What Is Exposure Therapy and What To Expect

Exposure therapy is a useful treatment modality that can help people learn how to overcome their fears and tolerate discomfort.

When faced with fear, our natural tendency is to retreat from it. From the time we are young children, we learn to avoid unpleasant experiences if possible. This 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 want. In these cases, exposure therapy can be a useful and practical treatment approach. Prolonged exposure therapy can be helpful for complex or particularly challenging situations.

What Is Exposure Therapy?

It may seem counterintuitive to move toward feared stimuli, but that is just what exposure therapy offers. Exposure therapy for anxiety is an approach to reduce anxiety symptoms by slowly exposing patients to feared stimuli. Exposure therapy 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 facing a 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 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 uses physical cues that are part of a fear reaction. Using physical cues during a therapy session can 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 key components of exposure therapy include:

• Graded Exposure
• What is graded exposure? Graded exposure therapy sets up a hierarchy of steps from least-feared to most-feared stimuli. Using graded exposure is helpful as one plans a course of action for treatment.
• Flooding
• Flooding psychology is the idea that managing difficult feelings and revisiting distressing thoughts is a healing method. Flooding therapy involves revisiting these thoughts and emotions in session so that the therapist can help the patient navigate strong feelings and explore coping strategies. Exposure therapy and flooding can feel risky, but the benefits are vast.
• Systematic Desensitization
• What is systematic desensitization? This important step in 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 systematically and gradually. Prolonged exposure therapy for PTSD is a safe way to help patients 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 many mental health conditions, including:

• OCD: Imaginal exposure and OCD can help reduce symptoms significantly. Exposure and response prevention for OCD helps learn how to end urges to behave in obsessive or compulsive ways when distressed.
• PTSD: Exposure therapy for PTSD can seem distressing, but facing feared stimuli is often the key to healing from the trauma. 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 life-changing because the feared social situation is faced with careful planning. Gradual exposure therapy for social anxiety is used in cases where it is necessary to work toward each step slowly, gradually increasing in intensity as tolerance is built.

Effectiveness of Exposure Therapy

Those beginning treatment may wonder how effective exposure therapy is. 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 patient work collaboratively and plan for the course of treatment for optimal success.

Benefits

The effectiveness of exposure therapy is based on the multiple benefits that it provides. Completing exposure therapy treatment has 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

Risks

Exposure therapy is a low-risk treatment modality. The planned nature of exposure therapy ensures that both the therapist and patient are prepared for each step of treatment. Part of the preparation for exposure therapy is establishing grounding techniques and coping skills.

How Exposure Therapy Works

Does exposure therapy work? Yes, exposure therapy is an evidence-based treatment that effectively manages anxiety and distress in several situations. Those who have heard of it may wonder how exposure therapy works. While moving toward a fear and exposing oneself to the feared stimuli may seem counterintuitive, 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 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 helpful approach.

Exposure Therapy Examples

Examples of exposure therapy can be found for many 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 many needs and is an effective treatment method.

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 exposure therapy treatment plan involves increasing distress tolerance, desensitizing the emotional response and improving overall functioning.
• Exposure therapy methods can be used for many 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. Evidence-based care is available if you or a loved one is struggling with substance use or co-occurring mental health disorder. Call The Recovery Village at Baptist Health today for more information.

Frequently Asked Questions

What does exposure therapy do for PTSD?

Exposure therapy in the form of prolonged exposure is commonly used to treat PTSD. Prolonged exposure teaches someone with PTSD to gradually and continuously approach feelings, memories and emotions related to their trauma. When someone continues to explore feelings associated with their trauma, it can help reduce the severity of the emotional reaction to the trauma.

What is the most common type of exposure therapy?

The type of exposure therapy used will differ for each person. A therapist can determine which exposure therapy technique will work best for you. 

These include:

• In vivo experience
• Imaginal exposure 
• Interoceptive exposure

When is exposure therapy not recommended?

Exposure therapy is not recommended for someone with certain comorbidities due to worsening those conditions. These can include:

• Borderline personality disorder
• Dissociation 
• Psychosis
• Suicidal behavior or ideation
• Substance use disorder
• Major Depression

How long does the treatment last, and how often should I go to therapy sessions?

Exposure therapy treatment typically lasts approximately 90 minutes per session and should occur over an 8–15-week period or approximately three months. 

Is there any science behind it?

Yes, scientific studies have proven the effects of exposure therapy as a trauma-focused psychotherapy technique. Repeated exposure to emotions, feelings and memories of a fear-based scenario reduces their impact over time with exposure therapy.