Exposure therapy

Overview

Exposure therapy, a type of cognitive behavioral therapy, involves a therapist creating a safe environment to gradually confront your fears. These fears may involve specific objects, situations, or activities that you typically avoid. While avoidance can temporarily alleviate panic, it often reinforces fears over time, impacting your daily life negatively.

The goal of exposure therapy is to show that you can confront and manage your fears, helping you develop more realistic beliefs about them. Through this process, you gradually become more comfortable with situations that induce fear. Professionals such as psychologists, therapists, or counselors are trained to conduct exposure therapy effectively.

Reasons for undergoing the procedure

A number of mental health issues can benefit from exposure therapy, including:

• Post-Traumatic Stress Disorder (PTSD).
• Complex Post-Traumatic Stress Disorder (PTSD).
• Acute stress disorder.
• Agoraphobia and other phobias.
• Generalized Anxiety Disorder (GAD).
• Obsessive-compulsive disorder (OCD).
• Social anxiety disorder.
• Panic disorder.
• Certain eating disorders.

For some of these conditions, you might require further therapies like EMDR, other psychotherapies, or medication.

Types of exposure therapy

There are several approaches to exposure therapy, such as:

• Imaginal Exposure Therapy: This method involves vividly imagining the object, situation, or activity you fear. For instance, if you have PTSD, your therapist may ask you to describe details of the traumatic event.
• In Vivo Exposure Therapy: “In vivo” means “in real life.” This therapy involves directly confronting the feared object, situation, or activity. For example, if you have a fear of heights, your therapist might have you safely walk across a bridge or look out from a tall building.
• Interoceptive Exposure Therapy: This approach triggers the physical symptoms associated with intense fear or panic, such as a pounding heart or shaking. The goal is to help you understand that while these sensations may be uncomfortable, they are not harmful. This therapy is particularly useful for those who fear the physical symptoms of panic more than the specific object or activity.
• Virtual Reality Exposure Therapy (VRE): Using virtual reality technology, this therapy simulates the feared objects, situations, or activities. It is especially useful for scenarios where real-life exposure is impractical, such as a fear of flying.

Additionally, there are various forms of exposure therapy according to when it is administered:

• Graded Exposure: Your therapist will have you list your feared objects, activities, and situations in order of intensity. You begin with less challenging exposures and gradually move to more difficult ones over time.
• Flooding: Similar to graded exposure, but you start with the most intense and difficult exposures initially.
• Prolonged Exposure Therapy: This method involves slowly approaching trauma-related memories, feelings, and situations. It typically spans about three months with weekly individual sessions, totaling eight to fifteen sessions, and is often used for treating PTSD.
• Systematic Desensitization: This technique combines exposure activities with relaxation exercises, making the experiences more manageable and helping you associate fears with positive, calming activities.

Risks

Since exposure therapy involves directly confronting your fears, it can initially be challenging. However, it’s important to know that this approach is effective and safe. Throughout the process, your therapist will support you every step of the way, ensuring your well-being and progress.

Before the procedure

Your therapist will ask about your fears and anxieties to gain a deeper understanding of your experiences. Together, you’ll create a plan for your exposure therapy.

The specifics of your treatment will depend on the type of exposure therapy and the nature of your fear or anxiety. Your therapist might assign homework for you to complete on your own or work with you in their office, as with imaginal exposure therapy or virtual reality exposure therapy.

During the procedure

During exposure therapy, you’ll confront and engage with what you fear, staying near it or in contact with it until your anxiety gradually decreases. This process involves multiple exposure activities over time.

Therapists typically start with mild to moderate exposure and progressively move to more intense levels. For instance, if you’re afraid of heights, you might begin by looking at pictures taken from high places. Once you’re comfortable with that, you may look out a third-floor window and gradually move to higher floors.

Your therapist will teach you strategies to manage your fear and anxiety in these situations. For example, if facing your fear causes an increased heart rate and shortness of breath, your therapist will guide you in using slow, controlled breathing or other relaxation techniques.

The intensity of exposure will gradually increase until you can interact with the previously feared situation, activity, or object in a healthy manner.

Exposure therapy durations differ according to:

• How bad your anxiety or fear is.
• The intricacy of your mental health issue.
• Your readiness to dedicate yourself to the therapy.

Outcome

Research shows that over 90% of individuals suffering from specific phobias experience substantial benefits from exposure therapy when they fully engage in and complete the treatment. In many cases, exposure therapy alone proves sufficient to alleviate their phobia.

In contrast, assessing the effectiveness of exposure therapy for more complex conditions like PTSD and OCD presents greater challenges for researchers. These conditions often necessitate additional forms of treatment. However, numerous studies have indicated that exposure therapy can play a crucial role in effectively managing these more intricate conditions.