What Is Exposure Therapy & The Benefits
Updated September 04, 2018
Therapy positively impacts the lives of many people. Whether it be psychotherapy, online therapy, relationship counseling, or one of the many other varieties, therapy can help people learn more about themselves and get through hard times.
Some forms of therapy, like talk therapy, focus more on introspection, while others are more active and behavior focused. One of these more active forms of therapy is exposure therapy.
What Is Exposure Therapy?
Exposure therapy is a type of behavioral therapy that helps people overcome their fears, phobias, and anxieties. Exposure therapy teaches a person to develop a new reaction to a given stimulus. For example, if someone feels a great sense of fear every time they hear a car horn, exposure therapy will work to change that fear into a more neutral response to hearing the noise.
Exposure therapy can be daunting, but it is sometimes necessary for many someones to overcome their fears. By avoiding a fear, the negative feelings associated with it only grow more intense. Exposure therapy forces people to confront these fears, with support from their therapist, so that the thing they fear can become more normalized. The goal of exposure therapy is that ultimately the person will no longer avoid or respond negatively to their feared situations or things.
Exposure Therapy And Cognitive Behavioral Therapy
The most well-known type of behavioral therapy is cognitive behavioral therapy (CBT). CBT is widely utilized to treat conditions such as anxiety, phobias, PTSD, and substance abuse disorders.
The fundamental idea behind CBT is that our thoughts influence our feelings which influence our actions. In the case of anxieties and phobias, the behavior that results from thoughts and feelings is avoidance or panic. CBT modifies this response by changing the way the person thinks and feels about the thing that is causing them anxiety and fear. To change your behavior and actions, you must first change your thoughts.
Exposure therapy is a common component of CBT for people with anxieties, fears, phobias, or post-traumatic stress disorder (PTSD). Exposure therapy changes a person's beliefs about a certain situation so that they no longer associate negative feelings with it, and thus can change their behavior when the situation or thing comes up in their lives.
Types Of Exposure Therapy
In general, exposure therapy involves presenting someone with a stimulus to reduce their negative response to that thing. The idea is to make the person more comfortable with the thing that they fear to the point where they realize that they can handle it. Within this broad concept of exposure therapies, there are a few different strategies that a therapist may implement.
Exposure Therapy Strategies
In Vivo Exposure: This is what most people think of when they think of exposure therapy. In vivo exposure therapy is the process of the person directly facing whatever it is they fear. For example, someone with a phobia of dogs would be instructed to pet a dog. In vivo exposure can either follow the "flooding" model, in which the person is immediately presented with the thing they fear, or "systemic desensitization," in which they gradually build up to directly facing their fears.
Imaginal Exposure: Imaginal exposure is a mental exercise. The person will imagine the thing that they fear and imagine themselves facing it. The goal of imaginal exposure is for the person to grow comfortable with the thing they fear in their mind, to reduce the fear response when confronted with the trigger in real life. This is particularly useful for people with PTSD, as they will be asked to recall the traumatic experience and work to reduce their fear response when thinking about the situation.
Interoceptive Exposure: This type of exposure therapy focuses on the physiological aspects of fear and anxiety. It is a way for someone to experience the symptoms they feel when they are confronted with their fear so that they can learn to experience the symptoms without invoking the fear response. For example, someone will do jumping jacks to get their heart rate up, so they can become comfortable with an increased heart rate and not automatically associate it with fear. Interoceptive exposure is particularly useful for people with panic disorder.
Virtual Reality Exposure: Technology has improved medicine in innumerable ways, and exposure therapy is no exception. Some people may use virtual reality to simulate putting themselves in the situation they fear. This is a great way to ease into in vivo exposure, or for situations when in vivo exposure is impractical, like if someone is afraid of flying.
Exposure Therapy Paces
In addition to the different strategies described above, there are different ways in which exposure therapy can be paced.
Graded Exposure: This is the most common, and for most people most logical, way to go about exposure therapy. The therapist will work with the patient to develop a "fear hierarchy," in which the patient ranks their feared objects or situations in order of severity. The therapist will then have the patient confront a thing or situation low on the list, that causes them distress, but that they can handle. From there, the tasks build in difficulty for the patient, until they are doing things that they would never have thought possible before due to their anxieties and fear.
Flooding: Flooding is the most intimidating form of exposure therapy for many people. The patient will still create a fear hierarchy, but rather than starting at the bottom of the list; they will begin with the most feared item. This is a good method for people who feel ready and motivated to get over their fears as soon as possible simply. But, flooding may be too intense for many people, and it certainly is not for everyone.
Systematic Desensitization: In systematic desensitization, exposure is combined with relaxing exercises to help make the exposure more manageable. It teaches the patient to associate the things they fear with the relaxing exercises, mitigating the fear response that they would normally feel when confronted with the stimuli.
