Exposure Therapy for Anxiety: A Step-by-Step Guide You Can Do at Home
Anxiety often tells us to avoid. But avoidance teaches our brain that those situations really are dangerous—and the anxiety keeps growing. Exposure therapy gently helps you face what you’re afraid of, so your brain can learn: this is uncomfortable, but it’s not dangerous—and I can handle it.
This guide gives you a simple step-by-step plan to start exposure work at home.
An important note on anxiety and neurodivergence: There is an important distinction between anxiety and autistic anxiety. Anxiety often revolves around worries about what might happen, whereas autistic anxiety is more about knowing what will happen and dreading it, for example having to deal with cognitive and sensory overwhelm and complex social interactions. I recommend this article by Dr. Neff on learning more about the difference.
It’s common for autistic people to experience both anxiety and autistic anxiety. The key difference is that we shouldn't use exposure techniques on things that are inherently challenging for us due to our neurotype. For an autistic individual, this might be things like crowded spaces, loud noises, bright lights, or extended socialising. Instead, we want to work on creating accommodations that make it easier to deal with these situations when they arise.
Why Exposure Works
Anxiety is your body’s alarm system. It wants to keep you safe. But sometimes it overreacts and gets triggered by situations that aren’t actually dangerous (like speaking up in a meeting, going to the store alone, or receiving a text without answering right away).
By repeatedly and intentionally facing those situations, without escaping, fixing, or avoiding, we teach our brain that we’re not in danger, even when the alarm goes off.
This is sometimes referred to as inhibitory learning. Instead of trying to erase the original fear, we’re building a new memory that says, “I was in that situation, and nothing bad happened.” Over time, this new learning becomes stronger and more accessible than the old fear memory.
You can think of it like laying a new path through a forest. The old fear path is still there, but the more often you walk the new one, the clearer and easier it becomes. Eventually, your brain starts using that new path automatically.
That’s how the alarm eventually quiets down.
What Happens in the Brain
When your body detects something that might be dangerous, information first goes to the thalamus, which asks: “Is this new? Is this dangerous?” From there, two messages are sent:
A fast signal goes to the amygdala, the emotional alarm system. It might say: "Uh oh! Danger!" and activate fight/flight/freeze.
A slower signal goes to the prefrontal cortex (PFC), your logical brain, which can decide: "Wait, this might not be a threat."
But by the time the prefrontal cortex weighs in, the amygdala may have already triggered a cascade of physical symptoms: racing heart, shallow breathing, tension. This is how the anxiety or panic response starts.
The thalamus can also register physical symptoms (like a racing heart) and send those back through the system again – keeping the cycle going. The more you panic about your panic, the more fuel you add.
This is where your response matters. The prefrontal cortex can help you interpret what’s happening. You can say to yourself: “This is anxiety. It feels intense, but it’s not dangerous.”
If instead your mind adds secondary fear – "Why do I feel this way? This is bad. I need to stop this" – that fear about the fear keeps the loop going.
Try telling yourself: “This is anxiety. I’ve felt this before. I can ride this out.”
Over time, when you stay in the situation and don’t escape, avoid, or use compulsions, your brain learns a new message:
“This is anxiety. I can handle it.”
The amygdala learns from experience, not from logic alone. That’s why exposure is powerful: it gives your brain the lived experience that you can tolerate discomfort.
This is how you rewire the brain. When you stop reinforcing the fear circuit through avoidance or safety behaviours, you weaken that connection. With practice, the amygdala learns to settle.
The goal isn’t to make anxiety go away faster, that’s just another avoidance strategy. The goal is to build trust in your ability to tolerate discomfort and stay present.
Step 1: Identify What Matters
We want to make anxiety less powerful not just to feel better—but so you can do what matters to you.
Write down the answers to these questions:
What’s important in my life right now?
What is anxiety getting in the way of?
What matters to meAnxiety gets in the way of...FriendsGoing to social events or making plansFamilyBeing present or expressing myselfEducationSpeaking up or asking for helpFaith or communityAttending gatherings or volunteering
Come up with a motivational phrase
This will be your "why" and it serves as a reminder of why you're doing this work, even when it feels difficult. The motivational phrase will help you reconnect with what matters, especially during the exposures.
Examples of motivational phrases:
“I’m doing this because I want to live a fuller life.”
