What Is Exposure Therapy: Basics & Why It Works

What is Exposure Therapy?

Exposure Therapy is a psychological method that has proven to be the most successful when it comes to dealing with fear. 

Exposure therapy or widely known as behavioral therapy is a whole process of using systematic techniques exposing someone to the very thing they are afraid of. 

Is that safe? Well, it depends on the feasibility of the treatment and whether there are underlying problems with exposure therapy. 

Anxiety can be caused by many underlying situations. Whether it is trauma, fear, phobia, or some traumatic experience, once the fear is present, it is quite hard to surpass it. 

The exposure therapy of anxiety will simply make you face your fears repeatedly to help break the pattern of avoidance and the fear itself – all of this in a totally safe environment. 

Goal of Exposure Therapy

The goal of exposure therapy is to alleviate and manage anxiety, fears, and phobias by gradually exposing individuals to the source of their distress in a controlled and supportive environment. 

This therapeutic approach aims to desensitize the person’s emotional and physiological responses, helping them learn that the feared situations are not as threatening as perceived. Through repeated and structured exposures, individuals can develop new, healthier associations and responses to feared stimulus, leading to reduced anxiety over time.

Examples of Exposure Therapy

1. Specific Phobias: A person with a fear of heights might progressively confront elevated spaces, beginning with pictures, then videos, and ultimately in-person exposure.

2. Obsessive-Compulsive Disorder (OCD): Someone struggling with contamination fears could gradually touch increasingly “contaminated” objects without performing compulsive rituals.

3. Post-Traumatic Stress Disorder (PTSD): A veteran might recount traumatic experiences to a therapist, gradually decreasing distress as the memories lose their power.

How does Exposure Therapy Work?

Exposure therapy is based on various exposure therapy principles. One of the most important principles is the principle of respondent conditioning, known as Pavlovian extinction. 

Respondent conditioning, also called classical conditioning, is a behavioral method or procedure where a conditioned stimulus (anxiety symptom) is paired with an unconditioned (neutral) stimulus. 

When treating fear or anxiety disorders, exposure therapy will expose you to the conditioned stimulus i.e. the object or situation that is causing you anxiety. 

For example, if you are afraid of elevators, the therapist will expose you to the use of the elevator until you become comfortable using it. 

When Exposure Therapy Is Not Recommended

Exposure therapy might not be recommended for individuals with severe trauma-related conditions who are not yet emotionally equipped to handle the distress caused by revisiting traumatic events. 

Those with certain health conditions like certain heart conditions or breathing disorders might need adaptations to exposure therapy can help ensure their safety during exposure exercises. Careful assessment by a qualified mental health professional is crucial to determine the suitability of exposure therapy for each individual’s unique needs.

Types of Exposure Therapy  

Based on the situation and the severity of the anxiety disorder, the 7 most used types of exposure therapy include:

1. In Vivo Exposure

This type of exposure is done by directly facing the situation or object that causes the anxiety symptoms to rise. 

In-vivo exposure is real-life scenario exposure. 

For example, if you are afraid of an insect, using the in-vivo exposure the therapist will gradually make you hold the insect in your hand.

2. Imaginal Exposure

This type of exposure is used when in-vivo exposure is not feasible or suitable to perform. The imaginal exposure consists of making the patient imagine the feared object or situation in their mind and describe the scenario in detail. This technique is very popular in the treatment of PTSD. 

3. Virtual Reality Exposure 

Virtual reality exposure is getting more and more used by many exposure therapists around the world. Thanks to advanced technology, using virtual reality exposure means testing all kinds of situations straight from the therapist’s office. 

For example, if the patient is afraid of flying, the virtual reality exposure will have the patient virtually placed in an airplane. 

4. Interoceptive Exposure 

Interoceptive exposure focuses on the creation or simulation of physical sensations or responses that a patient might have while experiencing an anxiety disorder. 

One of the best examples is hyperventilation. A person that is suffering from an anxiety disorder is oftentimes experiencing an increase in the heart rate. The therapist might make the patient simulate running to achieve hyperventilation and teach the patient that the particular response is not harmful. 

