Therapy on the Field: Exposure techniques for anxiety disorders

Normally when we think about the therapeutic encounter, we conjure up images of a somewhat cosy consulting room with an armchair or two, bookshelves against a wall and therapist and client sitting across from one other.  Rarely do we imagine meeting our therapist ‘on the field’, at the scene where a traumatic event may have occurred in our lives, an event/object/activity which may have triggered post traumatic stress disorder, phobias or panic attacks.  The feared event/object/activity becomes ‘avoided’ in order to alleviate the symptoms of anxiety it induces in the afflicted person.

To help a client overcome the anxiety disorder, in vivo exposure therapy techniques are essential tools of the trade for cognitive behavioural therapists.  Patient and therapist must leave the comfort and safety of the consulting room and engage with the avoided or feared object/place and confront this anxiety.  Experts claim in vivo treatments can significantly accelerate improvement in patients, once they have received sufficient coping mechanisms to manage the increased anxiety levels triggered by live exposure (e.g. cognitive, relaxation techniques).  By sitting with the anxiety, rather than running away from it, the client is given an opportunity to disprove the irrationality of the interpretations he holds about the feared object, activity or place. 

A word of caution however:  while not engaging in live exposure may deprive the client of a powerful opportunity to significantly overcome an anxiety disorder, live therapy executed too early in the therapy contract can set the client back considerably and can sever the trust between therapist and client.  Caution and experience on the part of the therapist in dealing with such behavioural interventions is essential and that the client feels comfortable and safe enough with the professional he/she is working with.