Exposure therapy is a form of behavioral therapy. It is designed to help someone overcome fear or anxiety associated with a specific activity or situation. Exposure therapy breaks the cycle of avoidance that many people find themselves in.
This article will explain what exposure therapy involves, as well as the types of disorders that it treats.
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Definition
Exposure therapy involves being exposed to the object or situation that triggers fear or anxiety. This is done repetitively, usually gradually and over a period of time, until the distress caused by the object or situation has decreased significantly.
The aim of exposure therapy is to reduce fear and decrease avoidance. This happens through learning that fear, anxiety, and avoidance do not help in reducing anxiety, as well as through recognizing that the outcomes that were feared are inaccurate.
Exposure therapy involves different kinds of exposures:
- Real life (in vivo) exposure: This involves being exposed to a feared object, situation, or activity in real life. For example, someone with a phobia of heights might be exposed to a situation such as standing on a bridge or going to the top of a high-rise building.
- Imagined (imaginal) exposure: This is vividly imagining the feared object, situation, or activity. For example, a patient being treated for post-traumatic stress disorder may be asked to visualize the events that caused their trauma in their imagination.
- Virtual reality (VR or in virtuo) exposure: Virtual reality technology might be used when in vivo exposure is not practical. In vivo exposure was historically viewed as better than VR, but a 2019 review of randomized controlled trials found no evidence that VR exposure was significantly less effective than in vivo exposure in phobia treatment.
- Interoceptive exposure: This involves bringing on physical sensations that are harmless, yet feared. For example, exposure therapy for panic disorder involves provoking sensations associated with panic attacks, such as hyperventilating or increasing the heart rate by running. It aims to disconfirm the idea that physical sensations will lead to harmful events such as a heart attack or embarrassing oneself in public.
Conditions Treated
Exposure therapy can be used to treat the following conditions:
- Specific phobia: This is the intense fear of, or anxiety about, specific types of objects or situations, such as flying or spiders. Exposure therapy is the main treatment for specific phobia.
- Generalized anxiety disorder (GAD): GAD is a common mental health condition characterized by excessive, chronic worry that interferes with a person’s ability to function normally. Imagining exposure, such as imagining the worst-case scenario associated with their worries, is more common in the treatment of GAD than real-life exposure.
- Social anxiety disorder (SAD): SAD is also known as social phobia. It is a type of anxiety disorder where people fear and avoid the judgment of others. Exposure therapy for SAD commonly involves real-life exposure, for example by participating in social situations that would normally be avoided.
- Panic disorder: This is characterized by unexpected and recurrent episodes of intense fear accompanied by physical symptoms, often with no warning or obvious trigger.
- Post-traumatic stress disorder (PTSD): PTSD is a mental health condition where you struggle to recover long after you experience or witness a deeply terrifying event. PTSD is often treated with prolonged exposure (PE) therapy, which incorporates both imagined and real-life exposures.
- Obsessive-compulsive disorder (OCD): OCD is considered a chronic (long-term) mental health condition. It is characterized by obsessive, distressful thoughts and compulsive ritualistic behaviors. A specialized form of exposure therapy, known as exposure and response prevention therapy (ERP or Ex/RP), can help treat OCD.
Process
Exposure therapies for each disorder tend to take on similar forms, though the type of exposure will differ depending on the source of the anxiety or fear.
In your session, your therapist may help you create an exposure fear hierarchy. This involves you ranking exposures from those that cause you least anxiety to those that cause a high level of anxiety or fear.
Therapy can then be carried out in different ways. These include:
- Graded exposure: This is where you will progress through different levels of exposures starting with those mildly difficult to those that are harder.
- Flooding: This is where exposure will start with the most difficult tasks.
- Systematic desensitization: In this case, exposure is combined with relaxation exercises to help make the exposure feel more manageable.
Types
Depending on the condition that is treated, different types of exposure therapy may form part of the treatment plan.
Prolonged Exposure Therapy
Prolonged exposure therapy is used to treat PTSD. In this type of exposure therapy, the patient is asked to repeatedly revisit the memory of what caused their trauma by visualizing the events in their imagination. They will also be asked to describe these events out loud in the session.
Their narrative of the events will be recorded and played back to them, with the aim of helping them process the traumatic memory. PTSD patients are also asked to use real-life exposure exercises as homework, typically involving gradual exposure to safe activities, objects, or places that were previously avoided.
Exposure and Response Prevention Therapy
Exposure and response prevention therapy aims to help individuals with OCD face uncomfortable situations and reduce compulsions, which they might engage in to relieve anxiety. Refraining from engaging in compulsive behaviors is an important aspect of this treatment. It involves both real-life and imagined exposures.
Outcomes
Randomized controlled trials have found positive treatment outcomes for exposure-based therapies for OCD, PTSD, anxiety disorders, specific phobias, panic disorder, and social anxiety disorder.
A 2016 study found that people who received exposure therapy to treat specific phobias had fewer symptoms, not only immediately after treatment, but eight years later as well, suggesting that exposure therapy has long-term benefits.
It has also been shown to be effective in reducing symptoms and other issues that those with PTSD might experience, such as anger, guilt, negative health perceptions, and depression.
Warnings and Drawbacks
While it has been shown to be an effective treatment, exposure therapy can be challenging. It requires the patient to be open to being put into a very stressful situation, and it may take some time for results to be seen.
It has been estimated that between 13% and 27% of patients will stop attending exposure therapy. Ending treatment prematurely makes it more likely that symptoms will return over time.
The conditions in exposure therapy also do not always reflect reality. Someone with PTSD, for instance, may be able to handle going through the memory of the events that led to their trauma in their therapy session, but may not be able to cope with the situation if it presents itself in reality.
Despite these limitations and challenges, exposure therapy is worth considering as a treatment option for the conditions highlighted above, as research supports its effectiveness.
In fact, one of the challenges facing exposure therapy is that it is not available enough. Many therapists do not have formal training in exposure therapy and therefore cannot practice it.
Summary
Exposure therapy is a type of behavioral therapy used to treat anxiety disorders, phobias, OCD, PTSD, and panic disorder. The person is repeatedly exposed to stimuli that usually provoke their anxiety or fear, in order to lessen it over time. The exposure may be done in real life, by imagining it, or via virtual reality.
A Word From Verywell
If you have a fear or condition that is impacting your life, exposure therapy may be able to help treat it. While the prospect of being exposed to the source of your fear or anxiety might be stressful, your therapist can guide you through the process and answer any questions you have.
Frequently Asked Questions
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Exposure therapy has been shown to be an effective treatment for a variety of conditions, including obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), anxiety disorders, specific phobias, panic disorder, and social anxiety disorder.
Exposure therapy can be challenging as it requires being put in a very stressful situation. Speak to your doctor about any concerns you have.
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Your session will involve your therapist supporting you in being exposed to the source of your anxiety or fear. This may be done in real life or involve you imagining situations where you are exposed. It can also involve the use of virtual reality (VR).
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There is no standard length of time it is known to work in, and it is not a quick fix since it requires regular practice and therapy sessions. Over time, however, exposure therapy may help you realize that you can confront the situation you fear and manage the anxiety it causes.