Help Your Clients Face Their Fears: High-Impact CBT Strategies for Successful Exposure Therapy

Exposure therapy can be one of the most powerful and effective tools for helping clients overcome anxiety. But many therapists hesitate to use it - or struggle to make it work - because clients may feel resistant, fearful, ambivalent, or unwilling to fully engage in the process. 

When exposure is introduced before laying the necessary groundwork, clients may avoid the assignment, drop out, or complete the exercise without experiencing meaningful change. For exposure therapy to be successful, clients often need careful preparation, strong motivation, and a clear understanding of the thoughts and fears that keep them stuck. 

In this free 1-hour CE webinar, Mike Christensen, MACP, Level 5 TEAM-CBT Master Trainer and Therapist and Global Clinical Director of the Feeling Good Institute, will teach and demonstrate high-impact CBT strategies therapists can use to help clients become more ready and willing to face their fears. 

You'll learn practical ways to overcome resistance, strengthen motivation, identify the core anxious thoughts that drive avoidance, and set up exposure exercises that are targeted, collaborative, and meaningful. 

Rather than simply asking clients to "do exposure," this webinar will show you how to prepare clients for exposure in a way that increases engagement, reduces avoidance, and helps them experience more powerful learning. 

This webinar is designed for therapists who want to sharpen their CBT skills and feel more confident helping anxious clients move from avoidance to action. 

Key Steps Discussed in This Webinar:

1. Understand why clients hold on to anxiety.

2. Use agenda setting to explore motivation for change.

3. Challenge anxious thoughts about danger and coping.

4. Identify anxiety triggers and safety behaviors.

5. Plan exposure exercises and explain their purpose.

6. Build therapist skills through role-play and feedback.

 In this video:

Jill Levitt: Welcome, everyone, to our webinar, Help Your Patients Face Their Fears: CBT Tools for Successful Exposure Therapy. I am really excited, especially about this topic today. I have to share that when I was a graduate student, my very first year in graduate school at Boston University, the very first patient that I ever saw was a patient with a driving phobia, and I learned how to do exposure therapy with her. I took her all over Boston, through the bridges and the tunnels, and helped her to face her fears, and I got hooked on doing exposure therapy from the very beginning. I like to say I was raised on exposure therapy, and I feel so blessed that I learned to use exposure therapy with my patients. I feel super passionate about it, and I'm really, really excited to host this webinar, and your presenter, Mike Christensen, I know is going to do an incredible job. So, our goal is to teach you how to do exposure therapy with your patients, to help your patients to be more willing to engage in exposure and face their fears, and also to give you an opportunity to practice one of the most important conversations that you'll need to have with your patients about doing exposure therapy. So, welcome. I'll just mention a few things about who we are at Feeling Good Institute, and then I'll introduce you to your presenter, Mike Christensen. Feeling Good Institute was created to help therapists to become more effective so that patients can recover faster and more fully. We train therapists in TEAM-CBT, which is a model developed by Dr. David Burns that combines powerful CBT methods with empathy, agenda setting, motivation, and structured treatment techniques, and we'll share some of those with you today. Over the years, we've also developed a structured certification pathway to help therapists not just learn the concepts, but to actually build the skills and the confidence to use techniques effectively with their patients in their sessions. Many of you will be asking, how do you get your CE credit today? It's very simple. At the end of the webinar, I will drop the link to the CE survey in the chat box. After you complete the survey, you'll receive your CE certificate of attendance via email, but it will not come out until about a week after the webinar. So please don't panic if you complete the CE survey and you don't get the certificate right away. I'll remind you of this at the end of the webinar as well when I drop it in the chat box for you. Let me tell you a little bit about Mike, and then I'll turn things over to Mike. Mike serves as the global clinical director at the Feeling Good Institute. He plays a key role in assisting other therapists in their growth and their development to become really phenomenal therapists. Mentoring others inspires Mike and fuels his passion for this work. He's a certified Level 5 master TEAM-CBT therapist and trainer and the director of Feeling Good Institute Canada. Mike's clinical specialties include anxiety, depression, and habits and addictions, and his goal is to help patients become their own therapists by empowering them with the tools they can use for the rest of their lives. He provides advanced online training with the Feeling Good Institute for therapists around the world and is the co-author of Deliberate Practice of TEAM-CBT with Dr. Maor Catz. Mike is also the leader of the FastTrack course at the Feeling Good Institute, and Mike and I actually love to partner together to offer high-quality training to therapists around the world. So I'm really excited to turn things over to Mike.

