It’s been a while since I last posted because my wife just had a baby! We’re super excited!!!!!!! Now the dust has settled, I’m going to be back writing again.
This article is a follow-up to my exposure lifestyle article on checking. Often in exposure therapy, many therapists do hypothesis testing exposures. This is where you test out an idea and see what happens. For example, testing out whether I become ill in the evening if I eat something that has touched the floor.
For many situations, hypothesis testing can work quite well. Let’s take a situation where someone is worried that if they ask more than one question in a shop the employee will become angry with them. It can be quite effective to try it out and see what happens. Rather than avoiding the situation, test it out and see for yourself. Similarly, let’s imagine someone is worried that if they drive over a bridge it will collapse. Well, this isn’t rocket science (though it can be very anxiety provoking)…Drive over a bridge and test it out. Another term for hypothesis testing is “behavioral experiments.”
Hopefully this all makes sense. Hypothesis testing during exposures can help. But here’s the rub, and something that many therapists and clients ask:
What Happens If The Thing You Fear Actually Happens?
For example, you ask more than one question in a shop and the employee gets irritated. Or you drive over a bridge and it actually collapses.
It’s a great question! It might happen. If you’re doing exposure to social anxiety then people may react critically to you. If you’re eating food after touching a contaminated surface you might get sick afterwards. Jonathan Grayson gave the classic example that if you’re doing exposures to not checking (e.g. whether the stove is turned off), your house might burn down. And this is what led to Dr. Grayson coining the term the “Three Houses Rule.”
The Three Houses Rule
In a nutshell, if your house burns down once, it could be chance. Peoples’ houses do burn down, unfortunately. If your house burns down a second time, it still could be chance. Unbelievably, houses do sometimes burn down twice. Very unlikely things have happened. For example, there are people who have been struck by lightning more than once! However, if your house burns down three times, it makes sense to take a step back and think about if there is anything happening that can lead to such an unfortunate series of events. Whether there is anything that needs to change before continuing with exposures.
Why Is This Important?
It gives you the wiggle room needed to effectively conduct exposure therapy and tolerate that sometimes bad things happen without giving up. It also prevents spurious correlations. Almost everyone has used this reasoning as a child in the form of the saying, “if at first you don’t succeed, try and try again.”
The most common example that I see this with is social phobia. Let’s take the example of an exposure to talking to people on the street and asking directions, with the person’s fear being that they will be ignored. Often, because social anxiety is high, the person has difficulty getting people to stop as their voice volume is too low, eye contact is poor, and body language is not confident. As a result, the worst fear happens and people just walk past. Three times! Now it could just be bad luck but in this case, unless the person is invisible, the thing that needs to change is increasing the skill to get noticed. So before resuming exposures, practice stepping in someone’s way or speaking a lot more loudly.
If you’re doing exposures to not checking the stove and your house burns down three times, let’s think about what’s happening in the house that might be making this happen before resuming exposures.
Keep Your Chin Up
Remember, if your fear happens it could totally be chance. That doesn’t mean you should throw in the towel with exposures. You’re taking a risk and sometimes bad things happen. If it happens twice, then the same logic applies. If it happens three times, have someone evaluate with you the steps you are taking and see whether there is a modification to make…Or whether you’re just ridiculously unlucky. This is the three house rule and I highly recommend trying to apply it yourself.
Thanks for reading!