Kids Read This
If you are going to go through these steps without a counselor, please have an adult with you. Do NOT jump ahead until you have practiced each step enough to feel confident you can handle that step. If you get too anxious, step away and do something else. Once you feel calmer, come back to the step and practice again.
In this step, each part will be a word or two words that might be triggering. I have put them in order beginning with less challenging and gradually becoming more challenging. However, everyone is different and some of the first words might be out of order for you. By the way, it is not actually the word, it is what the word means to you. What the word brings to mind and the feelings it evokes is what you have to face over and over until it isn’t so bothersome.
The words need to be spoken aloud. You need to repeat it over and over. If you keep doing that, the distress will decrease. Don’t be in a hurry. Don’t expect to feel better right away. It takes practice. Every new skill takes practice.
Therapists and Parents
If you haven’t had much experience with exposure we encourage you to go slowly with the process. If you are new to exposure and response prevention (ERP), become as familiar as possible with it. Clinicians, I don’t know about your training but ERP was quite different from how I (David) was trained and it took some time to get used to it. We cover some information about that on this site but additional resources are easily available. If you can get a copy, I found Dr. Abramowitz’s article: “The Practice of Exposure Therapy: Relevance of Cognitive-Behavioral Theory and Extinction Theory” very helpful for understanding the theory and process. If you dig around a bit, you may be able to find a copy on his UNC.edu webpage. If you have the time and resources, the training program offered by the International OCD Foundation is absolutely terrific.
All exposures need repeating. This is no exception and repetition will apply to all the steps that follow. Words, sentences and paragraphs need to be spoken aloud. I typically ask my client what they would like to do as far as who says the word(s) first. If my client is very anxious then I might say it just once each to start. Then gradually increase the number of times. I continue the word(s) until it is apparent the client is tolerating it or the S.U.D.s (Subjective Units of Distress) number has dropped appreciably. Go to this page for an explanation of SUDs and a handout. During the intake, your client may have used certain words to describe their emetophobia. However, do NOT underestimate the level of anxiety that might be associated with these words, even the words your client has used while getting background.
During each word(s), I will ask, “Do any memories or images come to mind?” I then have the client tell me about it. I always ask permission about that. It will enhance the exposure process. Often I will ask where in their body they feel the anxiety. I suggest it will help if they give permission for that feeling to be there while we practice. “It is there anyway,” I tell my patients.
Everyone
There are a lot of words in this step. If you can feel less anxious about the words, it will help with all the future steps. Most of the anxious memories someone might have are connected to the various words. That is really what this challenge is designed to master. Thinking of those memories (or whatever the words bring to mind) and accepting the feelings is how this works. This new response has to be repeated until it is far less challenging.
There are approximately 15-20 total word(s). We may make occasional changes to these steps and the totals can change so please consider the count as an estimate.
The first slide will have the letters scrambled. It may be helpful to try to guess the word(s) before revealing all the letters. That can be a ‘soft’ exposure for many people. For example, if the word is puppy, the first image may be yppup.
I encourage whoever is using this to start slow. Better to have too little anxiety than too much. It is important to grow in confidence through these steps.
Click on the slide show below to practice the first step.
Ha ha, just kidding. This dog is named Duke
Below are text copies of all the words if you prefer to use a printed version of the steps rather than the web-based challenge. The first is formatted as a normal sized page. The second is formatted so they can be printed on index cards. Please feel free to modify them for your situation. The third is a pdf.