When faced with something we fear, our natural tendency is to retreat from it. From the time we are young children, we learn to avoid unpleasant experiences if possible. In a sense, this learning is a practical survival skill that keeps us out of harm’s way. Sometimes, fear and avoidance are unnecessary responses that can interfere with our ability to live the life we would otherwise choose. In these cases, exposure therapy can be a useful and practical treatment approach. Prolonged exposure therapy can be helpful for situations that are complex or particularly challenging.
What Is Exposure Therapy?
It may seem counterintuitive to move toward feared stimuli, but that is precisely what exposure therapy offers. Exposure therapy for anxiety is an approach for the reduction of anxiety symptoms that gradually exposes clients to feared stimuli. The purpose of exposure therapy is twofold: It allows for increased tolerance of the difficult feelings associated with the fear and decreases the level of distress associated with that fear through repetition and reassurance of safety and familiarity.
Types of Exposure Therapy
There are several types of exposure therapy, depending on the needs and goals for treatment:
- In Vivo Exposure: In vivo exposure is the act of facing feared situation by directly confronting and engaging with it. In vivo exposure therapy for post-traumatic stress disorder (PTSD) is a way to work through difficult emotions and reactions related to trauma, such as visiting the site of a traumatic car accident.
- Imaginal Exposure: Imaginal exposure to stimuli can be used in the therapy office as a way to face the feelings associated with feared stimuli. Revisiting the fears and imagining the experience is necessary for healing. Imaginal exposure therapy can help reduce symptoms of distress related to traumatic events in the safety of the therapy setting.
- Interoceptive Exposure: Interoceptive exposure is the use of physical cues that are part of a fear reaction. By using these physical cues during a therapy session, the purpose is to recreate the bodily responses that occur during periods of intense anxiety to build tolerance of the feelings and learn alternative ways to respond to them.
Administration of Exposure Therapy
Exposure therapy is a helpful way to heal from anxiety related to phobias and feared situations, and it is done with thoughtful planning and intent.
Some of the key components of exposure therapy include:
- Graded Exposure
What is graded exposure? Graded exposure therapy is the act of setting up a hierarchy of steps from least-feared to most-feared stimuli. The use of graded exposure is helpful as one plans a course of action for treatment.
Flooding psychology is based on the idea that managing difficult feelings and revisiting distressing thoughts is a method of healing. Flooding therapy involves revisiting these thoughts and emotions in session so that the therapist can help the client navigate strong feelings and explore coping strategies. Exposure therapy and flooding can feel like a risky technique, but the benefits are vast.
- Systematic Desensitization
What is systematic desensitization? This important step in the process of exposure therapy is related to gradually improving one’s tolerance of distressing feelings.
- Prolonged exposure (PE)
What is prolonged exposure therapy? It is the gradual approach to exposure to feared stimuli, first by imaginal techniques and then in vivo exposure. Prolonged exposure therapy helps people work through fears in a systematic and gradual way. Prolonged exposure therapy for PTSD is a safe way to help clients cope with trauma and reduces the chance of retraumatization.
- Exposure and Response Prevention (ERP)
Exposure and response prevention therapy is a method that reconnects people with their sense of control around a feared situation by controlling the impulse to respond. Exposure and response prevention is particularly helpful for people with obsessive-compulsive disorder (OCD), as it reestablishes one’s ability to learn how to maintain control over an impulse in the face of distress.
Who Benefits from Exposure Therapy
Exposure therapy can be a useful treatment for a number of mental health conditions, including:
- OCD: Imaginal exposure and OCD can help reduce OCD symptoms significantly. Exposure and response prevention for OCD is helpful in learning how to quell urges to behave in obsessive or compulsive ways when distressed.
- PTSD: Exposure therapy for PTSD can seem like a distressing idea, but in reality, facing feared stimuli is often the key to healing from the trauma. The use of prolonged exposure therapy for PTSD is a gradual method for reducing distress connected with a traumatic event.
- Anxiety: Exposure therapy for anxiety is a practical method for improving one’s ability to sit with and build tolerance to distress. Exposure therapy for social anxiety can be a life-changing intervention in which the feared social situation is faced with careful planning. Gradual exposure therapy for social anxiety is used in situations in which it is necessary to work toward each step in a slowly, gradually increasing in intensity as tolerance is built.
Effectiveness of Exposure Therapy
Those beginning treatment may wonder how effective is exposure therapy. The effectiveness of exposure therapy is clear; the treatment is an evidence-based treatment modality for several mental health conditions. Like with any other treatment modality, it is important that a provider and client work collaboratively and plan for the course of treatment for optimal success.
Exposure therapy effectiveness is based on the multiple benefits that it provides. When someone has successfully completed exposure therapy treatment, there are many positive outcomes, including:
- Reduced sensitivity to previously distressing situations
- Decreased fear of associations with the stimuli
- Increased ability to tolerate fear
- Recognizing one’s power to overcome challenges
- Reduced anxiety
- Improved functioning
- Improved social skills
- Improved mental stability
Exposure therapy is a low-risk treatment modality. The planned nature of exposure therapy ensures that both the therapist and client are prepared for each step of treatment. Part of the preparation for exposure therapy is the establishment of grounding techniques and coping skills.
How Exposure Therapy Works
Does exposure therapy work? Yes, exposure therapy is an evidence-based treatment that is effective in managing anxiety and distress in a number of situations. Those who have heard of it may wonder how exposure therapy works. While it may seem counterintuitive to move toward a fear and expose oneself to the feared stimuli, those methods are exactly why exposure therapy works.
Exposure Therapy in Substance Abuse Treatment
Does exposure therapy work for those in substance abuse treatment? Yes, people with substance use disorder can benefit from the use of exposure therapy, particularly if substance use is a reaction to anxiety or distress. How does exposure therapy work for those with substance use disorder? Part of the work of substance abuse treatment involves examining triggers for substance use. Often, substance use becomes a method of self-soothing for those who have experienced trauma or severe anxiety. By learning to manage the distress of exposure without resorting to substances, this type of treatment can be a practical and useful approach.
Exposure Therapy Examples
Examples of exposure therapy can be found for a multitude of treatment needs. Examples of exposure therapy for social anxiety might involve practicing skills in low-risk settings and gradually expanding to more feared situations to build tolerance for the distress of socialization. OCD exposure therapy examples could involve identifying triggers for ritualized behaviors and learning to tolerate these distressing feelings without responding. Exposure therapy is beneficial for a variety of needs and is an effective treatment modality.
Key Points: Understanding Exposure Therapy & Your Recovery
- Exposure therapy and prolonged exposure therapy are evidence-based treatment modalities used to help reduce the impact of distress related to fear and anxiety
- The steps involved in exposure therapy treatment plan for increasing tolerance for the distress, desensitizing the emotional response and improving overall functioning
- Exposure therapy methods can be used for a number of challenges including phobias, PTSD, substance use disorder and anxiety
Addiction and mental health challenges can be difficult, but you don’t have to face them alone. If you or a loved is living with a substance use or co-occurring mental health disorder, evidence-based care is available. Call The Recovery Village Palm Beach at Baptist Health today for more information.
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APA.org. “What is Exposure Therapy?” Accessed July 21, 2019.
Goodtherapy.org. “Exposure Therapy.” Accessed July 21, 2019.
Kaplan, Johanna; Tolan, David. “Exposure Therapy for Anxiety Disorders.” Psychiatric Times, September 6, 2011. Accessed July 21, 2019.
MayoClinic.org. “Exposure therapy effective for pediatric anxiety and OCD.” Accessed July 21, 2019.