With the guidance of a therapist, a person will face their fears and anxieties in a safe setting, either in their imagination or in a real life scenario.

This article looks at how exposure therapy works, some different types, and what to expect from treatment.



What is exposure therapy?



Exposure therapy may help a person manage symptoms of social anxiety disorder.

Exposure therapy is a type of psychological therapy that can help people overcome their fears or anxiety disorders. It can help reduce feelings of anxiety, distress, or fear that a person may have due to a disorder or previous trauma.

In exposure therapy, a person will have exposure to a situation or stimulus that triggers feelings of fear or panic for them. Over time, controlled exposure to these fears in a safe space can help reduce their feelings of anxiety and distress.

A therapist may use different types of exposure therapy depending on the type of fear or disorder that the person has. For example, the therapist may create a real life scenario for the person to go through, or they may use talking therapy to encourage the person to imagine situations or recall traumatic events.



What can it treat?



Exposure therapy can help treat a variety of fear-based and anxiety disorders, including:

• phobias
• panic disorder
• social anxiety disorder
• post-traumatic stress disorder (PTSD)
• obsessive-compulsive disorder (OCD)
• generalized anxiety disorder
• trauma



Effectiveness

Exposure therapy can be an effective treatment for anxiety disorders. In fact, around 60–90% of people have either no symptoms or very mild symptoms of their original disorder upon completion of their course of exposure therapy.

A 2013 study looked at the effects of prolonged exposure therapy in 1,931 veterans with PTSD. The researchers found that prolonged exposure therapy was effective in reducing chronic PTSD and depression symptoms.

Another 2013 study found that narrative exposure therapy was effective in helping survivors of an earthquake in China. The researchers split 22 adult participants equally into two groups. The first group received narrative exposure therapy straight away, and the second group received treatment 2 weeks later.



Compared with the waiting group, the first group to receive the treatment had a significant reduction in:

• PTSD symptoms
• anxiety
• depression
• mental stress



What to expect



There are several different types of exposure therapy, and treatment will depend on each individual case.

The sections below will look at the types of exposure therapy available and what to expect from each.



In vivo

During in vivo exposure therapy, a person will confront a phobia or situation that causes fear or anxiety in real life.

If a person has a phobia of spiders, for example, they may gradually work toward handling a real spider.



Imaginal

During imaginal exposure therapy, a therapist will instruct a person to imagine in vivid detail the situation or trigger of their fear or anxiety. This can be an effective approach for people dealing with trauma, as it would not be suitable to recreate such events in vivo.

If a person has previous trauma or PTSD, they may recount their experience.



Imagining the source of fear or anxiety in a safe setting, alongside talking therapy, can help reduce feelings of distress.



Virtual reality

Some fears are not practical for a therapist to replicate in vivo. If a person has a fear of flying, for example, a therapist may stimulate the experience of flying using virtual reality technology.



This exposes the person to a realistic and similar experience to help reduce feelings of fear in association with flying, for example.



Interoceptive exposure

Interoceptive exposure therapy focuses on creating physical responses that people associate with panic or distress. For example, if a person has panic disorder, they may associate an increase in heart rate with the feeling of panic or danger.



For example, the therapist may instruct a person to run on the spot, in a safe setting, to create similar physical sensations without any sense of danger.



The therapist may also work with a client to establish a hierarchy of their fears or anxieties. This means placing scenarios in order of which the person finds the most challenging.



The therapist may then decide to expose the person to their smallest or biggest fear first. They may refer to these two approaches as graded exposure and flooding.



Graded exposure means that people face their least daunting fears first, before gradually building up to more challenging situations with time. This can help people build the confidence they need to overcome a bigger fear.



For example, if a person has a fear of snakes, they may first begin by looking at pictures of snakes. This may then progress to having a snake in the room behind glass, and eventually to holding the snake.



Flooding means that people begin with exposure to the most challenging fear first. This may then help them face lesser fears more easily.

People may require just one or two sessions to resolve an issue, or they may need a longer course of ongoing therapy sessions.



Prolonged exposure therapy

Prolonged exposure therapy provides repeated exposure and involves:



• education about the symptoms and how prolonged exposure therapy can help
• learning breathing techniques to help control feelings of distress
• in vivo exposure to scenarios that may trigger fear and anxiety — for example, a soldier with previous trauma of roadside bombing may begin driving to overcome the fear
• talking therapy, during which people recall traumatic experiences with a therapist to help them make sense of the events and reduce negative thoughts
• 
  

Prolonged exposure therapy may be helpful for people with PTSD and other responses to trauma. The gradual pace of prolonged exposure therapy can help people overcome their fears and anxieties with time.



Treatment can vary depending on an individual’s circumstances. For example, some people may meet one-to-one with a therapist for around 90 minutes for a course of eight to 15 sessions.

Who offers this therapy?



Psychiatrists, psychologists, and therapists may provide exposure therapy. A psychiatrist is a medical doctor with additional training in psychiatry.

A psychologist will have training to a master’s or doctorate level. Choosing a board-certified health professional ensures that they have been through a suitable level of training and examination.



People can look for a health professional who has expertise and experience in carrying out exposure therapy.



To find a qualified therapist, a person can check to see if a particular health professional is a member of a recognized organization, such as the International OCD Foundation or the Association of Behavioral and Cognitive Therapists.

It is important for people to find a trained professional to carry out exposure therapy. Improperly administered exposure therapy may cause further trauma, fear, or anxiety.



Vs. systematic desensitization



Systematic desensitization is a similar type of behavior therapy to exposure therapy. It includes relaxation alongside exposure to a stimulus that causes distress or anxiety.



Systematic desensitization follows the same gradual process of graded exposure therapy, and it works in the following stages:



• A therapist will train the person in how to relax their body through deep muscle relaxation.
• The person will order their fears or anxieties from weakest to strongest, to create a hierarchy.
• The person will then face their fears, starting with the weakest, either in their imagination or in a real life scenario.
• While the person is undergoing exposure to their fears, they will practice the muscle relaxation technique they have learned.



The muscle relaxation prevents a response of anxiety, so people slowly build up resilience to the stimulus and respond in a less anxious way.

Relaxation techniques may not be suitable for all types of exposure therapy.



Summary



Exposure therapy can be an effective treatment option for a range of phobias and anxiety disorders, including PTSD, OCD, and panic disorder.



People will work alongside a therapist to face their fears or anxiety triggers. A therapist may stimulate their fears through imagination or create a scenario in real life for the person to face.



Systematic desensitization is a similar approach, but it uses muscle relaxation alongside exposure to reduce physical responses of anxiety.



People wanting to try exposure therapy should seek a psychologist or therapist with the appropriate experience and expertise.