First, we'll make sure we both have a shared understanding of your goals and values, and where your anxiety is interfering. We’ll think about what actions “feed” your anxiety, and whether there are other interacting factors (such as current life context, trauma history, sensory needs, etc.). We'll take these other factors into account in our plan. I do not treat ADHD/Autism traits with exposure, and I do not focus on whether fears count as “irrational” or “rational.” The goal is to focus on the things you do because of your anxiety, and to work towards what you’d like to be doing instead.

Based on the information above, we'll create exposure ideas to gradually build towards your goals, using a list from “easiest” to “hardest,” called a “hierarchy.” The list acts as a road map for treatment; it doesn't need to be strictly followed. 

Example

Let's say that you’re terrified that a squirrel will bite you. When you’re in public spaces where there could be squirrels, you feel really restless and like your head is on a swivel. Sometimes you change plans, cancel plans, or leave things early when you run into a squirrel or feel that the risk is too high. You talk about the fear often with your loved ones, and you often feel drained from navigating all this stuff. You’ve tried to convince yourself to feel okay about squirrels, but that doesn’t calm you emotionally.

You want to be able to enjoy public spaces, feel less drained, and spend less time “in your head” about squirrel stuff. You want to feel confident going for a walk in the local park. The image in this section shows what a small hierarchy could look like for you.

We would then pick somewhere in this list as your starting point, and you would do rounds of that chosen exposure “trial,” in or between therapy sessions. At each session, you and I would check in on how the exposure is feeling, and then “level up” as you feel ready. As you level up, you train your “response prevention” skills more and more.