Mike Christensen: Thanks, Jill. Well, our hope for today is that by the end of this webinar, you'll be able to describe at least one common source of resistance to overcoming anxiety, and secondly, to have a bit of a skillset with explaining the rationale for exposure therapy in the treatment of anxiety. Now, in college and graduate school, we acquire significant knowledge. Today, we're going to provide you with additional insights on working with clients who suffer from anxiety. We recognize, however, that knowledge is different from the ability to deliver a method skillfully. You might understand exposure therapy, but struggle when a patient says, "I know, I know you think I should face this, but I'm not ready". How do we introduce exposure without pressuring? How do we respect the patient's hesitation while helping them to consider change? Today, we'll be providing a way to develop clinical confidence through deliberate practice, which involves application, feedback, and repetition. Later in the webinar, you will have the opportunity to practice with a new AI-generated practice partner, which is part of our new CBT Pro On-Demand program. Let me introduce you to Shawn. Shawn came to me as a senior in college struggling with crippling anxiety and panic. He was feeling exhausted and overwhelmed with the intensity of his anxious feelings. During the intake, Shawn shared with me that when he was eight years old, he occasionally spent time playing in the neighborhood with some of the older kids because he had an older sister a couple of years older than him. One day, Shawn was picked last when the teams were made up for a game of soccer, and they put him in net as the goalkeeper. Well, he made a mistake that led to his team losing, and one of the older kids on his team came over and criticized, belittled, and in many ways bullied him. Something inside of Shawn shifted in that moment, and in his mind, he determined that he would work hard to prevent ever making mistakes again and to avoid any situation where he might be criticized or picked on. Today, we're going to look at three models of overcoming anxiety to address anxiety, particularly focusing on how we can utilize the exposure model and set it up in a way that provides opportunities for our clients and patients to face their fears head-on and overcome them. The first is the motivation model, which suggests that there's something inside of all of us that clings to our symptoms, and for good reason. We hold on to our anxiety and worry because it serves a purpose. It reveals something about our character and our value system, and it helps us. The second is the cognitive model, and it suggests that it's our thoughts that drive our anxiety, and that if we can change how we think, we can change how we feel. The third is the exposure model, which suggests that avoidance is the cause of all anxiety. When we face our fears and learn that we can handle them, that the situation is not actually dangerous, our perspective changes on the things we fear as well as how we handle that fear. The motivation model - I don't know about you, but have you ever felt anxious or worried, and some well-meaning friend or family member tells you, "Oh, just calm down"? I don't know about you, but when that's happened to me - and I'm not a violent person - there's a part of me that wants to punch them and say, "No, I won't calm down". You see, there's a part of me that does not want to let go of my anxiety. It clings to it, hangs on to it for dear life. I want you to imagine for a moment that you're walking down a busy city street during rush hour. You have a small child with you who's approximately two or three years old. It could be your child, a niece or nephew, or maybe the son or daughter of a close friend you've been entrusted to care for. You're walking down this busy city street with a two-year-old. I ask you this question, and this is a question I ask a lot of my patients and clients: do you hold their hand, and why? I expect that all of you will say the same thing that my clients and others say: "Well, of course I'll hold their hand, I want to protect that child and keep them safe". Now, if I approached you, or I approached a mother walking with a two-year-old on that same busy street, and said, "Oh, don't worry, you don't need to be anxious, just relax, let them go, everything will be fine," most mothers, most parents, would become extremely protective, powerful, even fierce in safeguarding that child. You see, if you ask them to face their fears and let their child run free, they would reply, "No, that's ridiculous". See, this illustrates that there is a part of us that clings to our anxiety because it is valuable, beautiful, amazing, actually incredible. The challenge for us and our patients is that while this fear and anxiety have purpose and meaning and value in dangerous situations, these attributes get misapplied to safe situations, yet they still carry the same emotional impact as those dangerous encounters. We as clinicians need to acknowledge and bring to conscious awareness those values and benefits for our clients, because if we don't, they'll rise up as resistance and reluctance to engage in the required treatment methods and behaviors that will bring about long-term change and relief. Now, if you think about Shawn.

