[00:00:00] Welcome to Move With Deb. I'm Deb your friendly neuroplastician. And this is a podcast that explores the relationship between the body and the mind from a health at every size, judgment, free perspective. I teach you how developing a new internal conversation based on curiosity, self friendship and simple neuro-plasticity techniques can rewire your bodymind out of pain and emotional overwhelm to help you build the rich full life that you want to live. Disclaimer, this is not a replacement for medical care.
[00:00:50] Hello feelers and healers and welcome to Move With Deb, the podcast. Today I'm gonna talk about the heart of graded exposure and why it is a tool in creating embodied change is the willingness to see what arises when we undertake an activity.
[00:01:13] So I've been in a sex and intimacy coaching training program called Somatica(R), and the work is experiential. We talk, relate and play with exploring what we want more of. Sometimes rooting around in language and embodiment and connect. Uping up against what we don't want, what doesn't feel good to find what feels yummy.
[00:01:37] So one of the things I love about this work is that it's rooted in vulnerability and connection, but it is about change and to quote the somatica folks, change happens when you actually have the experience of something different. Not just talk about it or quote unquote figure it out because you're actually creating new neural pathways in the brain.
[00:02:00] Experiential work is essential to help people move out of their habits because in experiential work, people actually have new experiences and realize that they're capable of something different. Deepening these new feelings, which may at first feel unusual and awkward is essential to the process and takes time and repetition.
[00:02:25] And it is no different for pain reprocessing or building emotional awareness and flexibility. Other cornerstones that are at the heart of my coaching work is believing that there's not one quote unquote right way to do something, achieve a goal, be human. And when we find the freedom to find our way, believing that my clients are the experts of their own lives and the work we create together is about their meeting, their goals and.
[00:02:54] It's done through love and empathy, deshamifying and creating a non-judgmental relationship with oneself. Graded exposure is an activity that is about now, not later. One of the things in coaching or training that happens a lot is that we are focused on the future. Trying to improve or reach a goal or the past, regret loss, judgment about what has been, and also focusing on comparison to maybe how now is different from then around body size, ability, mobility, energy levels, pain, and so on.
[00:03:30] But at the heart of doing exposure work for pain reprocessing, it's about being in the now while holding the schema in your mind, becoming meta aware. It's one of the best tools that I love teaching people so that they can begin to shift their experience from only reacting to curious responding. I am speaking about this as a human. Somebody who has used this information to help me shift out of old habituated patterns, and one of my favorite mental health educators, Mark Freeman, he teaches about O C D and rumination and compulsions, and you know, it makes sense to wanna seek pleasure and avoid pain, and it's totally normal to see change as threatening. What he does that I love so much is he simplifies concepts to things we do in our head, time spent in our head and the shift is to spend less time in our heads and more time doing, more time being out in the world, experiencing things and doing, not thinking about taking the walk, but taking the walk.
[00:04:41] Celebrating doing things even when it's not perfect, not judging how it went, doing it imperfectly and learning, but not taking the presence of emotional or physical pain as a signal to completely stop. Discomfort is an amazing method of communication from the body, and we need to stop treating our bodies like a stoplight, only having red, yellow, or green options because as soon as something gets out of the green mode, we're already anticipating it going to red.
[00:05:15] Hardly ever the other way. We need to start where we are today and do stuff now at whatever amount is possible, but not without the tools of awareness, sensory reappraisal, emotional friendship, and deshamifying to keep us company and rewrite the internal script of what's happening when we are doing it We need exposure to have a corrective experience. They don't just happen on their own.
[00:05:46] I talk to my clients about their goals and I see a pattern in them and totally with myself that we set goals for the future and there's a way in which our today, mind and body almost doesn't matter or count because all of our attention is about that future experience we want to be having. One client I spoke to about her wanting to hike and have a picnic. And I asked, how much walking are you doing now? How can you have that experience or part of that experience now? Maybe a short hike and a picnic with a friend, a version of it that is less strenuous, a smaller peak collaborating friends and letting them know how they can support you to go at your pace.
