EXPOSURE IN CBT

31Jan

Posted by Laura Blog,Blogposts No Comments - -

Why it can feel overwhelming —

and why you don’t have to face it alone

By Shaun Hodgkiss, CBT Psychotherapist

Laura

When people hear the word exposure in Cognitive Behavioural Therapy (CBT), it often brings up images of being pushed into frightening situations before they feel ready. For many, this alone is enough to create anxiety about therapy itself.

If that reaction sounds familiar, it’s important to know that this response is understandable, common, and expected. Exposure works directly with fear — and fear is something the human nervous system is designed to protect us from.

This blog aims to explain what exposure really is, why it can feel daunting, and why support matters — without asking you to do anything on your own.

Why exposure can feel so scary

Exposure involves gradually approaching situations, sensations, thoughts, or memories that have come to feel threatening. These are often things people have learned to avoid because avoidance brings short-term relief from distress.

UK CBT literature consistently explains anxiety as being maintained through this cycle of fear → avoidance → temporary relief → increased fear (NHS Talking Therapies, 2018; Warwick University, n.d.). From this perspective, avoidance is not a weakness — it is a survival strategy that once made sense.

When exposure is suggested, it can feel as though that sense of safety is being taken away. People commonly worry that:

  • anxiety will become overwhelming

  • distress will spiral out of control

  • they will be unable to cope

  • exposure means “forcing” themselves to suffer

NHS and IAPT materials highlight that these fears are a natural response to anticipating threat, not a sign that someone is unsuitable for CBT (TalkPlus, 2023).

What exposure in CBT is not

One reason exposure can feel frightening is that it is often misunderstood.

Exposure is not about being forced into feared situations.

It is not about “just pushing through”.

It is not about eliminating anxiety altogether.

Instead, UK CBT guidance describes exposure as a collaborative, planned, and supported process, usually carried out with a trained therapist (NICE, 2013; NHS Talking Therapies, 2018). The focus is on helping people feel safer engaging with life again, rather than on enduring distress for its own sake.

Letting go of the idea that anxiety must disappear

Many people begin therapy hoping to get rid of anxiety, panic, intrusive thoughts, or uncomfortable bodily sensations entirely. While understandable, this expectation can unintentionally make exposure feel like a test that can be failed.

NHS CBT resources emphasise that the goal of exposure is usually not the complete removal of feelings, but rather learning that these experiences are tolerable, temporary, and less dangerous than they feel (Plymouth Hospitals NHS Trust, 2020).

Over time, many people notice that when they stop avoiding feared situations, their confidence increases and their anxiety naturally reduces — but this happens because their relationship with fear changes, not because fear is eliminated altogether.

Why support makes such a difference

Exposure is most effective when it is carefully planned and paced, taking into account someone’s history, current stress levels, and personal values (NICE, 2013). UK guidance consistently highlights the importance of delivering exposure within a structured therapeutic framework rather than as a self-directed challenge (NHS Talking Therapies, 2018).

Working with a therapist allows people to:

  • make sense of their fear responses

  • agree on goals that feel meaningful and realistic

  • move at a pace that feels manageable

  • reflect on experiences safely and compassionately

This support can be especially important for people whose difficulties are linked to trauma, panic, OCD, social anxiety, or long-standing patterns of avoidance.

A hopeful but realistic message

Exposure is not about becoming fearless. It is about becoming less restricted by fear.

Many people who engage in CBT discover that while uncomfortable feelings may still arise, those feelings no longer dictate their choices. Life begins to expand again — not because fear disappears, but because confidence and trust in oneself grow.

If exposure feels daunting, that does not mean you are “not ready” or “not suitable” for CBT. It often means you are human — and that support could make the difference.

You do not have to face these steps alone.

References

NHS Talking Therapies (2018) The NHS Talking Therapies for Anxiety and Depression Manual. NHS England. Available at: https://www.england.nhs.uk/wp-content/uploads/2018/06/nhs-talking-therapies-manual-v7.1-updated.pdf (Accessed: [24.01.2026]).