Jill Levitt: Is that what you wanted, Mike?

Mike Christensen: You can go to the next one, actually. Thanks, Jill. I just clicked on the wrong one for my notes here.

Jill Levitt: Got it, got it

Mike Christensen: Shawn's in his senior year in college. He's worked extremely hard to make sure he doesn't make mistakes, but he has this upcoming presentation, and he knows it will be followed by time set aside for the professor and his classmates to put him on the spot, challenge him, and give him critical feedback. Shawn practices for hours on end and studies incredibly hard to ensure that he doesn't make a mistake or have a wrong answer. You see, for Shawn, being criticized, challenged, and put down is terrifying, and he'll do anything to avoid it. So what does Shawn's anxiety do for him? How does it help him? What's the purpose of his anxious feelings? Well, as a therapist and clinician, we work with Shawn to brainstorm and come up with what these benefits would be, and in working with Shawn, we came up with a number of them. First, it helps him to be aware and sharp, to predict any potential questions that will come, and that preparation protects him from potential criticism. It also reveals and shows that he values doing quality work and his reputation. It energizes him to prepare. You know, as therapists, we bring this to conscious awareness, and then we do an exercise in TEAM-CBT that we call externalization of resistance, where we as the therapists take the role of the client's internal resistance - the part that's clinging to this anxiety and hanging on to the status quo - and paradoxically, we put the client in the position of arguing for change. Now, I'm going to ask Jill to join me right now, and she's going to demonstrate this skill. She's going to start with something we call the pivot question, which helps set up externalization of resistance, and I'm going to play the role of Shawn. Now, we're going to assume that Jill as a therapist has done a ton of great empathy, has done a great intake, and is really connected to Shawn, and we've got a moment in time that Shawn is wanting to work on this situation, and now we're looking at why. Why might he want to actually hang on to his anxiety? Jill's going to play that role of external resistance.

Jill Levitt: Okay, so, Shawn, yeah, we've talked a little bit about your anxiety, and you've shared with me that it helps you to be aware and sharp, that it protects you from potential criticism, that your anxiety really shows that you value quality work and your reputation, and finally, that it energizes you to prepare for things. So many beautiful values and benefits! I'm just wondering, given all these benefits and positive values, why would you want to change? Why is this something you'd want to work with me on?

Mike Christensen: Oh, well, it's true that there are those benefits, but I just get so exhausted in my preparation, and it's like I can never prepare enough. Then I get out of my head and I can't think straight. I need to do something.

Jill Levitt: Yeah, so you're saying that it does benefit you, and at the same time it causes you to feel so exhausted, and that the anxiety is so intense, right, that you can't even think straight. That makes a lot of sense to me, and of course I'd love to help you with your anxiety, but I do see some powerful reasons here, and I just want to ask you a little bit about them. You know, isn't it true that you really need this anxiety because it helps you to be aware and be sharp?

Mike Christensen: Well, in some senses it does, but I find that I get so anxious that it's like I get cloudy in my thinking, particularly when I think about doing a presentation. I'm not as sharp; it's like it's too much.

Jill Levitt: But doesn't hanging on to this anxiety really protect you from potential criticism? Don't you need this anxiety to protect yourself?

