The first time Kevin MacKenzie scrambled up a slide, a steep stretch of rock exposed by weather and geological forces, in the Adirondack Mountains, he swore he’d never do it again.
But the 56-year-old did do it again—and again and again. After multiple climbs, he became more comfortable, and today he even helps rescue other climbers who find themselves stranded midway up a rock face.
What MacKenzie has achieved is similar to a clinical technique called exposure therapy, a research-backed approach to taming a multitude of anxieties by exposing a person to their fears in a controlled way. “My fear never disappears,” MacKenzie says, “but repeated exposure has taught me I will have similar outcomes every time.”
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A DIY approach to exposure can work in some circumstances, says Jordan Conrad, a psychotherapist and director of Lexington Park Psychotherapy in New York City. “If you are clear about your fears and approach it seriously and carefully, you can try it on your own,” he says. “But sometimes a clinician is necessary to understand what’s at the bottom of an anxiety.”
For example, a person could have extreme anxiety about dating and might decide to expose their fears with a constant roster of romantic rendezvous. “But underneath that may be fear of abandonment,” Conrad says, “so that’s a wrong use” of exposure therapy.
Working with a trained therapist can help people to both drill down to the cause of their anxiety or fear and develop mechanisms for calming themselves down.
“We know that what exacerbates anxiety is avoidance,” explains Alissa Jerud, a licensed clinical psychologist and clinical assistant professor at the University of Pennsylvania. “Exposure therapy helps develop new, healthier relationships with your anxieties by breaking the avoidance habit.”
Traditional models of exposure therapy involve the use of habituation—through repeated exposure—to quell anxiety. Modern exposure therapy takes habituation and adds inhibitory learning, which helps patients rewrite their memory or beliefs about their objects of fear. Rather than completely deleting their fears, patients learn to tamp them down. For instance, if a person has a snake phobia, therapy can teach them that with very rare exceptions, they will likely never encounter a dangerous snake.
“If you’re struggling with thoughts that are overwhelming, or if you’ve tried small exposures and your anxiety flares up, you may want to seek therapy,” Jerud says.
Small, progressive exposures to the people, places, activities or memories that cause anxiety, conducted in a safe, controlled environment, can offer strategies to taming these aversions. In the clinic, a licensed therapist might guide a veteran with post-traumatic stress disorder through imagined exposure or someone afraid of spiders through real exposure—by gradually bringing them physically closer to the arachnids, for example—until they learn they are safe.
Therapist-led exposure therapy typically requires 15 to 20 sessions, according to Jerud, but every case is different. Patients need to do the “homework” that their therapist prescribes between sessions. “It’s like learning a new language,” Jerud says. “You need to practice outside of your appointments.”
A single exposure is unlikely to be enough—and as with learning a language, Conrad and Jerud recommend that individuals have “booster sessions” if anxiety flares up.
As MacKenzie has learned on his own, exposure doesn’t eliminate your fear. But it does allow you to skillfully manage it. “Enough time on slides has served as positive reinforcement that I will be okay,” MacKenzie says.
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