NICE (2013) Social anxiety disorder: recognition, assessment and treatment (CG159). National Institute for Health and Care Excellence. Available at: https://www.nice.org.uk/guidance/cg159/chapter/recommendations (Accessed: [24.01.2026]).

Plymouth Hospitals NHS Trust (2020) Exposure and habituation. Available at: https://www.plymouthhospitals.nhs.uk/display-pil/pil-exposure-and-habituation-6611/ (Accessed:[ 24.01.2026]).

TalkPlus (2023) Graded exposure. NHS Talking Therapies. Available at: https://www.talkplus.org.uk/wp-content/uploads/2023/12/Graded-Exposure.pdf (Accessed: [24.01.2026]).

Warwick University (n.d.) Exposure and habituation. University of Warwick. Available at: https://warwick.ac.uk/services/dc/pgr/phd_wellbeing/exposure_and_habituation.pdf (Accessed: [24.01.2026]).

EXPOSURE IN CBT

30Jan

Posted by Laura Blog No Comments - -

Why it can feel overwhelming —

and why you don’t have to face it alone

By Shaun Hodgkiss, CBT Psychotherapist

Laura

When people hear the word exposure in Cognitive Behavioural Therapy (CBT), it often brings up images of being pushed into frightening situations before they feel ready. For many, this alone is enough to create anxiety about therapy itself.

If that reaction sounds familiar, it’s important to know that this response is understandable, common, and expected. Exposure works directly with fear — and fear is something the human nervous system is designed to protect us from.

This blog aims to explain what exposure really is, why it can feel daunting, and why support matters — without asking you to do anything on your own.

Why exposure can feel so scary

Exposure involves gradually approaching situations, sensations, thoughts, or memories that have come to feel threatening. These are often things people have learned to avoid because avoidance brings short-term relief from distress.

UK CBT literature consistently explains anxiety as being maintained through this cycle of fear → avoidance → temporary relief → increased fear (NHS Talking Therapies, 2018; Warwick University, n.d.). From this perspective, avoidance is not a weakness — it is a survival strategy that once made sense.

When exposure is suggested, it can feel as though that sense of safety is being taken away. People commonly worry that:

  • anxiety will become overwhelming

  • distress will spiral out of control

  • they will be unable to cope

  • exposure means “forcing” themselves to suffer

NHS and IAPT materials highlight that these fears are a natural response to anticipating threat, not a sign that someone is unsuitable for CBT (TalkPlus, 2023).

What exposure in CBT is not

One reason exposure can feel frightening is that it is often misunderstood.

Exposure is not about being forced into feared situations.

It is not about “just pushing through”.

It is not about eliminating anxiety altogether.

Instead, UK CBT guidance describes exposure as a collaborative, planned, and supported process, usually carried out with a trained therapist (NICE, 2013; NHS Talking Therapies, 2018). The focus is on helping people feel safer engaging with life again, rather than on enduring distress for its own sake.

Letting go of the idea that anxiety must disappear

Many people begin therapy hoping to get rid of anxiety, panic, intrusive thoughts, or uncomfortable bodily sensations entirely. While understandable, this expectation can unintentionally make exposure feel like a test that can be failed.

NHS CBT resources emphasise that the goal of exposure is usually not the complete removal of feelings, but rather learning that these experiences are tolerable, temporary, and less dangerous than they feel (Plymouth Hospitals NHS Trust, 2020).

Over time, many people notice that when they stop avoiding feared situations, their confidence increases and their anxiety naturally reduces — but this happens because their relationship with fear changes, not because fear is eliminated altogether.

Why support makes such a difference

Exposure is most effective when it is carefully planned and paced, taking into account someone’s history, current stress levels, and personal values (NICE, 2013). UK guidance consistently highlights the importance of delivering exposure within a structured therapeutic framework rather than as a self-directed challenge (NHS Talking Therapies, 2018).

