When clients become experts in doing exposures (Social Anxiety, PTSD, OCD, Phobias), they become used to facing fear, disgust, and other uncomfortable feelings square on without tricks and escapes- while still pursuing the valued behaviors and thought processes they want. Sounds too good to be true? It’s not, but it takes discipline and hard work, but it’s well worth it when your life is held “hostage.” Check out my video + written primer, “What is Exposure Therapy & How Do You Do It” for more. What do we do when classic exposure (in-vivo, also called situational) doesn’t work?
Who Needs Imaginal Exposure?
Those who suffer with intrusive, unwanted sexual, religious, relational, catastrophic, and similar thoughts will need to spend most of their practice time using imaginal exposure. There are “4 Types of Exposure Therapy.” Imaginal exposure is an outstanding tool that helps sufferers face their fearful thoughts. Most of the time, the frequency and intensity of their thoughts reduces, but the beauty of the therapy is that regardless of whether you feel less distressed or not, you can learn to face life with confidence even when distressed or if a specific thought doesn’t go away the way you’d like it.
CBT & Journaling
Those who’ve tried therapy before, especially CBT, are typically familiar with journaling (some think of it as keeping a diary). Writing down our thoughts is as old as human history. It can be wonderful to process, remember, track, tell a story, and so much more. Writing down thoughts is extremely beneficial for multiple reasons.
Scripting is Weird
Intentionally writing down scary stuff on paper, saying it aloud, and having others say it to you is a bit different from other therapeutic tools. While some of the above benefits of journaling do occur, the primary aim is to face distressing triggers (stimuli) while reducing and eventually abolishing problematic responses. That’s what exposure therapy is. Often paradoxical and strange to the uninitiated, new clients commonly cock their heads sideways in disbelief when recommending exposure, especially imaginal exposure. See “Flip The Script: A Guide To Imaginal Exposure” for a detailed launch into understanding this practice.
The research doesn’t lie, and I don’t think my history with hundreds of clients does, either: exposure for thoughts works.
If you have OCD, take an obsessional fear, such as “what if I’m not attracted to my partner?” In therapy, you would have to address this as part of a larger process, but breaking it down for educational purposes, we’ll want to identify the core fear, e.g., “I need to tell them and move on, which would hurt us both, and I might accidentally let go of a great person if I do.” In scripting an obsession, you will want to sit with the concern without figuring it out, acting on it, compulsing, or anything else that gives it credit. This is hard to do. It takes practice. You’ll likely need a therapist to help.
How Exposure Scripting is Different Than Journaling
Things to look out for in exposure scripting different than just “journaling”:
- Don’t “free associate,” necessarily (i.e., don’t write down anything and everything that comes to mind when you’re first learning how to do it)
- Don’t try to keep a “complete” journal of your thoughts
- Don’t try to figure out obsessional or fear-based thoughts, the reasons you are having them, or any other way of engaging with the content. (Check out this video by Dr. Reid Wilson- “Why You Should Step AWAY From Your Worries”)
- Face your discomfort, don’t try to escape it
- Be careful with looking back at past writings to “test” or compulse.
There you have it. Journaling is different than scripting. Their purposes are different and yet some of the benefits can be shared. As with most things in therapy, their use needs to be functionally assessed, i.e., “for what purpose am I doing this?” Best wishes as you script fears and learn how to face scary thoughts. You will be better prepared to face reality as it comes.