Exposure therapy is about staring down fears, without looking away. This often means gradually confronting fears in real life, such as by standing closer and closer to a spider as a way of overcoming arachnophobia. These so-called in vivo exposures can be highly effective, but they aren’t always practical or possible.
Our Imaginal Exposure worksheet helps clients confront their fears through the power of the imagination. This involves visualizing a fear coming true in vivid detail until it’s no longer as distressing. Our worksheet guides clients through this experience in three steps:
- gathering information about the fear
- writing a story about the fear coming true
- listening and relistening to the story
This exercise is ideal for clients with OCD, phobias, generalized anxiety disorder (GAD), and any anxiety condition that involves a feared scenario or consequence. You can use the imaginal exposure as a standalone intervention, or as a complement to in vivo exposures. Imaginal exposures are not appropriate for clients with psychosis, borderline personality disorder (BPD), or post-traumatic stress disorder (PTSD).
Some important points to emphasize to clients:
- For best results, make the exposure story as scary as possible.
- Distraction, relaxation exercises, and compulsions undermine the benefit.
If clients find this too overwhelming, consider suggesting an in-session, therapist-guided exposure.
