Exposure Level 1

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This is a cognitive diffusion tool from Acceptance and Commitment Therapy.

First, list 5-10 distressing words that surround your phobia. 

For example: Nurse, phlebotamist, clinic, syringe, alcohol wipe, vacine, blood draw, etc. 

Next, assign each word a SUD out of 10.  Organize them from the least distressing to the most. 

Starting with the least distressing word, picture the word in your mind. Try changing it to different fonts, large and small, in different colours. Play around with putting the word on an imagined cupcake in icing. Try a giant neon sign. This might feel silly - that's part of the point! Notice if SUDs come down. 

Next, try saying the word until it stops making sense. Again, silliness is part of the process. Note if SUDs come down. 

Move on to writing the word. Write it over and over until SUDs come down. 

After each word has gone down to a 1 or 0/10, move on to the next, more distressing word.

Once you feel a sense of calm and "mastery", move on to the next exercise.  

From the above exercise, keep your pages of written words. 

Notice your SUDs when these pages are close to you, versus if you put them away and out of sight. 

Practice letting the written words be near you. Start with the least distressing (eg. seeing the paper on your desk) and once you feel SUDs subside, move on to a more distressing place such as at your kitchen table or bed. 

Work upwards until you feel comfortable with the words anywhere near you, including physically touching the pages.  For maintanace of this achievment, you might store these pages where you can see them frequently, such as on your fridge or in your bathroom. 

Similar to the first exercise, brainstorm a few distressing objects or images that are associated with your phobia. 

For example: a syringe, a torniquiet, a nurse, a bandaid, an alcohol wipe, a vial of blood, etc. 

Next, assign each object or image a corresponding SUDs out of 10, and organize them from least distressing to most distressing.

Starting with the least distressing, begin with sketching what it looks like. You do not have to imagine the image, nor do you need to flood yourself with the feared object. The idea is maintaining a sense of control and calm. 

Doodles are fine - no fancy artwork is required here! Notice what happens if you draw quickly or slowly. Experiment with different ways of drawing the object - big, small, from different angles, and trying different styles. Notice if SUDs go down. Only move on to the next object to draw once you have a sense of mastery. 

From the above exercise, keep your pages of doodles. 

Notice your SUDs when these pages are close to you, versus if you put them away and out of sight. 

Practice letting the drawings be near you. Start with the least distressing (eg. seeing the paper on your desk) and once you feel SUDs subside, move on to a more distressing place such as at your kitchen table or bed. 

Work upwards until you feel comfortable with the drawings anywhere near you, including physically touching the pages.  For maintanace of this achievment, you might store these pages where you can see them frequently, such as on your fridge or in your bathroom.