I found exposure therapy to be tremendously helpful, and I HIGHLY recommend to it anyone struggling with a phobia. It is so empowering to feel that you are conquering your biggest fears! Buuut how exactly does exposure therapy work?
Well, at my regular therapist's urging, I contacted the UPenn Center for Anxiety, and began a six month process! I did the over-the-phone intake back in January and was told that the grad students (the cheapest therapy option) were all booked up at that time, but that I would likely hear something in about a month. I was super relieved--hello avoidance!--and mostly forgot about it until I got a call in late February. I still wouldn't see someone right away, but I could come in for my in-person intake, and would likely be seen soon. I liked the girl that did my intake, and luckily, she became free a few weeks later and would be my exposure therapist! We decided to start on April 1, since a slot opened up for me right before I left for Chicago.
In my first appointment, my therapist and I created my "hierarchy"--a series of tasks related to driving (i.e. driving alone, driving in the rain, driving to work) ranked by how much they scared me on a scale of 1-100.
The idea was that I would work through these fears in order from "least scary" to "effing terrifying" throughout my course of treatment. Once I started doing the actual driving, my therapist would write my assignments (taken from my hierarchy) on sheets like the one below, and I would note when I did each one and how anxious I was before, during, and after. My anticipatory anxiety was usually waaaaay worse than my anxiety during the task. Our brains are so great at cooking up disaster and keeping us stuck in fear!
To that end, we also tried doing an "Imaginal" in which you script your biggest fears around your phobia, and then record it and listen to it repeatedly. I think it's supposed to make you comfortable with the idea that bad things could happen to you, but probably not to the ridiculous extent you've created in your head. (My imaginal involved car accidents, kidnappers, and ransom--enough said.) The problem for me was that I only ever had time to listen to it on the train, and trains/buses easily put me to sleep. Oops.
For me, the "game-changer" part of exposure therapy was the accountability. This is not surprising: I was a total teacher's pet in school (#perfectattendance #woot) and did my homework every single night, so for me, having to be accountable to another person who gave me assignments was an ideal system. I won't lie, though, I did briefly shut down and refuse (internally) to do my first assignment. But I realized that I would not only be ignoring an assignment (gasp!), but I'd also be paying my therapist to do nothing--she can't help me if I'm unwilling to hold up my end of the bargain and do MY work. So I pushed through and drove for about 20 minutes by myself (my first driving assignment), and progress snowballed from there. Overcoming that fear inertia is often the hardest part of anything scary, and I found that exposure therapy was just the push I needed in that direction.
I hope this post was helpful to anyone intrigued by the exposure process. Feel free to comment or e-mail any questions I may not have answered!