“I want to have meaningful connections with people.”
“This is hard, but it brings me closer to the life I want.”
“Avoiding this keeps me stuck. Facing it helps me grow.”
Step 2: Set Goals and Build a Fear Hierarchy
Write down what you want to be able to do—even if it feels impossible right now. Then rate how distressing each situation feels using a 0-100 scale.
Start practicing with things at the lower end of the range. If the activities at the lower end of the range feel totally impossible, go ahead and break these down into sub components.
Example: Social Anxiety Hierarchy
Difficulty-level & Activity
30 Making small talk with a cashier
50 Eating alone in a café
70 Attending a group event alone
85 Speaking up in a group conversation
100 Giving a presentation
Step 3: Identify Safety Behaviours
Safety behaviours are little things we do to try to feel less anxious. But they can accidentally keep anxiety going by reinforcing the idea that we aren’t safe without them.
Examples:
Constantly checking your phone
Holding water bottles, headphones, or keys
Avoiding eye contact
Bringing a friend “just in case”
Rehearsing what to say ahead of time
Avoiding silence in conversation
That said, it’s also important to understand the difference between anxious avoidance and genuine neurodivergent needs. If you’re autistic, ADHD, highly sensitive, or otherwise neurodivergent, some things that might be labeled as "safety behaviours" – like avoiding eye contact, stimming, or avoiding loud environments – might actually be essential ways you regulate your nervous system. The goal of exposure is not to force you to act neurotypical.
For example, if you naturally don’t make eye contact or feel overwhelmed by crowds or certain sensory input, this is not something that needs to be changed. Exposure is about helping you live in line with your values and feel less restricted by anxiety, not overriding your genuine needs.
Step 4: Practice Exposure – Step by Step
Here’s a simple process to follow every time you do an exposure:
1. Choose one exposure
Pick something from your hierarchy in the lower range.
2. Clarify the fear
What am I afraid will happen?
What uncomfortable feeling am I willing to practice tolerating?
3. Identify and choose not to do safety behaviours
Identify what safety behaviours you would normally do in the situation and decide to try and avoid them (e.g. don’t look at your phone, don’t rehearse your words).
4. Stay in the situation
Set a timer or stay until the anxiety naturally starts to reduce. That said, anxiety doesn’t have to go away for the exposure to be effective. The goal isn’t to eliminate anxiety in the moment—it’s to teach your brain that you can tolerate it and still do what matters. If the anxiety reduces, that’s great—but it’s not required. What we’re training is your ability to stay with the experience, even when it feels uncomfortable.
If you’re familiar with IFS, this can be a helpful time to tune in. You might notice that certain parts want to do safety behaviours, obsessively think things through, or escape the situation. You can gently ask those parts to give you a little space—so you can be with the part of you that is feeling anxious or scared.
If this doesn’t feel natural or accessible to you, that’s okay too. You can simply focus on being with the anxious emotion itself—without needing to view it as a part.
5. Use a helpful sentence or your motivational phrase if needed
“This is just a feeling—it doesn’t need to stop me.”
“This is anxiety. I can handle it.”
“This is uncomfortable, but it's not dangerous.”
“I’ve done hard things before. I can do this too.”
“I’m building a new pathway in my brain.”
“It’s okay to feel scared and still take the next step.”
6. Avoid analysing afterwards
Ask parts of you that want to analyse or criticise afterwards to give you some space. If you notice parts that are very active after the exposure, you can bring them to your next therapy session.
7. Reflect briefly
Did the feared outcome happen?
How did I cope?
What can I try next time?
Examples of Common Exposure Targets (General Anxiety + Social Anxiety)
Mild:
Leave a message unread
Ask for help with something small
Moderate:
Order something new from a menu
Say "no" to a small request
Share your opinion in a group
Challenging:
Start a conversation with someone new
Go to an event alone
Give a short presentation
Key Reminders
Anxiety is normal and not dangerous
We get to choose how we respond
Avoidance feels good short-term, but reinforces anxiety
Find your motivation: why does this matter?
Set goals and work in small steps
You don’t need to feel calm to make progress – you can learn to be okay with the anxiety and do the things you want to do
Celebrate small wins
Accept that anxiety may show up again, and that’s okay. You have tools to deal with it better next time.