Exposure is the first element of anxiety treatment, and the cognitive work exists mainly to get patients doing more of it. Benzodiazepines and leaning on medication undercut the learning, and exposure work goes nowhere until the patient accepts they need to learn something new.
How we use it
Exposure is number one. The cognitive component is number two, and its job is getting the patient to do more exposure.
“I have exposure as the top of the higher, like number one, and the cognitive component is number two, which the cognitive component is... getting them to do more exposure”
39:39Understanding Anxiety, GAD, and Treatments of AnxietyJun 2025 With just a specific phobia, a little avoidance is sometimes fine if it keeps the person running their life the way they want to.
“When you have just a specific phobia, sometimes a little avoidance is okay if it keeps you running your life the way you want to”
48:28Understanding Anxiety, GAD, and Treatments of AnxietyJun 2025
Medications and exposure
The treatment for anxiety is avoiding avoidance. Benzodiazepines decrease the efficacy of therapy because they reduce the ability to learn new information.
“benzodiazepines decrease the efficacy of therapy. And I feel like that's, it really decreases the ability to learn new information. So for anxiety, the treatment for anxiety is avoiding avoidance”
18:11Anxiety Medications Tier List: The Best and Worst Treatments for GADJul 2026 If anxiety is an overactive threat detection system, relying on a medication to quell it tells the brain it needs something external to fix the anxiety.
“Anxiety, Theory. Theoretically, is an overactive threat detection system. And if you rely on a medication And to quell that. That anxiety, you're telling your brain that I need something external to fix this anxiety”
6:50Anxiety Medications Tier List: The Best and Worst Treatments for GADJul 2026
Pitfalls
Exposure and response prevention is pointless until the patient can accept themselves and accept that what they learned in the past is not working and they need to learn something new.
“i just think that it's pointless to try to do exposures and response prevention type treatments until the patient can accept themselves and can accept that they have learned something in the past that's not working for them and they need to learn something new”
40:16Understanding Anxiety, GAD, and Treatments of AnxietyJun 2025
Talking to patients
Telling people not to be afraid will not convince them. The message is: be afraid, and act anyway in the direction that gets you where you want to be.
“Don't be afraid. Just telling people that is not going to convince them. Right. But be afraid and nonetheless act in the direction that will get you to where you want to be”
58:11Understanding Trauma and PTSD, Diagnosis and Dissociation | Episode 21Apr 2025
It also comes up on
- Behavioral activationBehavioral activation, exercise, light exposure and psychotherapy are the most important 'medications' for depression.
- Circadian rhythmLight exposure is accessible, low harm and low cost, and it weaves into sleep regulation, behavioral activation and exercise at once.
- Complex PTSDA mnemonic: PTSD is FEAR (fright, exposure, avoidance, re-experiencing). Complex PTSD is BAD FEAR, adding betrayal, affect regulation and developmental impact.
- Exposure and response preventionPatients should not enjoy ERP. It is slow, deliberate exposure to distress, and breathing techniques and calming skills do not treat the OCD.
- Light therapyLight exposure is among the most important treatments for depression, alongside behavioral activation, exercise and psychotherapy.
- OCDDuring exposure, be curious about the anxiety and watch it. ERP is distress tolerance, not distraction and not calming yourself.
- PTSDExposure is broad. Encountering traumatic material electronically as part of your work counts, a carve-out for people who work child abuse cases, and so does hearing people assaulted or killed in another prison cell.
- PTSDA mnemonic: PTSD is FEAR (fright, exposure, avoidance, re-experiencing), and complex PTSD is BAD FEAR, adding betrayal, affect regulation and developmental impact.
From these episodes
- Anxiety Medications Tier List: The Best and Worst Treatments for GADJul 2026 · 2 points
- Understanding Anxiety, GAD, and Treatments of AnxietyJun 2025 · 3 points
- Understanding Trauma and PTSD, Diagnosis and Dissociation | Episode 21Apr 2025 · 1 point
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.