What is Exposure Therapy?
Exposure therapy is a type of cognitive behavioral therapy that is evidence based. This approach is used to help individuals confront their fears in a safe and systematic way. Exposure therapy is guided by a therapist, in which a therapist helps the individual face their fears in manageable steps, which leads to anxiety reduction. By utilizing this type of therapy, therapists help individuals overcome fears and anxieties by breaking the pattern of fear and avoidance. It is common for people to have some fears and often when people are afraid of something, they tend to avoid the objects, activities, or situations related to that fear. While avoiding these factors can help to manage anxiety in the short term, over time, it can actually make fears worse. Additionally, it can interfere with overall quality of life and activities of daily living.
Common fears treated with exposure therapy:
Obsessive Compulsive Disorder (OCD)
Post Traumatic Stress Disorder (PTSD)
Social Anxiety
Phobias (heights, spiders, dogs, etc.)
Panic Attacks
Generalized Anxiety Disorder (GAD)
Any fear that involves avoidance
Typically, exposure therapy starts with having the therapist and the individual collaborate together to create an exposure or fear hierarchy. A fear hierarchy is a 0 to 100 rating of avoided situations, from least (0) to most distressing (100). The individual will usually start with the lowest rated fear and confront the avoided scenario using specific instructions and guidance from the therapist. With practice, the individual’s fear diminishes through a process known as habituation, leading to more time and energy to enjoy daily life. It is important to note that there are different types of exposure therapy and techniques that can be utilized, which often depends on each person’s unique presentation and symptoms. Below are some examples of how exposure therapy may be implemented:
If someone is afraid of going to the grocery store, they may start exposure therapy by looking at pictures of grocery stores. The next step might be imagining oneself inside the grocery store. Then, the individual would gradually work their way to being able to walk inside the grocery store and buy something as an exposure.
A person with social anxiety may avoid going to a crowded area or parties. During
exposure therapy, a therapist would expose the person to these types of social settings to help them become comfortable with them
Types of Exposure Therapy:
Imaginal Exposure: In this type of exposure a person will vividly imagine the fears in the safety of a therapy session or at home using a script or audio recording. For example, a person who is afraid of birds may be asked to picture being on a beach filled with seagulls.
In Vivo Exposure: The person will confront their fears in real life. This is done in a structured way that is guided by the therapist. For example, someone with a phobia of dogs may interact with a dog during exposure therapy.
Virtual Reality Exposure: Virtual reality technology may be used in situations when it is difficult to experience the cause of fear in reality. This may be done when someone has a fear of flying and they use a flight simulator to confront that fear.
Interoceptive Exposure: This type of exposure will trigger a physical sensation to show that it is harmless, even if it’s feared. For example, someone who is afraid of becoming lightheaded because they think it means they are having a stroke may be instructed to stand up quickly.
Types of Exposure Techniques
In addition to the types of exposure therapy described, there are also different techniques that are used depending on the timing, which include: graded exposures, flooding, prolonged exposure therapy, and systematic desensitization. Graded exposures utilize the anxiety/fear hierarchy previously described above (starting out with the lowest feared situation and moving your way up). Flooding is a technique that utilizes the same approach as a graded exposure, however, in this type of exposure, the individual starts with the most intense/difficult situation first. Individuals with PTSD will typically undergo prolonged exposure therapy. This approach involves having the individual gradually come closer to trauma related memories, feelings, and situations. Another common approach is the implementation of systematic desensitization. This approach involves combining exposure activities with relaxation exercises. This can help the exposure experiences to feel more manageable. It also helps the person associate their fears with positive and calming activities. Before someone engages in exposure therapy, it is helpful for them to have a good understanding and practice of relaxation skills.
Qualities of Effective Exposure Strategies
Safe: While exposure activities will make individuals feel uncomfortable, they should never be unsafe.
Controllable: It is important that exposure activities do not depend on other people or events. For example, “be approached by a stranger” is not within one’s control.
Specific: It is important to make exposure activities as specific as possible. For example, instead of “call someone on the phone” a better activity would be “call a specific friend on Thursday and talk for 20 minutes”
Repeatable: Exposure activities should be tasks that can be done multiple times.
Benefits of Exposure Therapy
There are many benefits of engaging in exposure therapy. This type of therapy can help people improve their emotional processing. This is done by helping individuals create realistic beliefs about a feared object, situation, or activity. Additionally, extinction typically occurs. This is done when a person unlearns negative associations with a feared object or situation (which happens after multiple exposures). People are also likely to experience habituation, which happens after repeated exposures to a feared activity, situation or object and the individuals reaction decreases. Another important benefit is increased self-efficacy. This is accomplished when individuals' are able to see that they are able to overcome their fears and manage their anxiety.
When To Seek Additional Support
It is important to note that exposure therapy should be conducted under the supervision of a trained professional. Trying to perform exposure therapy without help from a trained professional can lead to further fear and anxiety. If you are experiencing anxiety or fear that is impacting your daily life and ability to complete daily tasks, exposure therapy might be helpful for you. A therapist can work with you to create an individualized plan that will help you to face anxiety provoking situations, and ultimately break the cycle of anxiety.
At Balanced Minds Psychology & Wellness we specialize in assisting individuals navigating life’s challenges. To learn more about me and the services I provide, checkout my profile. If you are ready to start the therapy process, contact us today to start a free consultation.