The 4 essential conditions
Exposure and Habituation has 4 essential conditions to make it work effectively that you should check your plan against each time. Making sure your plan meets these conditions means you will be able to habituate and help your body to learn to switch off the alarm for things it doesn’t need to respond to.
Graded: The first condition is that is graded so there is enough
anxiety to habituate, but it is not overwhelming and feels manageable. 50-60% is a good starting exercise.
Prolonged: The second condition is that each time you do the
exercise you stay in the situation until your anxiety drops by 50% from the rating at the start of your exercise.
Repeated: The third condition is that you need to repeat each step of
the hierarchy until it no longer triggers a high level of fear. 4-5 exercises of exposure a week on average is needed to achieve this. Some weeks you will do a mix of steps if you habituate to one. This needs to be done over this short time frame so that the repeated exercises are close enough together for habituation to take place. You repeat each step of the hierarchy as an exercise until your anxiety drops to 40% or less before and at the start of the exercise. Then you know habituation to that step has taken place and you can move to the next exercise. Remember each step will produce an increased level of fear as you work up the hierarchy, even when you have habituated to the previous step, although it often gets easier than predicted.
Without distraction: The final condition is that you need to be
aware of any internal or external distractions, even subtle things that can distract you as you are doing the exercise. You must experience the anxiety without any safety behaviours or anything to bring your anxiety down artificially.
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© Marie Chellingsworth (2020). The CBT Resource.
