Exposure

Exposure is foundational in the evidence-based treatment of anxiety. It refers to the process of a person gradually exposing themselves to the object/activity/situation/feeling that makes them anxious so that their brain and body have a chance to react and then realize that the feared outcome did not occur or that they are able to cope. For example, if a person is afraid of dogs biting and avoids them, this person will continue to believe that if they get close to a dog, the dog will bite. If, one day while they are engaging in exposure therapy, instead of avoiding dogs, they approach a dog (ideally a friendly one), they are very likely to feel quite anxious! But if that dog then nuzzles their leg and wags her tail, over the next few minutes, it is likely that the person’s anxiety will go down as they realize the feared outcome isn’t likely to occur. Even if their anxiety doesn’t go down over the course of their interaction with the dog, they will still realize that they were able to tolerate the anxiety, and their brains still experienced a potent expectancy violation (see definition above). If they repeat this exposure enough times, they are likely to get to a point where they are only a bit nervous around dogs, or maybe not scared at all! In Exposure Therapy, we create a hierarchy of challenges (e.g., watching YouTube videos of dogs, walking past dogs on leashes at a distance, getting close to a dog but not touching, giving a dog a treat) from easiest to most difficult, and we start with something that feels a little scary but doable. The child “levels up” as they adjust to different challenges.

Age range: 1st grade through 5th grade.

Recommended for: This workbook is a must-read for any child and their caregiver who are looking for relief from phobia(s). It’s an interactive book that teaches children gold-standard cognitive-behavioral strategies to reduce their fears, and it’s applicable to any and all phobias, including fears related to animals (e.g., dogs, spiders, bees, sharks), nature (e.g., heights, thunderstorms), injuries (e.g., blood, shots), small spaces (e.g., airplanes, elevators), and/or anything else (e.g., clowns, balloons, vomiting).

Evidence-Based Practices: Exposure, Cognitive Restructuring, Diaphragmatic Breathing

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Age range: Preschool through 2nd grade.

Recommended for: This book addresses a common cause of accidents– a fear or reluctance to use the bathroom at school. In rhyming verse, Raj spells out all of the “rules” he has in order to make it through the day without using the bathroom (e.g., no juice, no cartwheels, no laughing). When he ends up having to use the bathroom at school, he realizes that it’s not so bad and that it allows him to have a lot more fun at school. This book could motivate a child to brave the school bathroom and be a start to conversations about bathroom-related exposures .

Evidence-Based Practices: Exposure

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Age range: Preschool through 1st grade.

Recommended for: Any child who ever feels nervous before taking a plunge–literal or figurative–(i.e., almost everyone) will really like this story. It’s best for a child who has had experience at a swimming pool with a diving board so they can relate to Jabari. This story could be used to start a conversation about facing one’s fears, and it provides a few concrete strategies for doing so (deep breaths, cognitive restructuring , jumping in). Therapists might find it useful as a way to start conversations about exposure therapy .

Evidence-Based Practices: Diaphragmatic Breathing, Cognitive Restructuring, Exposure

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Age range: Kindergarten through 5th grade.

Recommended for: Children who are ready to be more independent and less bothered by their separation anxiety will likely find this workbook to be helpful and non-judgmental. It’s not the most fun book, but it lays out a clear path to being able to enjoy birthday parties and tolerate nights with babysitters, which will be a relief to many children bothered by separation anxiety. Children who aren’t yet self-motivated to practice coping with separations may or may not be engaged enough by the metaphor of flying a hot air balloon to get on board with the activities presented. That said, it is a collection of the most effective Cognitive Behavioral Therapy tools for reducing separation anxiety, so it could be useful for a caregiver to read even if a child isn’t quite ready for it. Therapists may also find this book helpful to use during therapy sessions and/or as between-session homework for caregivers and children to complete each week.

Evidence-Based Practices: Psychoeducation, Cognitive Restructuring, Self-soothing, Exposure

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Age range: Kindergarten through 2nd grade.

