What Is Exposure Therapy And What Are The Benefits?
Have you been experiencing a specific phobia and wondering whether exposure therapy can help? If so, you’re not alone. According to Johns Hopkins Medicine, approximately 19 million people in the US experience one or more phobias. Exposure therapy is one type of treatment that often works for phobias, as well as for various anxiety disorders.
What Is Exposure Therapy?
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 to help people overcome their fears. By avoiding fear, a person can make the negative feelings associated with it grow more intense. Exposure therapy encourages people to confront these fears with support from their therapist so that the things they fear can become more normalized. The goal of exposure therapy is for the person to no longer avoid or respond negatively to their feared situations or things.
Exposure Therapy And Cognitive Behavioral Therapy
One of the most well-known types of behavioral therapy is cognitive-behavioral therapy (CBT). CBT is widely used to treat anxiety, phobias, PTSD, and substance use 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 how the person thinks and feels about the thing that is causing them anxiety and fear. In many cases, 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 aims to change a person's beliefs about a certain situation so that they no longer associate negative feelings with it. This can help them 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 they fear to the point where they realize they can handle it. Within this broad concept of exposure therapy, a therapist may implement a few different strategies.
Exposure Therapy Strategies
In Vivo Exposure: In vivo exposure therapy is the process by which a person directly faces whatever it is they fear. For example, someone with a phobia of dogs might be instructed to pet a dog. In vivo exposure may follow the "flooding" model, in which a person is immediately presented with the thing they fear; or "systematic desensitization," in which they gradually build up to directly facing their fears.
Imaginal Exposure: Imaginal exposure is a mental exercise. The person imagines the thing that they fear and imagines 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 can be particularly useful for people with PTSD, as they are often 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 tends to focus on the physiological aspects of fear and anxiety. It is a way for someone to experience the symptoms they feel when confronted with their fear to learn to experience the symptoms without invoking the fear response. For example, someone may do jumping jacks to get their heart rate up to become comfortable with an increased heart rate and not automatically associate it with fear. Interoceptive exposure can be particularly useful for people with panic disorder.
Virtual Reality Exposure: Technology has improved mental health care 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 can be an effective way to ease into in vivo exposure. It may also help in situations where 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 pace, and for many people, it’s the most logical way to go about exposure therapy. The therapist works with the individual to develop a "fear hierarchy." The person ranks their feared objects or situations in order of severity. The therapist then has them confront a thing or situation low on the list that causes them distress. The tasks build in difficulty for the person until they do things that they would never have thought possible due to their anxieties and fears.
Flooding:Flooding is a more direct form of exposure therapy. The person still creates a fear hierarchy, but rather than starting at the bottom of the list, they may begin with the most feared item. This can be an effective method for people who feel ready and motivated to overcome their fears as soon as possible. However, flooding may be too intense for many people. A therapist may be able to help you determine if it’s right for you.
Systematic Desensitization: In systematic desensitization, exposure is often combined with relaxing exercises to help make the exposure more manageable. It teaches the patient to associate the things they fear with relaxing exercises, mitigating the fear response when they are 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 and phobias. Exposure therapy can be 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’s common for people to experience increased heart rate or a stomach ache when confronted with something that causes them even mild fear or anxiety. However, people with panic disorder often grow to fear these symptoms, and thus they become more intense. This can lead people with panic disorder to avoid situations that may cause this fear.
Exposure therapy may help people with panic disorder become more comfortable with the physical sensations of fear. The goal is for them to become comfortable enough with these symptoms that they do not develop a full panic attack. This may help them to 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 can cause significant distress.
Exposure therapy for social anxiety disorder tends to involve facing social situations that they fear and ultimately remaining in those situations until the fear subsides. In the long run, it can show them that social situations don’t need to be feared.
Phobias: Exposure therapy for phobias is typically carried out by systematic desensitization. The person usually slowly becomes more comfortable with the object of their phobia by associating the feared object with relaxation. This approach usually involves a controlled exposure, in which the person is in a comfortable, safe environment and has the counselor's support.
