Exposure therapy is a form of cognitive-behavioral therapy in which clients are exposed to the things they fear in order to help them learn that these fears aren’t harmful. This approach has been used successfully to treat phobias and other anxiety disorders, addiction, and obsessive-compulsive disorder (OCD). For example, if you have OCD, you may be afraid of germs and have a compulsion to wash your hands several times a day. In exposure therapy for OCD, you would be exposed to the germs that make you anxious and see that it isn’t harmful to be around them. Exposure therapy could also help with other problems such as:
- Fear of public speaking
- Social phobia (fear of social situations)
- Panic disorder (sudden intense feelings of fear and anxiety, accompanied by physical symptoms such as a racing heart or sweating)
- Specific phobia (such as a fear of flying or heights)
- Post-traumatic stress disorder (PTSD; emotional problems that develop after exposure to a frightening event or ordeal in which you were threatened with injury or death)
- Obsessive-compulsive disorder (OCD; feeling of having intrusive thoughts that you feel you must act on).
- How Exposure Therapy Works
Exposure therapy is based on the idea that your fear isn’t dangerous; instead, you avoid situations that make you anxious so that you don’t learn that your fears are misplaced. According to the American Psychological Association (APA), research has shown that “the key component in exposure therapy is facing feared events until they no longer produce overwhelming anxiety.”
For example, if you have a fear of driving over bridges and avoid it by taking surface roads to all destinations whenever possible, exposure therapy could involve driving over a bridge until the anxiety lessens. You would be encouraged to stay with your discomfort and not try to distract yourself or just tough it out until the anxiety goes away on its own. If you have PTSD, exposure therapy may involve recalling the traumatic event in detail until it no longer causes overwhelming anxiety.
Exposure therapy can be conducted through imagery or real-life practice. Imaginal exposure involves repeating a frightening thought over and over until it has lost its power to upset you. When used for obsessive-compulsive disorder (OCD), this technique may involve imagining yourself touching a toilet seat and not washing afterward until the anxiety lessens.
The same approach is used with real-life exposure, such as spending time with someone who makes you anxious or putting yourself in a situation that you avoid because it’s frightening. The goal of both approaches is to help you learn that your feared consequences are unlikely or impossible. For example, if you have a fear of germs and washing your hands several times a day, exposure therapy would help you learn that being around germs won’t make you sick so that eventually the need to wash your hands will go away.
What to Expect from Exposure Therapy
An exposure therapist helps people gradually face their fears in a safe and controlled environment. You may work with your therapist in a session once or twice a week for about 30 minutes to an hour at a time. Also, you’ll learn coping skills such as using relaxation techniques and positive self-talk to help manage anxiety when you’re not with your therapist.
The goal of exposure therapy is to help you have a less extreme reaction. For example, if you have social phobia and avoid speaking in public, exposure therapy would encourage you to give a short talk that makes you anxious until it becomes easier. If part of your anxiety involves feeling that others are watching or judging you during the talk, exposure therapy might involve giving an impromptu talk in front of a small group of people instead.
One study, published in the Journal of Consulting and Clinical Psychology, showed that exposure therapy helped 90 percent of participants overcome their fear and avoidance of public speaking and it had benefits up to three years after the therapy ended (Hofmann & Otto, 2008). More research is needed to determine how
Types of exposure therapy
Exposure therapy can be used to treat several anxiety disorders, including PTSD; panic disorder; specific phobias (fear of dogs, heights or closed spaces); social anxiety disorder (e.g., fear of public speaking); and obsessive-compulsive disorder (e.g., fear of germs).
Exposure therapy has also been shown to be an effective treatment for depression, irritability, and mood disorders, according to on studies. For example, exposure therapy may help you break the link between an event that makes you furious and responding violently. It can also help you address difficult or painful emotions rather than relying on drugs or alcohol to cope with them.
Prolonged exposure therapy is a specific type of exposure therapy designed to treat PTSD. With this approach, you gradually expose yourself to the traumatic event in a safe but feared way. For example, if you were assaulted and now have a fear or anxiety about being outside alone at night, prolonged exposure therapy would encourage you to go outdoors during those times until the fear lessens.
Prolonged exposure therapy can be conducted in one of two ways: imaginal or in vivo. An imaginal approach involves recalling the traumatic event over and over again until it no longer causes overwhelming anxiety.
Imaginal exposure therapy is conducted in one session or over several sessions. Research studies have shown that this treatment, which emphasizes exposure to traumatic memory, is effective for PTSD.
In vivo exposure therapy involves facing a real-life situation related to the trauma. For example, if you were raped, this approach might encourage you to be around men or stop you from avoiding activities that were part of your normal routine before the rape (e.g., working in your yard).