[00:06:29] We often only think we know what's possible. What we aren't aware of is how much belief in our internal dialogue and relationship to pain and unpleasant sensation influences our mind and body's idea of what's possible. By engaging with exposure, we intentionally challenge our limiting beliefs. What if you coming to any activity with a heart of, "let's see what happens" "let's get super curious", "I wonder what this will feel like.". To be clear, this isn't about pushing through. It's about increasing our internal conversation and making it full of loving self friendship and relaxed curiosity as possible. It's like when we're working with nervous system states, we want to bring energy into our system to wake up activation, to start to rev our engines start things flowing But if we have been muted energetically, physically or emotionally, any go energy can feel quite loud and scary. But when we know and choose on purpose what's happening, we can allow, get curious, bring wonder and delight to any activity knowing that it's not dangerous.
[00:07:44] I wanna say graded exposure is different from what I hear people's talk about pacing, and I think pacing is like this idea that there's process by which we like increase the number of steps or increase the amount of activity by a certain time. And what I think is different with exposure is we're not limiting it. We're not saying, okay, you moved, you know, safely for 10 minutes this time. Let's increase that to 12 minutes tomorrow, because that really puts our attention on the clock or the time and not on the internal conversation in the body. So a lot of this is about for me, grading the exposure in terms of fear, grading, the exposure in terms of difficulty. Um, And maybe for you that does mean time, but being more nuanced and personalized about it.
[00:08:45] So maybe it's like, oh, I really wanna go on a trip. And that trip is going to involve a lot of varied different movement. So we're talking about grading the exposure both emotionally and physically. I just wanted to make it clear that that's what I am saying in my process.
[00:09:07] So here's a little reading about exposure therapy. Graded exposure is what it sounds like, graded, so, you know, on a spectrum, exposure, which is doing something, not just talking about it. It is the embodied version of trying. Exposure based therapies reflect a variety of behavioral approaches that are all based on exposing the individuals to the stimuli that frighten them.
[00:09:39] From a behavioral perspective, specific phobias are maintained because of avoidance of the phobic stimuli so that the individual does not have the opportunity to learn that they can tolerate the fear, that the fear will come down on its own without avoiding or escaping, and that their feared outcomes often do not come true or is not as terrible as they imagine. Avoidance can occur by either not entering a situation at all or by entering the situation but not experiencing it fully either because of consuming alcohol before taking a flight for a person with a flying phobia or, you know, some kind of Sensory checking out, right, like not being fully present.
[00:10:22] Exposure therapies are thus designed to encourage the individual to enter feared situations, either in reality or through imaginal exercises, and try to remain in those situations. The selection of situations to try typically follows an individually tailored fear hierarchy. It starts with situations that are only mildly anxiety provoking and builds up to the most feared encounters. Through some forms of exposure therapy, the individual starts out being exposed to a very anxiety provoking stimulus, rather than building up to that more.
[00:11:01] Right. So there's a gradual process or there's some, you know, kind of jump right in process. And when we talk about graded exposure, it's been interesting, with pain reprocessing. I talked to a client who was like, she started out gradual and then she just did the thing. So there was an easing in, and then there was some kind of moment of safety or willingness or you know, like that internal buy-in, which is like, yeah, I'm just gonna try it.
[00:11:35] So there was a corner that was turned that was decided by the client and that willingness to just jump right in. What I do is, I help people understand how to be this external loving witness to oneself when you are doing graded exposure. So back to this article, there are a number of variations of exposure therapy that work effectively in the treatment of phobia.
[00:12:00] So in vivo exposure involves actually confronting the feared stimuli, usually in a graduated fashion. In like a spider phobia, a person might first look at a picture of a spider and eventually work up to touching a large tarantula and flying phobia, a person might first read a story about a plane crash and then work up to taking an actual flight.
[00:12:23] With hypnosis, we can do all kinds of in the mind and body as we bring up the stimulus that feels uncomfortable, and then we do different somatic techniques. Bring that activation down and start to imagine what would feel better. So there's a a lot of different ways At the root, they all have the same heart, which is to do it.
[00:12:49] To move ourselves out of thinking about it and moving ourselves into doing the activity. And when we're talking about doing an activity that brings us some fear or trepidation or anxiety, it's like how can we be a good friend to the self that is scared rather than how do we avoid things that we think feel scary?
