Exposure Therapy

Exposure therapy is a technique used by therapists to help people overcome fears and anxieties by breaking the pattern of fear and avoidance. It works by exposing you to a stimulus that causes fear in a safe environment.

For example, a person with social anxiety may avoid going to crowded areas or parties. During exposure therapy, a therapist would expose the person to these types of social settings to help them become comfortable in them.

It’s thought that there are four primary ways that exposure therapy may help:

• Emotional processing. Exposure therapy helps you create realistic beliefs about a feared stimulus.
• Extinction. Exposure therapy can help you unlearn negative associations with a feared object or situation.
• Habituation. Repeated exposure to a feared stimulus over time helps decrease your reaction.
• Self-efficacy. Exposure therapy helps show you that you’re able to overcome your fear and manage your anxiety.

According to the American Psychological Association, some of the potential variations of exposure therapies include:

• In vivo exposure. It involves facing your fear in real life. For example, someone with arachnophobia may interact with a spider.
• Imaginal exposure. A thing or situation is imagined vividly. For example, a person who’s afraid of birds might be asked to picture being on a beach filled with seagulls.
• Virtual reality exposure. Virtual reality technology may be used in situations when it’s difficult to experience the cause of fear in reality. For example, somebody with a fear of flying may use a flight simulator.
• Interoceptive exposure. This type of exposure triggers a physical sensation to show that it’s harmless, even if it’s feared. For example, somebody who’s afraid of lightheadedness because they think it means they’re having a stroke may be instructed to stand up quickly.

Exposure therapy is used to treat anxiety disorders, including the following:

• generalized anxiety disorder
• obsessive-compulsive disorder (OCD)
• phobias
• panic disorder
• post-traumatic stress disorder
• social anxiety disorder

The techniques a therapist uses during exposure therapy depend on the condition being targeted.

Here’s what you may experience.

1. Once the cause of your fear or anxiety has been identified, your therapist or psychologist will start the process by exposing you to the feared stimulus.
2. Often, they use a graded approach, where they start by exposing you to a mildly feared stimulus or a mild version of your stimulus.
3. Over time, your therapist will expose you to more feared stimuli in a safe environment.
4. The number of sessions and length of time your treatment will take depends on your progress.

For example, if you’re afraid of mice, the therapist might start by showing you pictures of mice during your first session. In the next session, they might bring a live mouse in a cage. In a third session, they might have you hold a mouse.

Extensive research supports the effectiveness of exposure therapy for treating anxiety disorders, especially for treating phobias.

Here are some of the key findings:

• Phobias. A small 2020 research review showed that in vivo exposure appears to be the most effective treatment for a wide variety of phobias. Some studies reported that 80 to 90 percent of participants responded positively to treatment.
• Anxiety disorders in children. Another 2020 research review showed that exposure therapy was used in 91 percent of successful anxiety disorder treatments in children.
• OCD. A 2019 research review supported the use of exposure therapy for treating OCD. Exposure and response prevention is one of the first-line treatments for OCD. This treatment involves exposing a person with OCD to their obsessive thoughts and having them resist acting on them.
• PTSD. A 2016 research review showed that exposure therapy is one of the most research-supported treatments for PTSD. The 2017 Veterans Health Administration and Department of Defense and 2017 American Psychological Association guidelines both strongly recommend the use of prolonged exposure therapy, cognitive processing therapy, and trauma-focused cognitive behavioral therapy for treating PTSD.
• Anxiety disorders in older adults. A 2017 review of studies found a reduction of anxiety in older adults when exposure therapy was included in their treatment.
• Panic attacks. A small 2018 study found that a three-session therapist-guided exposure treatment was effective at treating panic attacks in a group of eight people. Six of the people in the group saw a reduction in symptoms and four showed remission.
• Social anxiety. Another small 2019 study found significant reductions in social anxiety in a group of six participants who stutter. The improvements were mostly maintained after 6 months.

Exposure therapy is a type of cognitive behavioral therapy normally conducted under the supervision of a therapist, psychologist, or psychiatrist.

Here are some tips to choose the right specialist:

• Start your search from reliable sources such as the American Psychological Association website.
• Check the national association or network that deals with your specific condition, such as the National Center for PTSD.
• Look for reviews from other people who’ve worked with the specialist.
• Ask people you trust if they can recommend a mental health specialist that they’ve worked with. You can also try asking a primary care physician for referrals.
• Ask questions such as:
  • How much experience do you have working with [your issue]?
  • What is your area of expertise?
  • What can we do if exposure therapy doesn’t work?

If you’re paying through your insurance, take a look at your provider’s directory or look at whether they cover out-of-network therapists in cases where exposure therapy is not covered by your insurance plan.

Exposure therapy is normally conducted under the supervision of a therapist or other medical expert. A small 2018 review of studies found evidence that therapist-directed exposure therapy was more effective than self-directed treatment for treating OCD symptoms.

Improperly trying to perform exposure therapy without help from a trained professional can lead to further trauma or fear. You shouldn’t try to treat a serious condition like PTSD yourself.

You can incorporate aspects of exposure therapy into your daily life to help you overcome mild phobias.

It’s a natural human tendency to avoid things and situations that you’re afraid of. Forcing yourself to experience your phobias may help you step outside of your comfort zone.

For example, if you have mild social anxiety, you might feel anxious being around crowds of people or parties. You can try to force yourself to spend time in progressively more crowded places.

Exposure therapy is a technique that therapists use to help you overcome fear. Research has found that exposure therapy can be effective at treating a variety of types of anxiety disorders including PTSD and phobias.

It’s best to undergo exposure therapy under the supervision of a trained professional. One place you can find specialists in your area is from the American Psychological Association website.