Virtual reality exposure therapy involves imaginal exposure. Researchers are currently exploring the use of in vivo exposure for PTSD, its relative effectiveness compared with imaginal exposure therapy, and whether combining the two approaches might be even more effective.
For more information, check out our full breakdown of exposure therapy.
Graded exposure therapies
There are three types of exposure therapy that involve graded exposure to a fearful stimulus. In all three, you start with your least feared exposure and work your way up to more difficult exposures.
Graded exposure therapy for specific phobias begins by exposing you to a frightening stimulus in the absence of anything dangerous (called interoceptive exposure). If you’re afraid of heights, for example, this type of therapy may have you standing on a stepladder while looking down. You would continue to stand on the ladder until you no longer feel anxious.
Repeated exposure therapy can help you build confidence in your ability to handle fearful situations. This type of therapy involves gradually exposing yourself to the feared stimulus while practicing coping skills, such as relaxation breathing.
Systematic desensitization involves working with a therapist to gradually relax as you face the fearful stimulus (in vivo exposure).
Post traumatic stress disorder
Posttraumatic stress disorder (PTSD) is an anxiety disorder that can occur after you’ve been through a traumatic event. PTSD symptoms usually start within three months of the traumatic event, but they may not surface until years later. The disorder can result in flashbacks to the trauma; disturbing dreams; emotional numbness; angry outbursts; feeling distant or cut off from others; trouble sleeping, and hypervigilance (being overly aware of your surroundings).
Talking about the traumatic event can help reduce your anxiety. Seeking counseling from a therapist who is trained in treating PTSD may also make a difference. PTSD symptoms usually don’t improve without treatment. But there are effective treatments for this disorder, including medications, psychotherapy (a type of counseling), and self-help strategies.
Empirical evidence from exposure therapists, self-help therapy groups and recent neurobiological research suggests that the symptoms of PTSD are best treated by exposure therapy. Prolonged exposure therapy is a type of cognitive-behavioral therapy, which involves exposing yourself to your fears in order to overcome them. This form of treatment has been shown to help people with posttraumatic stress disorder better manage their anxiety.
In contrast to the newer prolonged exposure therapy, standard forms of cognitive-behavioral therapy for PTSD have failed to show a robust response in published clinical trials. One reason may be that the speed and duration used in standard cognitive-behavioral treatment is not enough time to extinguish fear memories associated with traumatic events.
Anxiety disorders
Anxiety disorders are the most common mental illness in the U.S., affecting more than 18 percent of the population. Anxiety disorders can often be treated effectively with a combination of medication and psychotherapy. Cognitive-behavioral therapy is widely recognized as the most effective form of psychotherapy for anxiety disorders Treating anxiety disorders with medication alone may be ineffective because anxiety often occurs with other mental disorders
Exposure therapy is a type of cognitive-behavioral therapy that involves gradually exposing you to fear. This helps you overcome your fears by breaking the link between the thing you’re afraid of and the unpleasant feelings it provokes. In order to get the full benefit of exposure therapy, you must confront your fears. It’s best to work with a mental health professional who is trained in this approach. Relaxation exercises are the first-line treatment for panic attacks and from the peer-reviewed studies a safe environment with progressive muscle relaxation is the most effective.
Cognitive therapy for panic disorder involves looking at patterns of thinking that lead to fear and developing new ways of responding. A doctor or mental health professional will often guide this process in a structured way, but you can also do it on your own through self-help books or websites.
Cognitive restructuring has some clinical implications because exposure to response prevention has been shown to be more effective than cognitive restructuring alone. The combination of exposure and cognitive restructuring is recommended by clinical guidelines as the first-line treatment for OCD.
Self-help strategies such as stress management and relaxation techniques can also help reduce anxiety and panic symptoms and improve your general well-being. Although you may not get complete relief from these strategies alone, they can be useful in helping you cope while you’re waiting for professional help or an appropriate medication to become available.
Generalized anxiety disorder
Generalized anxiety disorder (GAD) is the most common type of anxiety disorder. People with GAD feel anxious or uneasy much of the time, even if there’s little or nothing to provoke the worry. They anticipate disaster and are overly concerned about health issues, money, family problems, or difficulties at work. Often they can’t pinpoint a specific fear or worry.
To treat anxiety disorders with exposure therapy, you would work with a mental health professional to construct a hierarchy of anxiety-producing events. You would start by imagining the least scary event and move up the list until you can confront your biggest fear. The therapist will ask you to expose yourself to the situation that causes anxiety until your fear subsides.
To further explore the benefits and methodologies of exposure therapy, consider visiting the following resources:
- The American Psychological Association (APA) offers a wealth of information on panic disorder and the role of exposure therapy in its treatment. Visit their site here.
- Gain deeper insights into treating specific phobias through exposure therapy with resources from the Anxiety and Depression Association of America (ADAA). Their resources can be found here
