What is Graded Exposure Therapy?

In this FAQ series, we asked clinical psychologist Catherine Gallagher what is gradual exposure therapy.

Fear can be a strange beast that presents itself in many different ways. As is true with people, fear is often a unique and individual experience for everyone – with people reacting differently to different stimuli. One thing that most can agree on, however, is that if something triggers a stress or fear response in you, rarely do you go to actively seek it out. But what is this avoidance of fear doing to our brain, and how can we start to re-write this chain of thought?
 

Everyone has something in this world that they don’t like. Be it that dog down your street, a colleague at work, or pineapple on pizza. While the intensity level of that dislike may vary, the response often tends to be the same. Avoidance. We begin to adapt to the world around us in order to minimise our confrontation with these dislikes. We learn to walk around a different block, alter what time we eat in the lunchroom, or change our toppings for a more specific order.

While at first these decisions are conscious, repeated enough, they become an unconscious reaction to avoiding discomfort. When we reach a level of anxiety or fear around a stimulus, our brain starts to become a little more hard-wired. Left-over from our in-built evolutionary survival system, humans are pre-programmed to stay away from situations or experiences that cause us potential harm or leave us feeling uncomfortable and vulnerable. This can become extra tricky in today’s society where a lot of the anxiety-inducing situations we experience come from within or from our own expectations of ourselves and the world around us.
 

While in today’s world we often seem convinced that the anxiety-filled situations we find ourselves in are “life or death”, in reality, most of these don’t actually present any danger. We panic over one line in an email or question what someone meant when they were talking about this or that. Yet, we still respond with our stress response of ‘flight, flight or freeze’ – our brain screaming at us to get out and minimise the danger risk immediately. Each time we trigger our anxiety and stress response, we contribute to our fear feedback loop and increase our willingness to stay away from those things or situations that may cause us harm. We label them as dangerous and file them in a separate compartment within our brain. While words, messages and people can sometimes be hard to stay away from, other such fears or triggers can be easier to avoid. Yet, the longer we avoid these, the more we can convince ourselves that they’re dangerous, justifying the risk levels to feed back into our preconceived feedback loop of fear.
 

Cue ‘Graded Exposure Therapy’. Aimed at breaking down those experiences causing you fear and anxiety, Graded Exposure Therapy helps to break down the link between the stimuli and your brain’s reinforcement triggering a stress response within your body.

As an example, let's use fear of dogs. Cynophobia, or a fear of dogs, is a very common phobia that can affect many people. Like all phobias, cynophobia can be triggered from previous bad experiences – such as being bitten by a dog, chased as a young child, or even just from being growled at by a big dog through the fence a few doors down. In this situation, an individual may employ the avoidance technique – developing a further fear response when in close proximity to any dog. They may worry that if they come into close contact with the dog, then they may be bitten or chased, linking this behaviour to all canine creatures.

Feeding your fear response, your brain then reinforces that link between dogs and danger, taking the original content and expanding it to cover any breed or situation in which a dog may be present.
 

So where does Graded Exposure Therapy come in? Helping to provide your brain with different experiences and messages, Graded Exposure Therapy helps to break down the link between all dogs and danger. While some dogs are best avoided or left alone, other dogs may be playful, calm, and safe to be around. By first learning to distinguish the difference between, for example, a large aggressive dog, growling and foaming at the mouth, and a calm and well-trained service dog, we can start to learn the difference between a dangerous dog versus one that is safe to be around and spend time with.

Graded Exposure Therapy helps to change the narrative within our brain. We start to learn how to spend time around those things our brain had told us to avoid. Over time, with repeated exposure, we begin to learn that perhaps our fear wasn’t as justified as we first believed. It can help us to grow and accept that perhaps we can spend more time in such situations, helping us to feel safer and get us to the other side of those negative experiences.

But how does it work? As the name suggests, Graded Exposure Therapy is gradual and performed in bite-sized chunks. Alternative methods of exposure therapy include ‘Flooding’, and while effective, flooding your system with stimulus and situations related to your specific fear can be rather traumatic and a lot for an individual to work through.

Graded Exposure Therapy exposes an individual to a situation that their brain has deemed dangerous and offers the chance to practice any skills and techniques learnt to help dampen that fear and calm themselves down. As one’s ability to settle their nerves and face their fears increases, so does the level of exposure to their specific fear-inducing stimuli. Over time, this gradual exposure can be a very effective method of helping someone to overcome their fears and move forward with their lives.