Mike Christensen: Well, I mean, criticism is terrifying, but you know, my other classmates seem to be okay with it, and I need to be able to be okay with it as well. I need to figure out how I can actually be able to handle it some way. You know, the anxiety just gets in the way of me learning and growing.

Jill Levitt: Right, that's really powerful. But Shawn, your anxiety shows that you value quality work and your reputation. Don't you need this intense anxiety to really hang on to this value of yours?

Mike Christensen: I don't think I need intense anxiety to hold on to that. I mean, I can still value quality work and my reputation without having to be so anxious.

Jill Levitt: Okay, and then finally, let me ask you about this last one. I mean, maybe if you gave up your anxiety, you'd have just no energy to prepare, or do you feel maybe you need this anxiety to just energize you to get your stuff done?

Mike Christensen: Well, I mean, it helps me get started, but then I just get so caught up in it that it becomes overwhelming, and then I'm exhausted, and my preparation ends up not being as strong. So I need to find some way of just tailing it back so I can stay focused. So you'll see here what's happening is Jill as the therapist is playing that internal resistance. She's actually trying to convince Shawn to stay anxious, and paradoxically Shawn is arguing for change. It seems backwards in a sense, and yet this is a key element of moving forward. We call this the agenda setting or assessment of the resistance phase of TEAM-CBT. So after we've successfully externalized that hidden reluctance and empowered the patient to champion their own transformation, we're ready to dive into cognitive methods and prepare for exposure work, which will bring about meaningful change. Now, the cognitive model, I'll remind you, suggests that our thoughts drive our emotions, and so if we change the way we think, we can change the way we feel. I want you to imagine that we have two nine-year-old girls who come from similar supportive families. They go to the same piano teacher and are in the same class. They have a recital coming up where they have to perform in front of an adjudicator who will judge them and give them feedback, as well as an audience including their parents, peers, and friends. Now, these two little girls are playing exactly the same song, and their skill levels are equal. The first girl is telling herself, "Oh no, I'm going to make a mistake, and that adjudicator is going to point out all my errors, then he's going to be critical and tell me all the mistakes I made, and my parents will be disappointed and sad, and everyone else is going to be looking at me and judging me". How is that little girl going to feel when she goes to play the piano? Nervous, anxious, scared, terrified. The second little girl, who I'll remind you has the same skill level, will actually make the same mistakes playing the same song, and comes from the same type of supportive family, is telling herself, "Oh, I can't wait to hear what the adjudicator has to say. He's going to give me some excellent feedback, and I'm going to learn and get better, and my proud parents are proud of me no matter what, and no one else is actually here to see me anyway-they're all here to see their children. This is going to be an amazing experience". How is this little girl likely to feel? Excited, happy, maybe even calm and relaxed. You see, the cognitive model suggests that it's not the situation or the circumstances that determine how we feel, but how we're thinking about that situation. So if we change the way we think, we can change how we feel. Now, there are two key thoughts that fuel our anxiety, and almost all anxious thoughts will be some form of these two. One is overestimating risk, and the other is underestimating coping. Something terrible is going to happen-in the case of this little girl, "I'm going to make a mistake and people will judge me"; in the case of Shawn, similarly, "I'm going to screw something up and they're going to be critical and harsh during my presentation". The second thought is, "I won't be able to handle it if it does. This will be terrible and awful, I won't be able to survive it". Now, when we think about Shawn, the terrible thing he thinks is going to happen is that he will make a mistake, people will look down on him and judge him, and that it would ruin his reputation. You can go to the next slide, Jill. Additionally, he may notice some of his physical symptoms and get in a state of panic by telling himself, "I can't handle this feeling. If my heart keeps racing like this, I'm going to pass out". Or his perfectionism will continue to fuel his anxious feelings as he tells himself, "If this isn't done completely right, it's a total failure". Now, we have a whole host of cognitive techniques to challenge these thoughts and come up with counterpositive, rational, and reasonable thoughts-things like examining the evidence, identifying distortions, thinking in shades of gray, or the semantic method, among many others, and this often provides immense relief for people. But sometimes they need a little bit more, which is where we can lean into the exposure model. Now, as a reminder, the exposure model suggests that avoidance is the cause of anxiety. When we are faced with an anxiety-provoking situation and we avoid it, we reinforce the idea that it is dangerous and that we couldn't handle the feelings of anxiety in that moment. Of course, we aren't talking about situations that are actually dangerous, but often people are cognitively aware that the situation is not dangerous, but the anxious feelings override their ability to be rational and reasonable in the moment. This is where exposure can be a powerful component of treatment. One way I explain it to my patients and clients is to say that there's a part of our brain, the prefrontal cortex, that's the thinking, rational, reasonable part, and then there are the emotional centers of our brain which are deeper below, and sometimes those emotional centers override the rational part and require a bit more proof. We need to do some experiments or tests to give that anxious part of our brain real-world data to bring it into alignment with rational thought. The process we work through is designing an experiment. First, we identify a specific anxiety-provoking situation in collaboration with our clients and figure out: what is the stimulus? What is the trigger? As well as what are the potential safety behaviors or actions they engage in to avoid facing that anxiety? And then we design experiments to test out the belief system. For Shawn, who wants to feel more calm and confident when doing presentations, his stimulus was the Q&A period at the end, and so his safety behavior was excessive preparation or avoidance of doing presentations that had a Q&A time. He wants to feel more calm and confident when doing presentations, and there are a number of experiments or exposure exercises we could do to prepare him. One potential experiment is to do a simulated roleplay situation where we have him imagine he's doing a presentation, and then we as his therapist play the role of the critical professor or judgmental classmates. This might sound cruel, and even suggesting this to Shawn will elevate his anxiety. Even thinking about doing a presentation makes him anxious, yet in many ways, it's the most caring thing we can do. We want him to have the opportunity to feel that anxious moment and realize, first off, that getting criticized is not dangerous. Additionally, we want to provide him with the opportunity to learn that he can handle it even when he gets those anxious feelings. The challenge, the problem for us when we present these opportunities to Shawn, is that he may say something like, "Oh, that sounds terrifying, I don't want to do that". He may be hesitant and resistant because it is terrifying, and the reality is it will be anxiety-provoking and scary. Part of the solution is that we want to build a higher level of awareness for Shawn in how exposure works and what he can expect during the treatment so that Shawn can go into it with some confidence in the process, recognizing that it will be anxiety-provoking, it will be uncomfortable, but there's a purpose to it. So we explain to him that there are two processes or outcomes that will take place in order to give him a new sense of confidence going into the situation, even though it will be anxiety-provoking.

