Understanding Exposure Therapy: A Path to Overcoming Anxiety and Phobias
Table of content:
What is Exposure Therapy?
Exposure therapy is a common practice utilized by mental health professionals who practice Cognitive Behavioral Therapy (CBT). Exposure therapy is meant to allow clients to engage with the source of their phobias or anxieties in a controlled, safe environment as a way to practice stress management techniques. This will help clients decrease avoidant behaviors, as avoidance is only able to be a short-term solution. This type of therapy is meant to help clients improve their self-image as they progress with regard to treatment goals. Exposure therapy is commonly used to help clients work through PTSD, OCD, panic disorder, social anxiety disorder, or other specific phobias.
How Exposure Therapy Works
Many people feel apprehensive about exposure therapy at first. It is natural to want to avoid the things that feel stressful, overwhelming, and scary. However, many therapists engage in gradual exposure therapy. In this model, a therapist will often work with the client to identify a range of stressors surrounding the stimuli that are triggering for the client. For example, a client who engages in therapy to address a fear of spiders may identify holding a spider as their maximum fear. In this case, let’s refer to this as Level 100. Sitting across the room from a spider in a clear, secure enclosure may be closer to Level 60 of engaging with this fear. Watching an informative documentary about spiders may be Level 20. Holding a small, plastic replica of a spider may be Level 5, and so on. The therapist and client would then have a clear guideline to help them engage in gradual exposures, both in and out of session. The therapist will take on the role of guiding the client through the exposure in a controlled, safe environment to help manage distress and decrease avoidance.
Types of Exposure Therapy
In Vivo Exposure
In vivo exposure refers to real-life exposure instances. For example, for someone dealing with Obsessive Compulsive Disorder (OCD) that causes them to compulsively wash their hands, in vivo exposure may look like going to a new place that does not have an accessible sink to help mitigate the urge to wash hands. Alternatively, this could involve someone with a fear of flying in an airplane and engaging in that fear by traveling by plane.
Imaginal Exposure
This type of exposure involves visualizing the feared object or situation. This may include some guided imagery of the client engaging with their fear while maintaining a calm, regulated demeanor. This could be a good resource for clients to build up confidence, as our brains often struggle to differentiate between real and imagined scenarios. Guided imagery is frequently used among athletes who have fears about “choking” in a competition. In this instance, a therapist may encourage them to imagine “choking,” and then imagine recovering from this swiftly. Alternatively, the guided imagery may remove the idea of “choking” altogether, asking the client to imagine themself engaging in their sport with incredible success.
Interoceptive Exposure
This model of exposure therapy asks clients to induce physical sensations related to fear, such as increased heart rate, difficulty breathing, or muscle tension. Then, the therapist can provide guidance to help their client work through these symptoms, increasing the client’s confidence in their ability to manage these symptoms successfully on their own. This is particularly common with clients who are treating panic disorder, which often includes frequent panic attacks and the fear of panic attacks recurring. Interoceptive exposure helps clients practice their ability to manage panic attacks when they do occur.
Benefits of Exposure Therapy
According to the American Psychological Association, exposure therapy is helpful because it introduces the opportunity for habituation, wherein increased exposures help mitigate the effect of the exposure over time. For example, if you were working through social phobia and part of your exposure included one short conversation with a stranger every day, eventually this event would stop feeling stressful. Additionally, successful exposures increase feelings of self-efficacy, or one’s assessment of their own ability to engage with one's fears. Finally, the American Psychological Association recognizes that exposure therapy allows someone to process their emotions (fear, terror, discomfort, etc.) in a controlled and supportive environment. Once those emotions have been processed, they may feel less overbearing in the future.
Challenges and Misconceptions
There are a lot of significant, valid fears surrounding exposure therapy. Many people feel that exposure therapy would be too difficult for them due to the extent of their fears. However, it is important to remember that people who are impacted by their phobias, anxieties, or compulsions on a daily basis are exactly the kind of people exposure therapy is designed to help support. This is why it is especially important to remain patient with yourself as you engage with this type of therapy.