Working with a therapist allows people to:

  • make sense of their fear responses

  • agree on goals that feel meaningful and realistic

  • move at a pace that feels manageable

  • reflect on experiences safely and compassionately

This support can be especially important for people whose difficulties are linked to trauma, panic, OCD, social anxiety, or long-standing patterns of avoidance.

A hopeful but realistic message

Exposure is not about becoming fearless. It is about becoming less restricted by fear.

Many people who engage in CBT discover that while uncomfortable feelings may still arise, those feelings no longer dictate their choices. Life begins to expand again — not because fear disappears, but because confidence and trust in oneself grow.

If exposure feels daunting, that does not mean you are “not ready” or “not suitable” for CBT. It often means you are human — and that support could make the difference.

You do not have to face these steps alone.

References

NHS Talking Therapies (2018) The NHS Talking Therapies for Anxiety and Depression Manual. NHS England. Available at: https://www.england.nhs.uk/wp-content/uploads/2018/06/nhs-talking-therapies-manual-v7.1-updated.pdf (Accessed: [24.01.2026]).

NICE (2013) Social anxiety disorder: recognition, assessment and treatment (CG159). National Institute for Health and Care Excellence. Available at: https://www.nice.org.uk/guidance/cg159/chapter/recommendations (Accessed: [24.01.2026]).

Plymouth Hospitals NHS Trust (2020) Exposure and habituation. Available at: https://www.plymouthhospitals.nhs.uk/display-pil/pil-exposure-and-habituation-6611/ (Accessed:[ 24.01.2026]).

TalkPlus (2023) Graded exposure. NHS Talking Therapies. Available at: https://www.talkplus.org.uk/wp-content/uploads/2023/12/Graded-Exposure.pdf (Accessed: [24.01.2026]).

Warwick University (n.d.) Exposure and habituation. University of Warwick. Available at: https://warwick.ac.uk/services/dc/pgr/phd_wellbeing/exposure_and_habituation.pdf (Accessed: [24.01.2026]).

Reclaiming Life After Trauma: How Structured PTSD Therapy Can Help

02Oct

Posted by Kim Wylie Blog No Comments - - -

By Shaun Hotchkiss, Trainee CBT Psychotherapist

Post-Traumatic Stress Disorder (PTSD) is more common than many people realise and often misunderstood. PTSD can develop after experiencing or witnessing a traumatic event, and can affect anyone, regardless of age, background, or circumstances. What I find most important, and hopeful, is that PTSD is highly treatable.

As a trainee CBT therapist, I’ve developed a particular interest in structured, trauma-focused work. I’m especially drawn to how evidence-based approaches like Trauma-Focused CBT (TF-CBT) and imaginal reliving can help people process distressing experiences in a safe, supportive, and structured way. When someone is living with PTSD, they might experience flashbacks, nightmares, heightened anxiety, emotional numbing, or feel constantly on edge. Understandably, many people try to push these memories away or avoid reminders of what happened, but this can keep the trauma feeling “stuck,” and continue to shape and control everyday life in distressing ways.

What I value about structured trauma-focused therapy is that it offers a way through and opportunity to regain a sense control in their thoughts and feelings. One key part of this process can involve reliving sessions, guided therapeutic work where clients revisit the traumatic memory in a safe and controlled environment. This doesn’t mean re-experiencing the trauma in an overwhelming way. It’s about gradually processing what happened, making sense of it, and reducing its emotional grip. Over time, many people find the memory becomes less intrusive in their thoughts and their unhelpful believes about themselves following the incidents changes to more helpful and rational assessments.