The first is what we call habituation, and this is really the traditional form of exposure that suggests that if you engage in an activity over and over again, you'll get used to it and the anxiety will drop. I like to simplify this by saying there's a part of our brain that gets bored of the stimulus. It's like if you go to a scary movie and the villain jumps out of the closet, the first time you see the movie, everyone in the theater jumps and screams. If you take that same group and have them watch the movie a hundred times, on the hundredth time they'll sleep through it. You see, that part of the brain no longer gets activated-it gets bored. Exposure naturally lowers anxiety through repetition, and facing the fear repeatedly without running away initiates a natural desensitization. You see, the brain stops viewing the stimulus as an active threat. It's like silencing the alarm-the brain simply gets bored with sounding the anxiety alarm. The second process that we want to make sure we let Shawn know about is called new learning, and recent research suggests that this process is actually far more valuable and important. We actually want to be careful not to guarantee for our clients that habituation will take place, because in some exposure exercises, it doesn't, and that's okay. I like to think of this as our clients becoming a powerhouse. We learn that not only is the situation not dangerous-that's what we call the expectancy violation, change the expectation that our clients have about the dangerous situation, realign their thinking-but we also learn that we can handle it even when we do feel anxious. This is called tolerance. If you think about people who perform a lot, like rock stars or people that are on stage a lot, when they do interviews with them, I've often heard interviewers ask, "You've been doing this for 20, 25 years, toured for most of your life, do you ever get anxious going up on stage?" And almost all of them say yes. You see, the difference is, even though it's an anxiety-provoking situation, it's not dangerous-well, most concerts-but they've learned that they can handle the anxiety and actually embrace the opportunity. You see, we want to bring alignment for what the anxious centers of their brain are thinking with the rational and learn that it's actually okay. Now, one of the key elements in preparing our patients is giving them a bit of psychoeducation regarding the process and the potential outcomes. Keep in mind, we're asking them to face their fears head-on. We want to face that fear directly and walk right into it rather than avoiding it. And when we practice preparing this, which we're going to do in a few minutes-I'm going to take Jill through a bit of a demo in a minute-you're going to work through four elements to keep in mind when preparing our clients for the exposure. The first is to explain that the goal of exposure is to face the fear head-on and eliminate the power that anxiety has over them. The second is to state that we become used to or comfortable with anything if done repeatedly, and this is called habituation. The third is that while we're doing an exposure, a learning process takes place, and we learn two things: one, that the situation is not actually dangerous, but secondly, we learn that we can handle any situation regardless of how it makes us feel. This is called tolerance. The fourth element I often include is an illustration or example, often from my own life, an experience that we've had in going through exposure. I was afraid of horses. I had a bad experience at a summer camp, and a horse I was on took off. 15 years later, my nine-year-old daughter decided she wanted to get into horseback riding, and it was exciting to me in some senses because now I had this exposure opportunity. Now, the goal was to face that fear, and so I went out to the barn one day with her, and we went out in the field where she had to get her horse, and my anxiety was going through the roof, and I could feel the anxiousness in my breathing, and my heart rate was racing. Horses are powerful animals, and you do have to be careful, but in this case, it was a well-trained horse, and my daughter was happy as a lark going out to get the horse. But I had to spend time with the horses over and over again, and when I did, I realized, "Oh, they're actually pretty wonderful animals". They were reasonably safe if you do things in a wise way, but secondly, even when I would go out there and feel anxious, I knew I could handle it. I knew that it was going to be fine. So I'm going to ask Jill to help me out here. We're going to walk Jill through a tool. We're going to put the link for this AI exposure introduction practice app in the chat box, and I want you all to click on it and have a look at it, and then I'm going to walk Jill through the process so you know how it works. Then we're going to give you all an opportunity to practice it for a couple of minutes. All right, so Jill…

