Fears lay on a continuum between realistic/helpful fears to unrealistic/unhelpful fears. For example, physiological arousal and scanning your environment for danger can be adaptive or helpful in certain settings (e.g., in a community with high levels of violence, walking an unfamiliar city street after dark) but less helpful in other settings (e.g., in the classroom). There is no clear, universal rule of what fears are and are not helpful; determining this can be challenging. One of the most common challenges clinicians have told us they face (especially when working with youth who face marginalization) is distinguishing between realistic and unrealistic fears to figure out what to target with Ex-CBT. 

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It is recommended that clinicians work closely with clients and their caregivers to determine what fears are appropriate to target with Ex-CBT. In addition, it is recommended that clinicians engage in ongoing self-reflection to increase awareness around their own perceptions of what constitutes realistic and unrealistic fears. You may consider asking yourself, “How might my own experiences inform my perspective on how realistic or unrealistic a fear is?”, and “What realistic fears have I dealt with or NOT had to deal with in your day-to-day experience?” Self-reflection in this context can help avoid making assumptions and instead rely on learning from the client/family.