Research in the UK continues to support this approach. Ehlers & Clark’s (2000) cognitive model of PTSD is a foundation of many trauma-focused CBT approaches, highlighting how unprocessed trauma memories and negative appraisals can maintain symptoms. NHS guidance, including NICE (2018) recommendations, places trauma-focused CBT as a first-line treatment for PTSD, especially when symptoms have lasted longer than four weeks.

What stands out to me most in this work is the change people begin to experience, when a memory that once felt unbearable becomes something that no longer dictates their life. Structured sessions give people space to face what happened, on their own terms, and to start rebuilding parts of life that may have felt lost.

If you’ve experienced trauma and are feeling stuck or overwhelmed, know that support is available, and recovery is possible.

Polyvagal Theory in Integrative Counselling for Trauma

24Sep

Posted by Kim Wylie Blog No Comments - -

by Laura Hendry

Understanding Our Body’s Reactions and Pathways to Healing

Polyvagal theory has become influential in the world of trauma therapy, giving counsellors new ways to understand and help people who have experienced trauma. Created by Dr Stephen Porges in the 1990s, this theory helps us see how our body’s automatic responses can shape our feelings of safety, our ability to connect with others, and our overall well-being. In this blog, we’ll look at how polyvagal theory is used in counselling, focusing on the fight, flight, and freeze responses, as well as new research on more complex patterns in our body’s reactions.

What is Polyvagal Theory?

At its heart, polyvagal theory says our body’s stress response is more complicated than just “fight-or-flight” or “rest-and-digest.” According to the theory, there are three main ways our body can react to danger or safety. One helps us feel calm and able to connect with others, another gets us ready to confront or run from trouble (fight or flight), and the last makes us shut down or freeze when things feel overwhelming. These responses developed over time to help us survive in different situations.

Fight, Flight, and Freeze: The Impact of Trauma

When someone goes through trauma, their body can become stuck in these survival modes. The “fight” response prepares us to stand up to danger. If that’s not possible, the “flight” response gets us ready to run away. If escape isn’t possible either, our body may “freeze” — we might feel numb or disconnected, like we’re shutting down. For people who’ve experienced trauma, these reactions can show up long after the original danger has passed, often without warning.

Counsellors are trained to spot these patterns in their clients. By using ideas from polyvagal theory, they help people feel safer and teach ways to calm their nervous system, such as deep breathing, grounding exercises, or connecting with others in a safe setting.

More Than Just Fight, Flight, or Freeze

Recent studies show that our body’s reactions aren’t always so simple. Sometimes, people feel mixed reactions at the same time — like feeling numb and restless, or shut down but also on edge. These blended reactions are common for people with complex trauma or PTSD.

Understanding these mixed states helps counsellors offer better support. Instead of seeing people’s reactions as only one thing or another, therapists can recognise that feelings can overlap and change, and they can adjust their help to match what someone is really feeling in the moment.

Using Polyvagal Theory in Counselling

Integrative counselling uses different techniques based on each person’s needs. A polyvagal approach might include mindfulness, gentle movement, or body-focused therapies, all with the goal of helping people feel safe and more in control of their bodies and emotions.

Research shows just how important it is for therapists to help clients feel safe, both emotionally and physically. When people feel truly safe, they can begin to heal from trauma, reduce anxiety, and start to reconnect with others and themselves.

References

  • Porges, S. W. (2011). The Polyvagal Theory: Neurophysiological foundations of emotions, attachment, communication, self-regulation. New York: W. W. Norton & Company.
  • Ogden, P., Minton, K., & Pain, C. (2006). Trauma and the body: A sensorimotor approach to psychotherapy. New York: W. W. Norton & Company.
  • Dana, D. (2018). The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation. New York: W. W. Norton & Company.
  • Schauer, M., & Elbert, T. (2010). Dissociation following traumatic stress: Etiology and treatment. Journal of Psychology, 218(2), 109–127.

As our knowledge grows, integrative counselling is leading the way in using polyvagal theory to help people move from just surviving to truly living—supporting recovery, connection, and hope.