., & Rodebaugh, T.L. (2018). Exposure therapy augmentation: A review and extension of techniques informed by an inhibitory learning approach. Clinical Psychology Review, 59, 41-51. doi:10.1016/j.cpr.2017.10.010
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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