Success Story
I was able to speak with someone who found incredible success from exposure therapy. This individual was raised by a parent who struggled with Substance Use Disorder (SUD). Luckily, this person’s parent got the support they needed in order to maintain sobriety for the majority of this person’s childhood. However, fears surrounding substance use were not easily forgotten. In high school, this person began engaging in exposure therapy surrounding substances. These exposures were gradual and took place over multiple years. Initially, exposures included listening to peers talk about recreational substance use and gaining factual information about substance use via documentaries. At the time this person began seeking treatment, they were deeply disturbed when substances were mentioned. This often looked like experiencing full-body trembling, strong avoidance of those topics, and a rapid heart rate. Now, this individual is able to calmly engage in scenarios where substances are present. The exposures prepared them to engage in the world without unmanageable distress, leading to increased self-confidence, strong relationships, and overall higher levels of daily joy.
Tips for Starting Exposure Therapy
Setting Realistic Goals and Expectations
Before beginning exposure therapy, it is important to know what you’re hoping to achieve through this work. It may be helpful to have an idea of the kinds of exposures you’d feel comfortable trying right away, as well as some exposures you’re hoping to work up to. This can help you see your progress over time.
Additionally, you should remember that exposures are difficult, mentally and emotionally. It’s important to have a solid support system around you. It may also be helpful to schedule some downtime after your therapy sessions so you have time to process and recover from the work of exposure therapy.
Finding a Qualified Therapist
It is very important to find a therapist you trust, regardless of the type of therapy you’re pursuing. Your ability to connect with your therapist will have an impact on your treatment. You should think about the kinds of things that will help you feel comfortable and safe while engaging in exposure therapy. For example, you may want to ask your therapist about their experience with exposure therapy, how they may blend multiple therapeutic perspectives, and their expectations of you as a client. These kinds of questions will help you gain a clear idea of the person you’re working with.
Conclusion
Exposure therapy is a highly effective treatment option. According to Cleveland Clinic, exposure therapy has a 90% success rate for people who complete the full treatment. If you notice that your daily life is heavily impacted by things like OCD, anxiety, phobias, or PTSD, exposure therapy could be especially valuable to you.
Trust Mental Health offers exposure therapy in California. Our therapists are trained to support you through these challenges and are prepared to meet you with compassion and care. Book a free fifteen-minute consultation today.
Key Points
Exposure therapy, a common practice within Cognitive Behavioral Therapy (CBT), helps clients confront their fears and anxieties in a controlled, safe environment. This therapy aims to reduce avoidant behaviors and improve self-efficacy by gradually exposing clients to the sources of their fears.
The blog describes different types of exposure therapy, including in vivo exposure (real-life scenarios), imaginal exposure (visualization), and interoceptive exposure (inducing physical sensations related to fear). Each type helps clients gradually confront and manage their fears or anxiety-related symptoms.
Exposure therapy is highly effective, with a reported 90% success rate for those who complete treatment. It allows clients to process emotions in a supportive environment, leading to reduced fear responses and increased self-confidence.
FAQs
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During an exposure therapy session, the therapist will work with you to identify your fears and develop a hierarchy of feared situations, starting with the least anxiety-provoking and gradually progressing to the most feared. You will then be exposed to these situations in a controlled and supportive environment. The therapist will guide you through the process and help you manage your anxiety as you confront your fears.
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It's normal to feel anxious during exposure therapy, as the purpose is to confront your fears. However, your therapist will work with you to develop coping strategies, such as relaxation techniques, to help manage your anxiety. The therapist will also ensure that the exposure is done at a pace that you are comfortable with.
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Yes, exposure therapy is often combined with other treatments, such as cognitive restructuring (a form of cognitive therapy), medication, or other behavioral interventions. Combining treatments can enhance the effectiveness of therapy and help address different aspects of anxiety.