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Areas › Worry and anxiety › Facing it a step at a time
This matters most when the real version is out of reach: the dog you cannot summon, the flight you cannot afford, the classroom that is thirty miles away. Start with whatever version you can arrange this week. Having one step behind you early is a large part of what makes the next one thinkable.
Facing a fear in steps works, and it works best with someone guiding the ladder. Read this as an explanation of how it works, and take the steps themselves to a therapist.
We shall show you the easy way (Quran 87:8). The path is described as being made passable rather than taken away, which is what a gentler first rung is.
Translation: M.A.S. Abdel Haleem, The Qur'an, Oxford University Press, 2004.
In a randomised non-inferiority trial, one hundred people with spider phobia were assigned either automated virtual reality exposure or the gold standard single session of real exposure, and the virtual version was not inferior. A separate meta-analysis found that the link between how present people felt in the virtual environment and how anxious they became was real but modest, which suggests the stand in does not have to be perfectly convincing to do something. Both concern virtual reality rather than imagining, so the parallel is suggestive rather than settled.
Miloff A, Lindner P, Dafgård P, Deak S, Garke M, Hamilton W, Heinsoo J, Kristoffersson G, Rafi J, Sindemark K, Sjölund J, Zenger M, Reuterskiöld L, Andersson G, Carlbring P. (2019). Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial.. Behaviour research and therapy doi
Ling Y, Nefs HT, Morina N, Heynderickx I, Brinkman WP. (2014). A meta-analysis on the relationship between self-reported presence and anxiety in virtual reality exposure therapy for anxiety disorders.. PloS one doi
Strength of evidence: one line of research. A single study, or a theoretical account.
A pictured version stirs up enough of the same fear to be worth practising against.
Being shown a breathing technique is not the same as being able to use one. Practise it while nothing is wrong, often enough that it runs without you having to remember the order.
Start with the body. Slow breathing, muscles let go one at a time, a piece of music, a familiar object in a pocket. Small levers, and they turn fear from something happening to you into something you are doing something about.
Ask which step they are willing to try, and then go with their answer. A smaller step they chose themselves tends to get attempted, and a bigger one you chose for them often does not.