Jill Levitt: yep. I'm going to open up this window.

Mike Christensen: Yeah, excellent. So this is the opening window, and it's got the skill description, which we've talked about, and if you click on the skill criteria there, it reminds us what those four criteria are. Now you're going to scroll down to the bottom, and you scroll right down to the bottom of the screen there, it'll say "Ready to practice", and you click on "Start now", and it's going to take you to the practice screen. Now, before you hit "Start roleplay", you can see you've got at the top, if you scroll up, there is your skill criteria again. Just to remind people, the first is to explain the goal of exposure is to face the fear head-on and eliminate the power that anxiety has. The second is state that you can become used to or comfortable with anything done repeatedly, called habituation. And the third is that while doing an exposure, a learning process takes place, and we learn two things: that the situation is not dangerous, and secondly, that we can actually handle it regardless of how it makes us feel. This is called tolerance. The fourth is-it's kind of a bonus criteria-you can illustrate in some way with an exposure experience you've engaged in or heard about that can bring the process to life. Now, at the bottom, if you scroll down, it'll say "Start roleplay". And now just wait. When you push "Start roleplay", a voice of a client will come up, and then you're going to respond doing your best to implement each of the four skills. Once you hear the voice of the patient, you can click the "Record audio" button and give your response, and then after you've finished recording, then you hit "Stop recording". It will transcribe, and then you could hit the "Submit response" button, which will give you some feedback. So Jill's going to do that for us now, so we'll watch her do a little demonstration.

Jill Levitt: Okay, fingers crossed. There's a lot to cover in this one. I'm going to hit "Start roleplay", and then I'll also scroll back up to the skill criteria so you guys can look at the skill criteria along with me. So let me see how it goes.