Who Can Benefit From Exposure Therapy?
Unlike some therapies that can benefit almost anyone, exposure therapy is specifically designed for helping people overcome their fears. Thus, if you have no fears to overcome, there is no reason to participate in exposure therapy.
Exposure therapy is particularly useful for people whose fears and anxieties interfere with them living their everyday lives. The following conditions are commonly treated with exposure therapy techniques:
Panic Disorder: It is normal for all people to experience symptoms such as increased heart rate or a stomach ache when confronted with something that causes them even mild fear or anxiety. However, people with panic disorder grow to fear these symptoms, and thus they become more intense.This leads people to panic disorder to avoid situations that may cause these symptoms of fear. Exposure therapy helps people with panic disorder become more comfortable with the physical sensations of fear. The goal is for the person to become comfortable enough with these symptoms that they do not develop into a full panic attack so that the person can stop avoiding so many situations or things out of fear.
Social Anxiety Disorder: People with social anxiety disorder tend to avoid certain, or all, social situations out of a fear of being judged or rejected. This fear and avoidance can cause major disruption to their lives. When someone has to participate in a social situation they would have liked to avoid; it causes great distress.
Exposure therapy for social anxiety disorder will have the person face social situations that they fear and ultimately remain in those situations until the fear subsides. In the long run, it will show them that social situations are not to be feared.
Phobias: Exposure therapy for phobias is typically done by systematic desensitization so that the person slowly becomes more comfortable with the thing that they fear to ultimately overcome the fear and associate the feared object with relaxation. It should always be a controlled exposure, in which the person is a comfortable, safe environment, and has the support of the counselor with them.
Obsessive Compulsive Disorder (OCD): Often, the obsessions,and compulsions that characterize OCD are based on irrational fears, like fear of germs. If someone with OCD based on a fear of germs is forced to touch a doorknob, for example, they will become overwhelmed with thoughts of the germs and proceed to wash their hands repetitively, in whatever fashion is typical for their obsession. Exposure therapy for OCD is two-pronged. It both exposes the person to a trigger for their obsessions and compulsions and also practices response prevention. In the case of the example given above, the person would be exposed to germs in a normal, daily situation (like touching a doorknob) and try not to have the responsibility of washing their hands obsessively afterward.
Post-Traumatic Stress Disorder (PTSD): Everyone experiences fear when something scary or shocking happens, but most people recover from the trauma relatively quickly. For people who develop PTSD, the fear and trauma linger, and leads them to feel scared and stressed even when they are not actually in danger. They may experience flashbacks to the traumatic event or nightmares that trigger their symptoms or avoid certain places or situations that remind them of the initial event. Both of these things cause significant stress and interfere with one's daily life.
Exposure therapy for PTSD is conducted as prolonged exposure therapy. PET is based on the associate learning theory and is conducted one-on-one between the patient and a therapist. They work to dissociate certain triggers from the trauma that cause a negative response. For example, if someone had a traumatic experience with a fire, the smell of any smoke may cause them severe anxiety now. During PET, the person will be exposed to the smell of smoke, and dissociate the smell from their trauma so that the smell no longer causes them severe distress. Ultimately, someone undergoing PET should be able to reduce their response to triggers of their PTSD and greatly reduce their overall anxiety and distress.
How Does Exposure Therapy Help?
Of course, the main benefit of exposure therapy is that it helps people overcome their fears. It can also make them more willing to try new things in the future and feel less restricted in their daily lives. It is also a great confidence booster, especially when the fear has been a big interference with living a normal life. The sense of freedom that comes with overcoming fears can be extremely empowering.
Experts believe there are a few mechanisms that explain why exposure therapy works, including:
Extinction: This is the weakening of associations between the feared item or situation and the physical bodily response. The association that caused the person anxiety or stress will cease to exist after sufficient exposure.
Habituation: Habituation is the idea that after repeated exposure, one's response to stimuliis weakened. Thus, exposure therapy weakens the fear response people feel about the stimulus, and they become more accustomed to the exposure to the point that it is no longer a fear.
Self Efficacy: This relates back to the point of confidence and empowerment. Successfully participating in exposure therapy will show the person that they are stronger than their fears, and thus the feelings of anxiety or stress surrounding the fear will be greatly decreased. It can also give the person confidence that they are capable of managing their anxiety, and do not need to revolve their life around avoiding their fears.
Emotional Processing: The experience of exposure is a great opportunity for the person to gain a better understanding of their fear and their emotions overall. Ideally, they will learn to view their fears more realistically and can become more comfortable with moderate, normal feelings of fear and anxiety. Exposure therapy is an extremely beneficial practice for many people suffering from phobias or anxieties. If you are struggling with any of the conditions mentioned in this article, the first step is to talk with a counselor or therapist. They can help you figure out if exposure therapy is the right choice for you.