Obsessive-Compulsive Disorder (OCD): Often, the obsessions and compulsions that characterize OCD are based on irrational, or exaggerated, fear of germs. If someone with OCD based on a fear of germs is forced to touch a doorknob, they may become overwhelmed with thoughts of the germs and proceed to wash their hands repetitively.
Exposure therapy for OCD tends to be two-pronged. It both exposes the person to a trigger for their obsessions and compulsions and helps them practice response prevention. In the example given above, the person would likely be exposed to germs in a normal, daily situation (like touching a doorknob) and try not to wash 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 tend to linger and lead 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. Also, they may avoid certain places or situations that remind them of the initial event. Both of these things can cause significant stress and interfere with their daily life.
Exposure therapy for PTSD is usually conducted as prolonged exposure therapy (PET). PET is based on the associative learning theory and is conducted one-on-one between the client and 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 smoke may cause them anxiety now. During PET, the person will likely be exposed to the smell of smoke and dissociate the smell from their trauma so that the smell no longer causes them distress. Ultimately, someone undergoing PET may 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 tends to help 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 can also boost confidence, especially when fear has affected their ability to live 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:
Extinction: This weakens associations between the feared item or situation and the physical bodily response. The association that caused the person anxiety or stress may cease to exist after sufficient exposure.
Habituation: Habituation is the idea that after repeated exposure, a person’s response to stimuli is 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 to confidence and empowerment. Exposure therapy may show a person that they are stronger than their fears. Thus, the feelings of anxiety or stress surrounding the fear may be significantly reduced. Self-efficacy can also give the person confidence that they can manage their anxiety and do not need to avoid their fears.
Emotional Processing: The experience of exposure can serve as an opportunity for the person to understand their fear and emotions better overall. Ideally, they learn to view their fears more realistically and become more comfortable with moderate, normal feelings of fear and anxiety.
Try Exposure Therapy
If you are experiencing a phobia but are nervous about going to a therapist’s office, you might try online therapy, which research has shown to be just as effective as in-person therapy. With an online therapy platform like Regain, you can talk to a therapist about the different forms of exposure therapy to see which is right for you. You can engage in therapy via phone or video chat from the comfort of your own home, which may be especially useful if you have a phobia that makes it challenging to leave home. You can also contact your therapist in between sessions via in-app messaging if you have questions or concerns, and they’ll get back to you as soon as they can.
If you are experiencing anxiety, fear, or a specific phobia, you don’t have to face it alone. With Regain, you can be matched with a therapist with training and experience in exposure therapy. They can help you figure out if exposure therapy is the right option for what you’re experiencing. Take the first step to freedom from fear and reach out to Regain.
Frequently Asked Questions (FAQs):
What Happens During Exposure Therapy?
Exposure therapy is a form of cognitive-behavioral therapy that can be beneficial for helping an individual face their fears. Avoiding a feared object or situation can exacerbate feelings of anxiety in the long run. During exposure therapy, a mental health professional provides a safe environment for an individual to confront feared objects/situations gradually.
The American Psychological Association states that exposure therapy has effectively treated various anxiety disorders, such as obsessive-compulsive disorder, phobias, panic disorder, social anxiety disorder, post-traumatic stress disorder, and generalized anxiety disorder.
How Long Does It Take For Exposure Therapy To Work?
The time it takes to see the effects of exposure therapy can vary from a few weeks to a couple of months. It is common for the first exposure therapy sessions to trigger anxiety, as an individual is acclimating to facing their fear instead of avoiding it. Over time, the individuals learns to tolerate discomfort, their anxiety around the object/situation generally decreases. Research has shown that exposure therapy is effective at treating many types of anxiety disorders.
What Is Exposure Therapy Good For?
