Living Your Fears Away Through Exposure (In Vivo)

Therapists sometimes use the term in vivo to mean in life. In medicine, in vivo refers to an experiment performed within or on the organism. When we are treating anxiety disorders, obsessive-compulsive disorder, and emotional disorders of any kind that involve avoidance or other safety behaviors, we often design or contrive exposures that directly confront emotional triggers.

During the usual course of living, people don’t normally go into a public bathroom and put their palms down flat on a toilet seat, rub their hands together, then exit the bathroom without washing their hands. This designed exposure may be used as an “over the top” demonstration that helps clients experience the reality that most of our extreme fears of contamination are distorted and dysfunctional.

Treatment through exposure means that you are planning to go out of your way to learn to habituate to the triggers that are impacting your ability to enjoy more of life without fear and anxiety. Day-to-day living means that you aren’t avoiding negative emotion-provoking triggers.

As part of treatment, but also in “Keeping Fears at Bay” (see Part 4 of this workbook), clients take opportunities to face fears and remain mindful of their emotional reactions as they go on with their day without engaging in compulsive avoidance or performing rituals. We think of this strategy as “living” your fears away.

By the way, therapists get triggered now and then. At a certain point in my life (first author), I decided that I wanted to learn how to swim better. I thought I might want to compete in shorter triathlons and took some masters’ classes (“master” in this sense just meant older, it didn’t imply the mastery of anything). Like most novice swimmers I had some anxiety about looking like a drowning man flailing about trying to find his floaties. After breathlessly swimming some laps, my swim coach, who happened to be a friend, suggested I go into the deep end of the pool. He told me to expel all of the air from my lungs, sink toward the bottom of the pool, relax, and when I felt like I needed to breathe to slowly go to the surface and grab some air. Then, I was to exhale all of the air and repeat for five or ten minutes. I realized immediately that this was an exposure treatment, and as I swam toward the deep end of the pool, I felt some anxiety in my body. I thought about swimming to the edge of the pool and hanging on while I caught my breath and calmed down, but I knew that was anxiety avoidance so I resisted and did as instructed. I got into the rhythm of grabbing some air, exhaling, and slowly sinking until I felt a need to get some oxygen in my lungs. I relaxed, as I began to realize I could do this for hours at a time. I later learned that this activity is sometimes known as drown-proofing. Following that exercise, I returned to swimming laps. My stroke improved. I felt calm and, to this day, I can still jump in a pool and feel confident and relaxed. Drown-proofing has become a metaphor I occasionally use when explaining exposure and response prevention work.

We live our lives in the deep end of the pool. It doesn’t take much emotional energy to walk around the shallow end of the pool, but it isn’t very fun or interesting to stay there. It also won’t improve your cardiovascular fitness. It’s a lot more interesting to swim in deeper water, dive down and pick up toys or coins at the bottom of the pool, play Marco Polo, and jump off diving boards in the deep water.

We encourage everyone to look for the growing edges in their lives. Emotionally intelligent people generally experience more success in work, play, and relationships. Socially anxious people can reduce anxiety over the long term by putting themselves in more social situations rather than using the excuses: “I’m not interested. I don’t like crowds. People are always busy.”

Social anxiety and introversion are not synonyms. Social anxiety refers to avoiding social contact and/or performance because it becomes uncomfortable. Introversion means spending time in one’s own thoughts and finding a source of stimulating and interesting ideas. However, an introversive person can also be outgoing, meaning they can reach out to others and interact without feeling anxious. Likewise, an extroversive person, who prefers the stimulation that comes through interaction with others, may become socially anxious and uncomfortable when conversations lag and others are silent. So, for an introversive person, the growing edge may be to work on reaching out to others more frequently. The extroversive person may profit from learning to be silent when there is a pause in the conversation.

If you were the victim of an armed robber who forced you to go to an ATM and withdraw money, you would naturally become hyper-aroused around ATMs. If you suffered PTSD as a result, you might also become hypervigilant and feel anxious when you drive into the area in which the robbery occurred. You may find yourself driving well out of your way to avoid the neighborhood of the ATM, staying home more frequently, experiencing flashbacks and nightmares, and avoiding going outside in the dark. Once you complete exposure therapy, you might occasionally make a point of drawing money from an ATM, using only one reasonable precaution.

The idea behind living your fears away is to take advantage of circumstances as they present themselves and keep your fears at bay. The attitude of “bring it on” becomes the mantra for the person who is able to turn a potential trigger into an opportunity for exposure. This helps us to behave ourselves into a better way of feeling, head up and shoulders back, living a quality life.