Clinical ApproachI have used cognitive-behavioral therapy with exposure since 2016 in a variety of settings ranging from schools to inpatient units. My clinical approach for anxiety and obsessive-compulsive disorder uses cognitive-behavioral therapy with exposure. This is an evidenced-based approach that recognizes the relationship between thoughts, feelings, and behaviors.
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Credentials
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The cognitive behavioral model for anxiety and OCD focuses primarily on behaviors in the triangle above to help clients think about their fears and the consequences of those fears in new ways. The best way to target maladaptive behaviors is exposure and response prevention.
How Anxiety Develops
Figure 1: Development of Anxiety
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Figure 2: Exposure Therapy for Anxiety
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I show a simple model of how exposure and response prevention works above. In Figure 1 above, my dog Molly starts out as cute, but with anxious behaviors becomes just as scary as a bear that was sitting in my backyard. This can happen when someone sees Molly for the first time, causing their anxiety to increase. Afterward, they engage in some kind of avoidance behavior (like backing up, or walking away), which lowers their anxiety, but only a little bit and only in the short-term. By continuing to avoid Molly, they never learn that she will not harm them, so the anxiety continues to increase every time they see her. This pattern (the lightning bolt) continues until Molly becomes just as scary as the bear.
How Exposure Works
Exposure works by slowly and gradually introducing someone to Molly. This usually involves creating a fear hierarchy (sometimes called a fear ladder) with exposures that gradually help us face our fears at our own pace. The first exposure challenge (in Figure 2) is typically the hardest and anxiety takes the longest to decrease. Afterward, when we repeat those exposures, they get easier, and the anxiety decreases faster. Soon enough, we
This model has been used for nearly 100 years, and can be applied to many different problems and disorders. For example, in the case of OCD, instead of being afraid of Molly, individuals with OCD typically fear their own thoughts, which we call obsessions. (Check out a longer explanation from iocdf.org.) Fear hierarchies and exposure therapy focus on those obsessions and compulsions.
Personalizing Therapy
The benefit to this approach is that treatment plans can be tailored to specific clients. Individuals move through their hierarchies and therapy goals at different paces; moreover, they experience different social contexts (e.g., one's gender identity, race, family situation, socioeconomic status) that are directly incorporated into treatment planning. In addition, progress is monitored carefully through every session to track client goals and symptom reduction. This allows us to work collaboratively with data and to change anything as needed.