Exposure therapy (a form of cognitive-behavioral therapy) can be an effective treatment for various anxiety disorders, such as obsessive-compulsive disorder, phobias, panic disorder, social anxiety disorder, post-traumatic stress disorder, and generalized anxiety disorder. Research has found that 65-90% of people reported a significant decrease in anxiety symptoms following exposure therapy.
Is Exposure Therapy A Form Of CBT?
Yes, exposure therapy is a form of cognitive-behavioral therapy. It is a behavior therapy that aims to decrease fear and anxiety by gradually exposing an individual to their feared object/situation. Studies have found exposure therapy to be an effective way to decrease anxiety symptoms and improve quality of life for individuals living with anxiety disorders.
What Is An Example Of Exposure Therapy?
An example of exposure therapy is an individual with social anxiety disorder being instructed to give a speech in front of an audience. Confronting their fears of public speaking may allow them to see that embarrassment or judgment from others is unlikely, and if it does happen, they can manage it. Exposure is often tailored to an individual’s specific needs, which makes this an effective treatment for many individuals living with anxiety disorders.
What Are Exposure Techniques?
An article published by the American Psychological Association discusses various exposure therapy strategies, including in vivo exposure, imaginal exposure, and virtual reality exposure.
In vivo exposure refers to an individual directly facing their feared object/situation in real life. For example, an individual with a specific phobia of dogs may see a dog from afar and then gradually work toward petting the dog.
Imaginal exposure involves asking an individual to imagine and describe a feared object/situation.
Virtual reality exposure may be used to simulate a specific environment during therapy. Studies have found that virtual reality tends to be more accepted among patients as a controlled way to do exposure therapy that seems less intimidating than in vivo or imaginal exposure.
Another technique in exposure therapy is called graded exposure, in which an individual ranks tasks according to their level of fear. Using graded exposure, an individual starts with less difficult exposures and then gradually moves toward more difficult ones that evoke more fear.
What Are The Eight Phases Of EMDR?
According to the EMDR International Association, the eight stages of EMDR are history and treatment planning, preparation, assessment, desensitization, installation, body scan, closure, and reevaluation. Studies have revealed that EMDR is an effective treatment for treating anxiety disorders such as post-traumatic stress disorder and panic disorder.
How Do You Do Interoceptive Exposure?
Interoceptive exposure is a technique that tends to focus on exposing an individual to a feared physical sensation that they may avoid out of fear. For example, an individual may be asked to perform a task (such as running in place) that causes a rapid heartbeat. Evoking this physical sensation in a safe space may help the individual learn that this feeling doesn’t necessarily mean they are in danger.
Is Exposure Therapy Harmful?
Although it may be uncomfortable, exposure therapy tends to be a safe and effective treatment for anxiety disorders. An individual is usually not thrust into their most feared scenario immediately. Graded exposure is a technique that allows an individual to start with exposures that are the least anxiety-producing and gradually work toward more difficult exposures. Exposure therapy can be uncomfortable and difficult, particularly at first. Still, by learning to tolerate the discomfort, an individual may experience decreased anxiety and increased quality of life in the long run.
How Much Does Exposure Therapy Cost?
A session with a psychotherapist is typically around $100 per session. However, rates often vary depending on the location and expertise of the therapist. You can also try online therapy services, such as ReGain, which costs between $60 and $90 per week.
Can Exposure Therapy Make Anxiety Worse?
It is likely for an individual to experience increased anxiety during exposure therapy, particularly during the first several sessions. However, the goal is that by breaking the cycle of avoidance and intense fear, an individual will learn that they can face their fear, which can decrease distress in the long term.
What Is The Difference Between Exposure Therapy And Prolonged Exposure Therapy?
The American Psychological Association describes prolonged exposure (PE) as a type of cognitive-behavioral therapy that focuses on helping individuals confront memories and feelings related to past trauma. Prolonged exposure can be especially effective for individuals living with post-traumatic stress disorder.
As described above, exposure therapy is used to treat various fears, phobias, and anxiety disorders.
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