[00:13:12] The idea is we want to recognize the avoidance, but use the avoidance as a trigger for where the work needs to happen. Always then with the framework of self-compassion, bravery, curiosity, self friendship. Rather than fear-based demands pushing through aggression and cruelty. So what is one thing that you want to do more of that you're noticing you're spending a lot more time thinking about than doing, and then what is like the next step? What's the next smallest step? To do that thing, or what's the smallest bite version of doing that? So say you wanna go take a walk five times a week, but you're not even doing it once a week. Right? Meeting, whatever feeling or thought pattern that arises when you're ready to go, take that walk and noticing what comes up.
[00:14:14] Some of it is like being a good witness, being a good self-compassionate witness for yourself. In, a lot of exposure therapies. There's also like a cognitive component, right? So it involves cognitive restructuring, as they call it, to challenge disordered or irrational thoughts. And I don't like that language cuz I don't like calling my thinking distorted or irrational even when I actually recognize, hey, that's distorted or irrational.
[00:14:44] So I just like to call it thinking. Sometimes I like to ask myself, how can I be wrong about this? So instead of trying to fight myself to not believe what I'm thinking, because that is some kind of internal gaslighting that I think helps increase a lot of distrust and fear our own thinking. So I just always like to assume. That like, you know what? Thinking is an action. My brain sometimes gets it wrong. So let's start to lean in and investigate this thinking that I'm doing and see like, oh, okay, well I understand why I'm thinking this, like, oh yeah, that thing happened in the past and I don't want it to happen now.
[00:15:23] Of course that's popping up in my brain and my brain says like, yeah, don't do, don't do. That thing that you did in the past that was really sucky. And I would be like, yeah, totally. Brain. I got you. Of course, I understand why you don't wanna do that again.
[00:15:38] And then this is the part where I'm like restructuring the cognitive work, which is like, but I got you. But I trust myself. But that thing only happened one time. The fear continues to happen, but the event only happened once. Or just recognizing like, yeah I get why you don't wanna do it because you feel so much shame. So let's bring down the volume on the shame. And then the thinking I find solves itself.
[00:16:09] Like it's not always the thinking that's the problem. It is how the thinking is affecting your feelings, your emotions, the sensations in your body, and your ability to take actions. If I was just thinking random thoughts, like, you know, purple spiders, love to sniff baby powder. And like that was just a thought that like rambled through my brain and it didn't bother me and I didn't think twice about it.
[00:16:34] Like, who cares what the, who cares how wrong or distorted or irrational that thought is really doesn't matter. It has no effect on my life. So I want to just be clear, like don't get all twisted about labeling your thinking or being worried that you have distorted thinking or irrational thoughts. We all have distorted thinking and irrational thoughts.
[00:16:59] I mean, we could just look at politics and I'm not even gonna go into it, but we have all kinds of biased thinkings. We have negativity biases, we have heuristics. Our thinking is never like true and rational. So I really want to put that judgment aside.
[00:17:19] Whenever we're doing mind body work, what I think is essentially important is, does this bring me into deeper friendship, connection, empowerment, and awareness With myself. I don't ever wanna do mind body work in which somebody is left feeling less secure or more fearful or more confused. Sometimes we get confused along the way in the journey, right? We're trying to like connect the dots and make all this stuff make sense and like that part's okay, but it's not about like, oh, don't trust yourself, cuz your brain is disordered. When we get to a place of safety, When our mind and our body are in sync, when our nervous system is relaxed, we often can reflect on things and totally understand why we felt something, why we thought something, and if it was incorrect, if it was distorted, if it needed, an update in our understanding, we can always do that.
[00:18:29] So I just wanna say like fear, like when we have a phobia, we, we want to work on the fear activation. And not spend a lot of time arguing whether we're allowed to have this phobia. Because when you try to take somebody's fear away or tell somebody that their fear is like stupid, if you're trying to say like, no, that's not gonna happen.
[00:18:51] Mm. The natural response is like, You don't know and we might go looking for evidence that it is more possible that it will happen, right? Like if you're afraid of dogs and somebody has a dog and you're like afraid of it, and they're like, my dog's nice and my dog's not gonna bite you, that's not actually creating safety, right? They're just kind of negating your fear and maybe you're like, no dog bites actually happen a lot, right? And maybe you'll go on Google and find out more about dog bites and you're actually going to double down on that cognitive belief that dogs actually will bite you. That your fear is validated and you're gonna be increasing that fear based on this person's response to you. So when I work with people, I always just wanna say like, yeah, that fear is real. And how is that showing up in your life? What is that keeping you from doing that you would like to be doing? How is this fear affecting you and how would your life be if you did not have it? Like, would you like to work on your dog phobia? Because then you could go hang out with your friend and their dogs like it's up to you.
