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: Preschool through 2nd grade.

Recommended for: Therapists can use this book as an introduction to exposure therapy to address a fear of the dark. Caregivers and children can read this book together and talk about how Dark can be a friend. I might follow up a read of this book with a fun, dark-themed activity like making shadow puppets.

Evidence-Based Practices: Exposure

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Age range: Preschool through 2nd grade.

Recommended for: This story is applicable to a child who gets anxious when they aren’t able to follow a routine, whether in the context of anxiety, OCD, autism, or anything else. It’s a really fun, adorable story with a lot of heart and a very sweet ending. The ultimate message is that although it can be scary to break out of a routine, sometimes doing things differently can present new possibilities (like discovering a new favorite food, fun experience, or good friend).

Evidence-Based Practices: Exposure

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Age range: Kindergarten through 2nd grade.

Recommended for: Children who have a hard time with change will relate to Camilla who initially struggles to adjust to a beaver dam turning her forest’s creek into a pond. With time and participation in preparing the forest community for the change, Camilla ultimately concludes that “there’s lots to like about a pond.” This story is particularly relevant to kids who love maps, as Camilla is a cartographer and maps play a big role in her adjustment to the change.

Evidence-Based Practices: Exposure

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Age range: Preschool through 1st grade.

Recommended for: Young children who like things to be “just so,” especially in a neat/tidy/clean/organized manner will relate to Willow who learns (accidentally at first) that tolerating some messiness is worth it for the fun that comes with it. Therapists may find this to be a non-threatening introduction to the benefits of exposure and/or to a conversation about the pros and cons of needing things to be just so, in order to motivate a child’s openness to practicing flexibility.

Evidence-Based Practices: Exposure

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Age range: Preschool through 2nd grade.

Recommended for: Children who are afraid of the dark will likely enjoy this story about stepping into the darkness and paying attention to the peaceful sights and sounds it brings. It’s a beautiful, soothing story. This book leads well into a mindfulness exercise as well as a brief introduction to exposure .

Evidence-Based Practices: Mindfulness, Exposure

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Age range: Preschool through 1st grade.

Recommended for: Young children who have difficulty speaking to and/or in front of other children will feel reassured by this book that they’re not the only ones. They may also be inspired by Sam’s bravery to face their own fears and speak up in front of their peers. This book could be used to start a conversation about the potential benefits of exposure and about how the outcome of Sam’s bravery (e.g., support from his peers) was different from his fears (e.g., that they’d laugh at him).

Evidence-Based Practices: Exposure

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Age range: Preschool through 2nd grade.

Recommended for: Ideal for introverted kids who enjoy staying home and relaxing (nothing wrong with that!) but who feel anxious when they’re expected to try new things or interact with other kids. Hector has a lot of worries that cause him to tell his friends that he’s “too busy” to hang out (in reality he’s going to take a nap or read a good book), but he ultimately realizes he’s missing out on fun things and braves his worries to join his friends. Good introduction to the techniques of exposure and visualization .

Evidence-Based Practices: Exposure, Visualization

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Age range: 1st grade through 3rd grade.

Recommended for: Children who get stuck in perfectionism will likely benefit from this book’s reminder that imperfection, although scary at first, can be freeing. Kids with super high standards for themselves or who get anxious when things don’t go according to plan may find relief in the balance Penelope strikes when she lets herself “just be Penelope” rather than Penelope Perfect.

Evidence-Based Practices: Exposure

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Age range: Preschool through 2nd grade.

Recommended for: A sweet book to read with a child who is afraid of loud thunderclaps. It teaches children to count the seconds between a lightning flash and a thunderbolt as the storm approaches, and it reminds children that they can be scared and still be brave. Do not read this book with a child if you aren’t open to baking a cake with a frightened child during the next thunderstorm. It’s just about non-optional.

Evidence-Based Practices: Exposure

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