Recommended for: These books (there are two nearly identical versions–one featuring a girl, Lola, and one featuring a boy, Leo) are great for therapists to use with children with Selective Mutism (SM) as a way of destigmatizing the experience and of introducing the idea that there are different steps the child can take to work towards overcoming their SM. The books come with a website where you can print out paper dolls of the characters in the story, which I really love. Caregivers can read these books with a child at home, too, especially if they have a therapist they and their child are working with or if they’re already familiar with the techniques included in the books (e.g., making a worry box, diaphragmatic breathing). Also available in French.

Evidence-Based Practices: Diaphragmatic Breathing, Cognitive Restructuring, Exposure

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Age range: Ideal for 1st through 5th grade, but much of the workbook is applicable to kids a bit younger with some extra parental support.

Recommended for: This interactive workbook is a good fit for any child experiencing sleep challenges. It’s appropriate for kids who resist going to sleep, who are struggling to sleep on their own, who have difficulty falling asleep, and those who wake up frequently during the night. It teaches pre-bed relaxation skills, helps a child develop a good bedtime routine, and addresses fear of the dark, nightmares, and scary thoughts that often arise at bedtime. This workbook uses a metaphor of a child being a sleep magician, and it teaches kids fun slight-of-hand magic tricks in each chapter.

Evidence-Based Practices: Sleep Hygiene, Relaxation, Cognitive Restructuring, Exposure

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Age range: Mid- to late-elementary schoolers, but much of the book is applicable to kids a bit younger with some extra parental support.

Recommended for: This workbook is likely to be useful to children with social anxiety who would like to feel more comfortable in social situations and who don’t hate clowns (there are some prominant clown references). It’s most relevant to children who are anxious when interacting with peers, but the interventions also apply to kids with performance-type anxiety (e.g., when giving a presentation, perfoming in a recital). It’s a great introduction to cognitive behavioral therapy (CBT) for social anxiety. This workbook could be completed over a number of weeks by caregivers and children, in a therapy office, or as “homework” between therapy sessions.

Evidence-Based Practices: Cognitive Restructuring, Exposure, Relaxation

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Age range: Preschool through 2nd grade.

Recommended for: Many children will enjoy this book simply because it’s a good book. It’s a particularly great read for a child who avoids tasks they’re afraid they won’t succeed at. It’s a story that normalizes and neutralizes failure and celebrates giving something a try.

Evidence-Based Practices: Exposure

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Age range: Kindergarten through 3rd grade.

Recommended for: This book is a fairly fun introduction to exposure therapy and could be really helpful for therapists to use when introducing this concept to children. It’s especially relevant for a child who has a fear of dogs, but it could apply to many specific fears (e.g., fear of spiders, snakes, clowns, elevators, heights). Caregivers who are familiar with the concepts of exposure therapy and feel prepared to support a child in facing their fears in this way may also find this book useful for an at-home read.

Evidence-Based Practices: Exposure

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Age range: Kindergarten through 5th grade.

Recommended for: I highly recommend this workbook for parents and children to work through together over many weeks or even months. It’s ideal for a child who would like to feel less anxious and who is ready to learn some strategies for getting their anxiety more under control. This workbook is based on cognitive behavioral therapy (CBT) and is a comprehensive collection of evidence-based practices for childhood anxiety. Therapists may also be interested in using this book in session with clients as a way of structuring their treatment or as between-session “homework” for children and their caregivers as a means of reinforcing in-session content.

Evidence-Based Practices: Psychoeducation, Cognitive Restructuring, Exposure, Diaphragmatic Breathing, Progressive Muscle Relaxation, Mindfulness

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Age range: Preschool through Kindergarten.

Recommended for: Young children with separation anxiety will likely benefit from reading this book with a caregiver or therapist. It introduces the idea that practicing separations will help the anxiety, not make it worse, and that caregivers aren’t being mean if they don’t accommodate their child’s separation anxiety. It easily leads into a conversation about how a child can cope with separations and how they and their caregivers can start practicing small separations to build up to bigger ones (i.e., graded exposures).

Evidence-Based Practices: Exposure, Visualization, Cognitive Restructuring

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Age range: Preschool through 2nd grade.

