Exposure Therapy: How It Works and Who Can Benefit
Reviewed by Kirsten Davin
What Is Exposure Therapy?
Exposure therapy involves exposing an individual to the object, situation, place, or memory that they fear. People tend to avoid what they are afraid of, which only exacerbates their fear. Exposure therapy allows people to confront their fears in a safe environment and overcome the negative symptoms they experience.
How Does Exposure Therapy Work?
Therapists typically follow a fear hierarchy that acts as a roadmap for treatment. A fear hierarchy is a guide to gradually exposing someone to the situation that triggers their fear, starting with the least upsetting trigger and moving down the list. At each stage of exposure therapy, the therapist will help the client manage their anxiety, fear, and other negative feelings.
Benefits of Exposure Therapy
While exposure therapy may be uncomfortable at first, it can be beneficial in reducing avoidance and anxiety symptoms.
The potential benefits of exposure therapy include:
- Milder reactions: By being exposed to your fear gradually and repeatedly, the intensity of your reaction will likely decrease and become more manageable.
- Eliminated symptoms: Sometimes, exposure therapy can entirely eliminate certain symptoms of fear and anxiety.
- Improved emotional regulation: Exposure therapy aims to teach people how to interrupt their emotional response to their fear and regulate it both mentally and physically.
Increased sense of agency: Many people who experience exposure therapy report an increased sense of self-confidence and self-esteem, knowing that they can successfully survive and even thrive in situations that once caused them fear.
Types of Exposure Therapy
In Vivo Exposure
In vivo exposure involves confronting fears outside of therapy. This is often used as homework to give someone real-life practice in self-regulation. For example, someone who has social anxiety may try engaging in a short social interaction. Before in vivo exposure happens, a person will work with their therapist to identify potential situations involving their fear and discuss techniques to overcome it.
During imaginal exposure, a person is asked to vividly imagine their fear. Under the guidance of their therapist, they will describe, in detail, the object, place, or situation they are afraid of. While doing this, they will be asked to take note of the emotions they feel so they can begin to process them. By processing their emotions, they can work toward reduced anxiety and fear.
Virtual Reality Exposure Therapy
Virtual reality exposure therapy is a great option if the object or situation which a person fears is inaccessible, unaffordable, or unable to be confronted in real life. For example, someone who is afraid of flying may use a flight simulator to help confront their fear1 instead of spending the time and money to go on a real airplane.
Interoceptive exposure involves exposing someone to potentially triggering physical sensations that may be contributing to their fear and anxiety. For example, someone who experiences fear when they feel lightheaded because they are afraid they might be having a stroke may be asked to stand up quickly to trigger lightheadedness. Exposure to this physical sensation in a safe environment can help alleviate symptoms of fear and anxiety.
Exposure Therapy Techniques
During exposure therapy, a person can expect to benefit from the following techniques:
- Graded exposure: Graded exposure involves gradually exposing someone to their fear. For example, someone who is afraid of shots might be exposed to a picture of a shot, a covered needle, and the experience of holding a needle, until they can receive a shot without anxiety.
- Systematic desensitization: This approach involves exposing someone to stimuli that become increasingly anxiety-provoking. Relaxation methods2 such as meditation, muscle relaxation, guided imagery, and breathwork are used to help keep someone calm during the process.
- Flooding: Flooding is when someone is exposed directly to the anxiety-provoking object or situation that they are afraid of. This can involve real-life exposure or a description of the feared stimulus.
- Prolonged exposure therapy: Prolonged exposure therapy involves gradually exposing someone to their fears over the course of several months. This technique may be used to carefully expose someone to traumatic memories to help manage symptoms of posttraumatic stress disorder (PTSD).
Exposure and response prevention: Exposure and response prevention encourages someone to face their fears and let obsessive thoughts happen without attempting to take actions to reduce or eliminate stress.
Exposure Therapy as a Treatment
Exposure Therapy for Anxiety
Exposure therapy can be used to treat many different forms of anxiety. A therapist may use exposure therapy to reduce fear and excessive worry by exposing someone to what provokes their anxiety symptoms.
Exposure Therapy for PTSD
Exposure therapy can be incorporated into treatment for posttraumatic stress disorder (PTSD). Those who have PTSD may avoid certain places or situations that trigger memories of the traumatic event. Exposure therapy can help someone overcome this avoidance and reduce PTSD symptoms.
Exposure Therapy for Phobias
Exposure therapy has also shown success in treating phobias. Phobias involve intense and irrational fear of certain situations, objects, or places. Exposure therapy can help someone face their phobias in a safe environment and begin to reduce the resulting stress and anxiety.
Exposure Therapy for OCD
Obsessive-compulsive disorder (OCD) involves intrusive, persistent thoughts or obsessions that cause distress, along with compulsions or actions that are carried out in an attempt to reduce the distress. Exposure therapy can help someone who has OCD by exposing them to triggers for their compulsive behaviors and encouraging them to resist acting on them.
Exposure Therapy for Social Anxiety
Social anxiety involves intense fear or worry about socializing. This may be improved with exposure therapy. During exposure therapy for social anxiety, a therapist may expose someone to thoughts or memories of social situations. They may encourage their client to attend a small party in order to address this fear.
Is Exposure Therapy Right for You?
Exposure therapy should be used with a professional therapist as a guide. A therapist can help you determine if exposure therapy should be incorporated into your treatment plan based on your specific mental health concerns and goals.
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