5. Graded Exposure 

Graded exposure is the most used and common type of exposure therapy. Graded exposure means gradually exposing the patient to fear-inducing objects

Usually, when using graded exposure, the therapist uses a ladder or exposure guide. This means that first, the patient will be exposed to situations or objects that are deemed as low in intensity, and then gradually progress to the more intense ones. 

6. Flooding 

The flooding technique is used in combination with the in-vivo exposure and the imaginal exposure. The flooding technique of exposure is one of the most intense types of exposure that a therapist can use. 

Flooding means deliberately exposing the patient to objects or situations that are most frightening for the patient for a prolonged period of time.

7. Systematic Desensitization

Systematic desensitization is a combination of exposure therapy with relaxation exercises.

Therapists often use systematic desensitization to perform exposure therapy using physical or mental exercises, so the patient is more comfortable and able to manage and associate with the feared objects and situations more easily and stress-free.

How Do You Use Exposure Therapy For Anxiety?

Exposure therapy for anxiety involves systematically confronting fears under the guidance of a therapist to foster gradual fear reduction and emotional resilience. Individuals dealing with anxiety disorders often encounter triggering situations, like public speaking, driving, or reminders of distressing events.

In this therapeutic approach, individuals are encouraged to envision or directly engage with these anxiety-inducing scenarios. They might start by imagining the situation, then progress to real-life exposure and response prevention. For instance, a person might sit in a car, gradually driving short distances, and eventually extending the distances over time.

This step-by-step exposure process empowers individuals to manage anxious thoughts and sensations. By confronting fears, the therapy promotes a shift from an emotional processing of perceived danger to a realistic assessment of the situation. Exposure therapy effectively addresses:

• Panic disorders

• Phobias

• Social anxiety disorder

• Generalized anxiety disorder

• Post-traumatic stress disorder (PTSD)

• Obsessive-Compulsive Disorder (OCD)

Exposure Therapy for OCD

Exposure therapy is a potent approach for managing Obsessive-Compulsive Disorder (OCD), a condition characterized by distressing obsessions and ritualistic compulsions. In OCD, individuals experience intrusive thoughts that trigger anxiety, leading to repetitive behaviors aimed at alleviating the distress.

With exposure therapy, a person collaborates with a therapist to confront their obsessions deliberately. The process involves gradually exposing themselves to triggering situations while refraining from engaging in compulsions. For example, if someone fears contamination, they might touch a doorknob and refrain from washing their hands immediately.

Over time, this repeated and prolonged exposure to feared triggers, without giving in to compulsions, weakens the link between obsession and anxiety, diminishing the need for compulsive behaviors. Exposure therapy enables individuals to regain control over their lives by reducing the grip of OCD’s cycle of fear and ritual.

Exposure therapy has been found an effective treatment for various types of OCD, including checking, contamination, symmetry, and hoarding, fostering significant improvements in overall well-being.

Effectiveness of Exposure Therapy

Exposure therapy is effective due to its ability to reshape maladaptive responses to anxiety-inducing stimuli. By gradually exposing individuals to their fears in a controlled manner, it helps them learn that the feared stimuli or outcomes are less likely or less severe than anticipated. 

This process triggers a process called “extinction learning,” where the brain forms new associations, reducing the fear response over time. Additionally, exposure therapy empowers individuals by demonstrating their capacity to confront and manage their anxieties, boosting their confidence in coping skills.

Frequency of Exposure Therapy

The frequency of exposure therapy sessions can vary based on the individual’s needs and the severity of their condition. Typically, sessions are conducted weekly or bi-weekly. However, the pace of exposure exercises might differ. In the initial stages, shorter, less intense exposures might be more frequent. 

As progress is made and anxiety diminishes, sessions might become less frequent while maintaining the complexity of exposures. Collaboratively determining the appropriate frequency with a trained mental health professional ensures a tailored approach that maximizes therapeutic benefits.