Recommended for: This book could open up some important conversations about fears and bravery with children who are holding beliefs that they shouldn’t be scared or that others will judge them if they are. It is also an extremely sweet book about a boy overcoming his fear of dogs to comfort a dog when she is scared. I would not recommend this book for a child who isn’t expressing some embarrassment/shame/denial of their anxiety, as this could introduce the idea that someone might make fun of them for their fear (it’s not that this book is endorsing this, but it’s part of the plot).

Evidence-Based Practices: Exposure

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Age range: Preschool through 2nd grade.

Recommended for: This book is a fun read for a child who is shy and/or quiet, and needs a reminder that others will appreciate them for their strengths and passions, just as they are, if they can be brave, be themselves, and let others get to know them! Available in English and Spanish.

Evidence-Based Practices: Exposure

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Age range: Kindergarten through 2nd grade, maybe 3rd.

Recommended for: A child with a lot of safety-oriented worries who is at all interested in knights or medieval lore. This story destigmatizes anxiety (knights are inherently cool and brave, right?) and presents the value of exposure (i.e., doing things they care about even if they’re scary) and expectancy violations (i.e., bad outcomes happen, and they’re not nearly as bad as the knight expected). Different coping strategies are briefly shared by the knight’s classmates (also knights), which might give these techniques a bit of extra credibility! The knight is particularly anxious about participating in jousting practice in front of his classmates; this will likely resonate with children who experience significant anxiety in performance situations (e.g., sporting events, recitals, etc.).

Evidence-Based Practices: Exposure, Cognitive Restructuring

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Age range: Preschool through 2nd grade

Recommended for: A child with lots of worries will feel seen by this story and will likely feel reassured that despite their worries, they can still make friends and have fun. It’s ideal for children who have been criticized for worrying and/or who have started to criticize themselves for it and who need a reminder that this isn’t helpful or deserved. It’s also a great starter to a conversation between a child and their caregivers about what their caregivers can do to be helpful when the child is feeling worried (e.g., helping them to engage in something fun even if they’re worried!) instead of simply imploring the child not to worry.

Evidence-Based Practices: Emotional Literacy, Exposure

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Recommended for: Many young children who are anticipating or experiencing a separation from a caregiver will love the emotional journey of this short, simple book and will benefit from the book’s conclusion– despite the owl’s worries and fears, Owl Mother always comes back. This book is probably best for a child whose parent is going to work or leaving for a short period of time, rather than a longer separation.

Evidence-Based Practices: Exposure

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Age range: Preschool through 2nd grade.

Recommended for: Children who are shy or afraid to show their true selves will love this book about a shy, quirky guy who works hard to literally blend into the background. He accidentally stands out one day, which causes people to notice him and ultimately love him for who he is.

Evidence-Based Practices: Exposure

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Age range: Kindergarten through 3rd grade.

Recommended for: This book helps a child to shift their relationship with the dark from foe to friend. It is best for a slightly older child who will tolerate or even enjoy the book’s creepiness (e.g., kids who like ghost stories) and who will understand the ending–it’s a bit subtle. It’s a great story.

Evidence-Based Practices: Exposure

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Age range: Preschool through 2nd grade.

Recommended for: This book is a good read for children who want to be able to make friends and talk with unfamiliar people but who are anxious about it and sick of adults telling them to “just say hi” as if it were easy. It shares a couple of strategies for working up the courage to say hi (practicing in a mirror, taking a deep breath), and it models an exposure challenge and subsequent decrease in Shelli’s worries following a positive outcome (she makes a friend!).

Evidence-Based Practices: Exposure

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Age range: Kindergarten through 4th grade.

Recommended for: This book is a very fun and very wise story about learning to live with change, and sometimes even liking it. It’s wonderful for kids who are nervous about change, as well as kids whose uniqueness is sometimes criticized by others who prefer things to stay the same. It introduces the idea of experimenting with small changes as a means of building up to bigger changes, which is a great set-up for talking about change-related exposure therapy .

Evidence-Based Practices: Exposure

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