What Is Exposure Therapy And How Does It Work?
For some mental health disorders, putting yourself in front of what you are afraid of can effectively overcome that level of fear and anxiety. Exposure therapy is the way that this is done. Of course, it’s a very intricate process to use exposure therapy, and it won’t work for everyone. The important thing is to talk with a mental health professional who can help you and your therapy process and understand if this therapy type will work for you.
Understanding exposure therapy
In exposure therapy, you don’t jump immediately into a situation that terrifies you. Instead, you gradually introduce yourself to that situation or object. The therapist you work with will discuss precisely what you’re afraid of and then help you develop a process of using exposure therapy to overcome it. Through this process, you’ll slowly be acclimated to the fear, and eventually, if all goes properly, you can overcome that fear.
Where it works
There are several different areas where exposure therapy has been proven to work, with phobias, panic disorder, social anxiety disorder, post-traumatic stress disorder, generalized anxiety disorder, and obsessive-compulsive disorder being some of the most successful. In each of these types of mental health disorders, your therapist will help you understand what frightens you the most and will generally have to create a list of things that scare you that escalate from slight fright up to something you find terrifying.
Your therapist will generally discuss your fears, including what you think would happen if you experienced that fear. What would you do, or what would it mean for you? For example, an intense fear of public situations may be caused by a fear that you will do something silly or not fit in. The therapist will then help you work through these fears and the irrational beliefs or thoughts behind them through regular sessions. They will then introduce different situations and stimuli that mimic being in the situation you are afraid of, slowly changing your thoughts and perceptions.
Types of exposure
In vivo exposure
This type of exposure is about directly facing the object or situation you fear. If you are afraid of large crowds, you would physically go into a large crowd and possibly speak in front of them. You would be attempting the thing that scares you the most by being physically invested in that type of situation, around the object you are afraid of, or even engaging in an activity you are most afraid of.
Imaginary exposure
With imaginary exposure, you aren’t physically in the situation, but you pretend to be. You would, for example, close your eyes and picture that you are there, in that situation or with that object or doing that activity. By going through the situation in your mind, while you are physically in a safe space, you can understand the thoughts and feelings and even experience them while knowing that you can open your eyes and be somewhere that you are comfortable and safe or be right there with your therapist the entire time.
Virtual reality exposure
Virtual reality is another great way to expose yourself to different situations and objects; this is not the same as reality therapy. In this exposure, you’re somewhere between the imaginary and in vivo exposure because you’re in a safe space, but the experience isn’t entirely in your mind. This can help you understand the sights, smells, and situations entirely instead of only what you can picture in your mind. It can help you get a better immersion without really being there, which is one way to start working through different fears with a more concrete appearance.
Interoceptive exposure
With this type of exposure, you bring on the sensations that occur during your fear without actually being around your fear. For example, if you experience a racing heartbeat, you could do something that would increase your heart rate to show you that this is not something you need to be afraid of. This type of therapy is about learning about the symptoms and the side effects to understand how they influence you and how they can change your thought processes better.
Levels of exposure
Graded exposure
With this type of exposure, you’ll create a hierarchy to create low-fear-level situations or objects up to high-level ones and slowly work your way up the list.
Flooding
Here you start with what you fear most in difficult situations to jump-start trying to overcome those fears.
Systematic desensitization
This process teaches you how to relax in situations that cause fear. You’ll likely go through relaxation exercises where you can learn to associate relaxation with the feared situation or object.
Get the help you need
You can overcome your fear with these therapy methods and processes. It takes different amounts of time for everyone, but it is most definitely possible to accomplish.
If you choose to face your fears with online therapy, you can push yourself forward and achieve better success without ever having to leave your home. That’s because the treatment is conducted online, without you having to go to a physical office to talk to someone face to face. Research shows that online therapy is effective, too, with one review of 14 studies finding that it’s just as effective as in-person treatment. If you’re ready to get started, contact an online mental health professional to take the next steps.
FAQs
Is exposure therapy harmful?
Generally, no. The process can be uncomfortable; other treatment options may work better for some patients. However, multiple studies have shown that exposure therapy is highly effective for stress- and anxiety-related disorders, including PTSD and OCD. According to the American Psychological Association, exposure therapy is an excellent treatment option for war veterans and survivors of sexual violence.
The patient can engage with their fear without further trauma, which helps them un-learn any paranoia or phobia. This behavioral therapy may be the most effective treatment option in some patients with PTSD, a condition that impairs normal stress response.
Who created exposure therapy?
The concept of exposure therapy is based on fear extinction, a type of Pavlovian conditioning, which is a crucial idea in psychological science. South African psychologist James G. Taylor was the first to use exposure therapy in a psychiatric setting, drawing up psychiatric Joseph Wolpe’s belief that mental illness stemmed from harmful thought patterns and behaviors. Taylor also developed the idea of exposure and response prevention. These are now all core principles of cognitive-behavioral therapy.
Modern clinical psychology has updated these ideas to include the latest research and cognitive science. There are even virtual reality exposure programs available. Psychology science is always improving to find the best techniques.
How long does it take for exposure therapy to work?
The timelines for exposure therapy vary depending on the condition being treated. According to the American Psychological Association, prolonged exposure, including imaginal and in vivo exposure, is typically effective for treating PTSD over 8 to 15 sessions. Interoceptive exposure, commonly used to treat panic disorders, may be done in less time. The efficacy of exposure therapy depends on the initial process of graded exposure, in which the patient’s fear hierarchy is identified.
What are exposure techniques?
Exposure therapy’s most common techniques include in vivo exposure, in which the patient is asked to face their fear in a real-life situation where nothing bad will happen; imaginal exposure, in which they engage in a hypothetical scenario; and interoceptive exposure, in which they bring on the physical symptoms of their fear without the trigger. Virtual reality exposure is a good option if in vivo exposure is not feasible (e.g., flying on an airplane).
Depending on the condition being treated, these techniques may be followed with response prevention, self-reflection, and mindfulness to help patients unlearn their fear. The efficacy of exposure therapy varies by the individual but can be highly customized to their needs.
How do you do interoceptive exposure?
Interoceptive exposure is a technique in which you create the physiological symptoms of a panic attack, flashback, or compulsion. It is very effective for OCD, hypochondria, and panic disorders. For example, if you fear having a heart attack if you speak in public, you can elevate your heart rate by running in place or jumping jacks. According to psychology science, this teaches you that your body can tolerate stress.
How long should you be in therapy?
Most exposure therapy treatment plans comprise 8 to 15 sessions, generally once or twice per week. However, everyone’s needs are different. You and your therapist should set clear goals for your progress and check in regularly to be sure you stay on track. As a general rule of thumb, the more you participate in your sessions and the more you show up, the faster progress you will make. Remember that the first few sessions can be uncomfortable — stick with it!
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