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What Is Exposure Therapy?

In the world of therapy, there are many different ways to treat the various issues and disorders that a person may experience in their lives. For the most part, there are no right or wrong answers when it comes to treatments but some are definitely much more effective than others. In some cases, the act of talking with a qualified therapist is enough to get someone mentally healthy and can dramatically improve their lives. 

However, for other people, this may not be enough to help them with their problems. One such example is individuals suffering from crippling fears and phobias. Even the mention of the word can upset them emotionally and physically. It is for individuals such as these that exposure therapy was created. 

What Is Exposure Therapy?

Exposure therapy is a psychological treatment that was developed in order to help people to confront their fears. When someone is afraid of something, they naturally will try to avoid whatever it is, whether it’s an object, activity, or situation. 

In the short term, this avoidance can help to reduce feelings of fear but in the long term it may end up causing the fear to become much worse and develop into a mental disorder. It is for these situations that a therapist may recommend an exposure program in order to help the person break this pattern of avoidance and fear. 

This exposure program will rely on the therapist creating a safe environment in which they can expose their client to the thing they fear and want to avoid. By being in a controlled environment that is safe, this exposure to the feared objects, activities, or situations over time can reduce fear and the desire to avoid them. 

Some of the issues and problems that have been scientifically demonstrated to be helped by exposure treatments include: 

  • Generalized anxiety disorder
  • Obsessive-compulsive disorder
  • Panic disorder
  • Phobias
  • Post-traumatic stress disorder
  • Social anxiety disorder
  • Trauma

How Effective Is Exposure Therapy?

One of the most effective treatments for anxiety-related disorders is exposure therapy

In fact, between 60 and 90 percent of people report having very mild or no symptoms at all of their original disorder after completion of their exposure therapy program. 

In 2013 there was a study looking into the effects of prolonged exposure therapy in 1,931 veterans suffering from post-traumatic stress disorder. The research showed that prolonged exposure therapy was effective in reducing both chronic post-traumatic stress disorder symptoms and depression. 

Also in 2013, there was a study that found exposure therapy helpful for survivors of an earthquake in China. The research team split 22 participants into two equal groups of 11. The first group received exposure therapy immediately, while the second group received treatment two weeks afterward. When the two groups were compared, the first group to receive treatment showed a significant reduction in post-traumatic stress disorder symptoms, anxiety, depression, and mental stress. 

The Different Types Of Exposure Therapy 

There are many different types of exposure therapy and treatment will depend upon the specifics of the individual case. The most common types of exposure therapy are one of the following:

  • In vivo exposure: This is directly facing the feared object, situation, or activity in real life. If someone has a crippling fear of spiders then they may be instructed to handle a spider or if someone suffering from social anxiety might be instructed to give a speech in front of a large audience.
    Because this version of exposure therapy takes such a direct approach to breaking a person’s anxiety, it can be very difficult for the person to endure. A person may feel their anxiety increasing every second that they are in the exposed situation, so a therapist must be trained to judge when their patient is at a breaking point and can no longer handle the stress.
    The positive side of this particularly challenging version is that the patient will eventually begin to understand the perceived consequences of their fear is not reasonable. For example, say someone has obsessive-compulsive disorder and must wash their hands five times after using the bathroom. In vivo exposure will only permit them to wash once, and over the course of treatment, they will understand they are not getting sick or dying from only washing once. Therefore the patient will become conditioned to the situation they feared, and it will no longer provoke anxiety.
  • Imaginal exposure: Using their imagination, the patient will vividly imagine their most feared object, situation, or activity. Imaginal exposure is most often used as a sort of warm-up to in vivo exposure as research has shown that in vivo exposure is a more effective treatment than imaginal exposure. However, in vivo is not always an option due to it being impractical or inappropriate.
    If a patient is afraid of dying from a toxic substance or sickness then obviously exposing them to this fear would be unacceptable. Additionally, if the fear stems from previous trauma sustained, then recreation would not be possible either. Someone that is experiencing post-traumatic stress disorder could be asked to recall details and vividly describe their traumatic experience in order to reduce feelings of fear and anxiety.
  • Virtual reality exposure: In cases where in vivo exposure is not a practical option, virtual reality exposure has become a possible alternative. If someone has a fear of flying, for example, instead of spending lots of money flying around the country, they can simply use virtual reality technology to simulate a flight.
    Other examples where virtual reality exposure may be a superior alternative to in vivo exposure would be fears of tight spaces, fears of driving, and fears of heights. In addition, virtual reality exposure has been used to help treat post-traumatic stress disorder in some Vietnam, Iraq, and Afghanistan Wars. The virtual environments would be tailored to those which the person may have encountered such as jungles or deserts and so far have been shown to reduce symptoms experienced by these veterans.
  • Interoceptive exposure: Deliberately bringing on the physical sensations that are feared but also harmless. Similar to in vivo exposure, interoceptive exposure strategically induces the physical symptoms that are associated with a threat or fear and encourages the patient to maintain contact with the sensations.
    For example, when someone experiences fear or panic, then their heart rate will naturally increase. As a result, a person may begin to associate an increase in their heart rate with feelings of danger and panic. So interactive exposure would require them to run in place for 30 seconds or so and increase their heart rate to create similar sensations without the sense of danger. The patient will then be able to understand the difference between their fear and the symptoms that cause it. After being exposed to these symptoms and experiencing them fade away, the patient will begin to reduce their anxiety levels in the event they ever experience them naturally.

The Different Paces of Exposure Therapy

There are a few different paces to exposure therapy that may be used, depending on the fears of someone and how intense they experience the symptoms of anxiety. For some people, their fear may come from a place of not knowing much about or rarely experiencing the object, situation, or activity. For them, they can quickly be introduced. For others, it may take a much slower approach. 

These are some of the different paces of exposure therapy and what they are called:

  • Graded exposure: The therapist will help the client construct an exposure fear and anxiety hierarchy list, in which their most feared objects, activities, or situations are ranked in accordance to difficulty. They will begin with the mild and moderate difficult exposure and slowly progress to the harder ones. 
  • Flooding: This method is basically the opposite of the graded exposure and starts with the hardest tasks first. The idea is that if you can conquer your strongest fears, then the weaker ones will be no problem at all.
  • Systematic desensitization: In extreme cases, exposure can be combined with learning relaxation exercises to make the fear more manageable and to slowly associate the feared objects, activities, or situations with relaxation. By slowly introducing smaller elements of the fears until this new exposure is acclimated and using relaxation techniques along the way, a patient will slowly be able to conquer the entirety of their fear.

The Takeaway

Exposure therapy is a method used by therapists to literally expose the clients to their greatest fears in order to help them reduce the levels of anxiety and stress associated with them. In safe environments where the therapist is in control, they will introduce their clients to their fears and teach them ways of relaxation in order for them to eventually conquer these fears.

Exposure therapy has been proven time and again to be an effective method of treatment for several various disorders and illnesses. By literally confronting their fears, a person will begin to understand that a majority of their fear was irrational. In most cases, the object, activity, or situation they feared the most was harmless. 

While talking to a therapist about your fears can go a long way toward alleviating them, facing them in person, in a controlled environment such as exposure therapy, may remove them forever.

Sources

  1. Exposure Therapy (goodtherapy.org)
  2. Narrative Exposure Therapy (psychologytools.com)
  3. What Exposure Therapy is and What to Expect (medicalnewstoday.com)
  4. What Is Exposure Therapy? (apa.org) 
  5. Anxiety_ExposureTherapyandCBT_FAQ.pdf (ebbp.org)

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