Planning your first week of exposure and habituation

Planning your first week of exposure and habituation exercises

Select a first exercise on the easier section of your hierarchy. It should be one that still meets the condition of graded, whilst giving enough physical symptoms of anxiety to habituate to. Aim for 50-60% anxiety as a starting point. You may have lower graded exercises, but these won’t provide enough symptoms to habituate. Write your chosen exposure exercise into the exposure diary and make a plan for when you will do it and be able to repeat it 4-5 times over the next week. Remember it can take somewhere between 20 minutes to 120 minutes to come down and each person metabolises the adrenalin back in at a slightly different rate. So leave enough time for the first exposure exercise. After that, if the conditions are met, each repeated exercise of that step should come down a little more quickly and not go as high. That gives you an indicator of how much time you will need to set aside for the first week.

Once you have decided when you will be able to do your first exposure exercises, fill in the dates and times on your exposure diary. This is where you will detail what you did, how it went and your anxiety levels to check if you are habituating to it. You can then plot it out on the blank habituation graph. Your Practitioner supporting you will help you to review how it went and problem solve any difficulties in your next session. An example of Alison’s completed week 1 diary is provided for you to see what she did, her ratings and when she stepped up. When you begin to prepare to do your exposure exercise before going into the situation, just before the planned start time, fill in the ‘Before Exercise’ rating to indicate how much anxiety you are experiencing. Use the rating scale at the bottom of the diary to help you. Just as you start your exposure exercise in the situation, re-rate your anxiety again using the ‘Start of the Exercise’ rating column. This is the figure you will use to know when to stop the exposure exercise when this level has dropped by 50%. Once your anxiety has dropped by half, fill in the time you did the exercise over in the ‘Duration’ box on the worksheet. This helps you to plot your exposure on the habituation graph to see how your anxiety went and how long it took to drop for each exercise.