Can you use skills during exposures?

You definitely can use skills during exposure protocols. We would argue that you have to use skills for exposure protocols to work. Most emotion regulation skills and mindfulness are not about avoidance of emotion but experiencing emotion fully. Even if you are not in physiological distress with emotion, you will still be using skills to experience emotions that can be tolerated.

The figure below shows a generic skills chain that might be used during exposure protocols. Distress tolerance skills are available if the exposure trial is experienced as too intense for you to tolerate the physical sensations. These skills are important to increase tolerance of distress and also to prevent avoidance behaviors that may be self-destructive or ineffective.

If the exposure severity is judged accurately, your response would be more moderate and tolerable. You would be using more mindfulness of current emotion, model of emotion, and checking the facts of the emotion. There may be times you would need to decide on the options of problem solving an accurate emotion when facts in the environment are invalid (for example, being treated unfairly compared to others), opposite action where the emotion may be invalid to the circumstance or not resolving, and mindfulness of current emotions to ride the wave the wave of emotion that matches the exposure. 

Exposure protocols that are only moderately distressing to you will mostly make use of the opposite action required to start the exposure, followed by plenty of mindfulness of current emotion. A model of emotion or checking the facts on emotion will not be necessary since you know in advance what emotion you are challenging and that it is an invalid response to a given situation either by being the wrong emotional response or too intense of an experience of an accurate emotion.

Hopefully we have convinced you that you must have some skill in regulating emotion to benefit from exposure protocols. Please refer to the podcast episode for mindfulness of current emotion.

Generic example of a skills plan that might be needed for an exposure protocol.  Checking the facts helps to determine if the emotion is justified based on the situation or if it is unjustified. A justified emotion with an ineffective action will also call for opposite action much like an unjustified emotion. Many exposures will be arranged as justified and tolerable as is often the case with PTSD or social anxiety. Sometimes with OCD, emotions are unjustified based on magical thinking, e.g. repeating things by number to feel right or prevent a feared catastrophe.   

All Therapists are Jerks, and . . .: Ep 17. Mindfulness of Current Emotion (libsyn.com)

All Therapists are Jerks, and . . .: Ep 11. Mindfulness (libsyn.com)