(AI Client Voice): "People will look down on me if I say something stupid".

Jill Levitt: Okay, now I'm going to hit "Record audio", and I will give my best. Okay, so, Jennifer, yeah, we've talked about the fact that you're really worried that people will look down on you if you say something stupid, that you're really struggling with some social anxiety, and we've talked about the idea that we're going to try exposure therapy as kind of one of the methods that we have to overcome the social anxiety, and I just wanted to review with you that, you know, one of the goals of exposure therapy is really to help you to face your fears kind of head-on rather than avoiding interacting with people. We're actually going to have you start talking to people and do some exposure exercises together, and there's kind of two main processes that happen when we do exposure therapy. One of them is just simply by facing rather than avoiding these social situations, you're going to get used to them. You're going to stop being so afraid of them. It's like something that we do day in and day out, we can't possibly continue to be afraid of, and kind of that getting used to it and your body getting used to it is called habituation. The other thing that's going to happen is that by facing these situations rather than avoiding them, you're going to start to learn some new things, and I hope that at least two important things will happen. One is that you'll learn the thing you're most afraid of—that people will judge you or look down on you-is actually not likely to happen, that you'll end up having a lot more positive interactions. The other thing is also that you'll learn that you can handle it, that if you do get extremely anxious or someone does say something slightly critical of you, that you'll actually be able to tolerate it, that you'll be able to handle it, and that's called tolerance. And I think if you could imagine, let's say that instead of being afraid of social situations, you were afraid of dogs, you can imagine you and I might spend time hanging out with dogs, and if we could get you to hang out with dogs, an hour a day every day, you'd probably be a lot less afraid of them, maybe even within the week, and you'd probably learn the two things we talked about: that dogs actually aren't as scary as you thought, and that if you did get really anxious, you'd still be able to handle it, right? That these are experiences or emotions that don't ultimately harm you and that you'd be okay. Okay, that's the end of mine. I'm going to hit "Stop recording". Transcribing it, right? And then I'm going to hit "Submit response". 

Mike Christensen: Excellent. 

Jill Levitt:  And then I'll scroll up so you can see the feedback that I got. Did you want me to read this, Mike, or you want to talk us through this?

Mike Christensen: This is great. So you'll see that with the feedback, there's going to be some ways to kind of improve and change and also what you did well, and then you can build on that. And when we do deliberate practice, we encourage people to take one patient statement and actually repeat it over and over again- four, five, six, seven times. And in our experience, when I suggest this to people initially, they go, "Oh, why don't I just move on to the next one"? But then when they try it, they do an experiment where they test it out, they repeat it over and over again, on the fifth or sixth time it suddenly comes to life and they become very skilled at it. This is the deliberate practice approach. And so we're going to give you all five minutes now to click on that link, go through to the practice, and this is where you can practice on your own in the comfort of your own office or home, get some feedback. And I would suggest that you take the five minutes and just do as many rounds with the first scenario that comes up as you can, and put "Repeat scenario" at the bottom once you've gotten your feedback. All right, so everybody's got the link there.  I think, Jill, if we got that in there.
Jill Levitt: I did. I will add the link again here. Let me just go back to that. Let me put the link one more time in the chat. And I think someone asked, "What are we doing with this"? This is not anything for us to do anything with; this is just an exercise for you guys to practice. There you go. And then, yeah, as Mike said, if you do exactly what I did and then you get feedback, then you can click "Try again". I actually... we didn't go through the feedback that I got, but I thought it was spot-on and super helpful, yeah. So, all right, so the goal is now, go ahead and take your five minutes, click on this link to practice. If for whatever reason it doesn't work for you, that's okay. You know, I mean, let us know, but hopefully you'll practice for about five minutes, and then Mike and I will start talking again to keep working with you. 