[00:20:05] So the root of graded exposure, where I think it really works, is in, holding the both, and it's like the holding the vision of yourself, having already solved this fear and phobia, and along the journey of increasing the graded exposure, like having the exposure, we also are caring for ourselves and creating safety along the way, and even holding open the frame of we cannot know all the things that are possible to happen, but maybe can we trust that whatever happens, we can figure it out?
[00:20:46] And maybe sometimes that means coming up with a plan. Who knows? It's, it's easy to talk about in kind of vague ways when we're getting specific about whatever it is that you're working on, then we solve for specific problems.
[00:20:58] So I'm trying to think if there's anything else I should say in particular about graded exposure. Think the idea is waiting until you're ready, what that is is practicing waiting, and so giving yourself pieces of exposure is really important, but at the dose that feels just at the edge of your limit, knowing that that will change over time. Knowing that with more exposure, like you have the exposure, you meet your brain and your body with encouragement and love and safety, and that you keep pairing that together and moving that needle and sometimes taking a big dose of exposure if you feel like you're really ready for fuck around and find out and see what happens. Maybe you're just ready to dive right in, which that is so different from pushing yourself, from telling yourself you have to, from making it, you know, very high stakes.
[00:22:01] So those are the kinds of things that I like to talk to in graded exposure and in all of the change work that I do, whether it's this intimacy coaching, whether it's pain coaching, whether it's general life coaching, like getting through life coaching. The learning happens in the exposure and the brain gets to update its prediction in the learning. What happens in the brain changes, and it can only change with the stimuli of the exposure.
[00:22:32] Oh, I don't know if I believe that. Well, it only happens with the experience of the stimuli of the exposure, but also the exposure can be imaginative. So we can start with exposing ourselves in our imagination. That's also what I wanna say. There's lots of evidence for imaginative exposure, but that's still exposure.
[00:22:55] We're still thinking about doing it. We're not thinking about doing it and avoiding, we're then imagining doing an activity. And that sometimes is the first best and safest step for doing the activity. And that is certainly along the journey of graded. So that's what I wanted to share, and it's been really fun how this comes up in all of my client sessions.
[00:23:21] Going from talking about things to doing things in the client sessions. We do graded exposure. Today I worked with a client on allowing sadness and noticing what her brain wanted to do when she was coming up against an uncomfortable feeling, and we just spent some time feeling it and just letting it be there, creating safety, having that feeling and, you know, and then like coming in and out, allowing ourselves to titrate, recognizing different nervous system states, using different tools on purpose tapping or bilateral stimulation or shifting into peripheral vision. So in a session with me, we have a lot of tools that are available and then we see what we need, but we are trying to go from talking to embodiment and start to practice things we want to be experiencing more of.
[00:24:19] And I wanna encourage you to go do that in your life. Like is there a thing that you keep thinking about not doing? Is there a fear that you're having or worry and you want to crack that open? and whether you need help with that as a guide, I am here, doing one-on-one sessions with people.
[00:24:39] Also there are mind body Facebook communities, around Curable app or Alan Gordon's work. So there's, tell me about your pain. There's the curable community. There's some other TMS Facebook groups and they're full of people who are doing the same work. Also deep dive into emotions like with, Nicole Sach's Journalspeak. That is also a form of exposure therapy that is a form of emotional exposure. And that one is definitely very, in vivo. You just jump in, rip that bandaid off, feel all the things, and then chuck it out and soothe yourself.
[00:25:16] Her process is intentionally provocative, to be able to allow us to come in contact with things that we are usually avoiding. So there's lots of different ways to do this work. One is not the right way. There's no one right way. There's just whatever the right way that it is for you. And so that my friends, is what I think of as the heart of graded exposure. It is what brings you into that sense of willingness.
[00:25:49] So I hope, as always is my hope that this podcast is helpful for you and want you to be gentle but curious, and I look forward to sharing more concepts with. More conversations about how our mind and our body work together, and if you are interested in having a consult call with me. Please check out my Calendly link and sign up for a free consultation call. Okay, I hope you are having a great day.