My previous post was about exposure: what is it and why is it important. I’m certain that if you search about exposure on google you will find a significant amount of academic and non-academic information on the different types of exposure, how to do it, when to do it, pros and cons, and etc. Nevertheless, you may not find too much discussion or write ups about what is at the heart of my clinical work: values-based exposure practices. In fact, when I google it myself, I only found one article on it related to the treatment of pediatric chronic pain and a book that refers to this process “Acceptance and Mindfulness treatments for children and adolescents” by L. Greco and S. Hayes (2008).
Over the years I conducted different types of exposure exercises (in-vivo, imaginal, interoceptive) for different struggles such as fear of driving on the freeway, fear of heights (acrophobia), fears of contamination, fear of a particular traumatic memory (PTSD), etc. It’s actually because of all those experiences, in addition to my academic training, that I became a strong believer in exposure-based interventions.
Despite working most of the times with clients that were willing to do exposure work, I did encounter many times some people who were simply too scared of the process or not ready to do it (in spite of all explanations and multiple interventions to address their ambivalence). It was after several workshops on Acceptance and Commitment Therapy, a type of Cognitive Behavioral Therapy, I learned different values-based interventions that have become part of my clinical work these days.
Values are the directions that provide meaning and purpose to our life. Although finding our values is important, it’s also more important to “live them.” As someone said, “values without actions are like words taking by the wind.” We live our values by establishing goals and taking concrete actions in those directions. For example, if one of my values is “being a caring daughter”, one of my goals could be to call my mother every Sunday and ask her how she’s doing.
The combination of values-based and exposure-based interventions have become at the core of my clinical work. I did found, as research continues to find, that it does make a significant difference to embrace behavioral change because of something that matters to us. It’s different to change your diet because the doctor has recommend you to do it versus changing your diet because you would like to be healthy to raise your grandchildren. It’s different to do an exposure exercise about driving on the freeway in order to overcome your driving phobia versus driving in the freeway because you will be able to visit your mother and be the caring daughter you want to be.
For those clinicians who practice exposure interventions, I would like to add that it’s different to conduct an exposure exercise with the main purpose of habituation/desensitization than to conduct an exposure exercise in which habituation/desensitization will happen but the driver of the process is a value.
In my clinical work, prior to start exposure-based interventions, I invite my clients to answer the following question:
What is the exposure in the service of?
If you are wondering whether or not to engage on a exposure practice, I would like to invite you to answer two questions:
1. What happens to the thoughts, images, emotions, places, or bodily sensations if you continue to avoid them? Do they go away and never come back?
2. What happens to your life if you continue to avoid those thoughts, images, places, emotions, or bodily sensations?