Mike Christensen: We'll give you one more minute. I trust you enjoyed that exercise and found it valuable. What we just did together is a good example of the difference between learning about a clinical skill and actually practicing it. And Jill, shall I get you to go to the next slide? This exercise is also part of something we call CBT Pro On-Demand where you can continue to build your skills beyond today's webinar at your own pace. The platform includes expert-led training and there's more than 60 hours of continuing education, guided learning experiences, as well as deliberate practice exercises like the one we just completed. It's designed to help you move forward from understanding a technique to feeling more confident using it with clients. You can scan the QR code or visit cbtproondemand.com, and we'll also be sending you information after today's webinar. Now, some of you—we're going to go to Q&A here in just a second—some of you may be wondering what happened to Shawn. How did Shawn do with his exposure exercise? Well, Shawn in many ways represents you, and Shawn represents me. If I asked any one of you to open up your video and put you on screen and spotlighted you right now and said, "I want you to demonstrate a skill that you just learned and aren't very good at," and everyone in the audience-I think we have over a thousand signed up for the webinar today-they're going to give you critical feedback afterwards, almost all of us would say that would raise our anxiety; we'd feel somewhat anxious. See, Shawn is you, and Shawn is actually me. Many of the attributes of Shawn are exactly my journey. That neighborhood soccer game was me in that net, and that kind of feared fantasy exercise where I had caring TEAM-CBT therapists do a critical, judgmental, rejecting exposure exercise with me, that really happened. And when it did, my fear of failure, judgment, and criticism, which was terrifying and crippling at times, has now arguably become one of my greatest strengths. It's one of the things I love the most. In today's webinar, I made some mistakes, lost my notes for a second, and Jill and I weren't on the same PowerPoint slide at one time, and that was okay. Do I get a little anxious when I present? Absolutely. And yet, I love it. When I'm teaching and presenting, I thrive on TEAM-CBT. I thrive on it and the feedback, and I welcome that even though I still get a little anxious. The reason is that Dr. Burns and other TEAM-CBT therapists like the ones we have at FGI, the Feeling Good Institute, provided an opportunity for me to do exposure work during my early days of training, and I continue to engage in exposure activities with my fear of horses, driving in the winter, shame in public situations-lots of shame attacking-and fear of losing in a race, which sounds strange, but that was a big fear of mine. But now we want to have an opportunity to answer some of the questions that have come up, and so, Jill, I'm going to invite you to join me, and then we'll have a bit more information for people as well.

Jill Levitt: Okay, let me join you here, and then also, please do submit questions. I just got a few questions, but a few more are rolling in, so I'll start with what I got, the questions that I got so far. 

Q&A

Jill Levitt: Thank you so much for joining us today. We hope that you learned a lot, that you'll join us for future sessions, and if you like the tool, we hope that you'll try CBT Pro On-Demand, and we hope to see you in a webinar in the future.

Mike Christensen: Awesome. Thanks so much, everyone.

Jill Levitt: Thanks, everybody.

Frequently Asked Questions

1. Why do some clients resist overcoming anxiety?

Clients may feel that anxiety keeps them prepared, protects them from criticism, or helps them maintain high standards. The webinar explains how exploring these perceived benefits can help clients become more willing to change.

2. How does agenda setting help prepare clients for exposure therapy?

Agenda setting explores the client’s motivation and hesitation. In the demonstration, the therapist voices reasons to keep the anxiety, allowing the client to explain their own reasons for change.

3. What anxious thinking patterns are discussed in the webinar?

The webinar highlights two patterns: overestimating the likelihood of something bad happening and underestimating the ability to handle it. It discusses examining evidence and identifying thinking errors to challenge these beliefs.

4. How are exposure exercises planned?

The therapist and client identify a specific trigger, the feared outcome, and any safety behaviors. They then design an exercise to test the client’s beliefs, such as role-playing questions and criticism after a presentation.

5. What if anxiety does not decrease during an exposure exercise?

The webinar explains that reduced anxiety, or habituation, is not guaranteed. Clients can still learn that a situation is less threatening than expected and that they can cope even while feeling anxious.