What Is Exposure Therapy?

The various types of exposure therapy can help people manage social phobias as well as post-traumatic stress disorder.

Some people regularly experience the unrelenting grip of a specific fear. These can be simple fears of social situations, certain animals or these fears can stem from traumatic experiences, such as war, abuse or catastrophic events. Exposure therapy can help bring back a sense of normalcy to these people’s lives. The use of exposure therapy has become essential in addressing anxiety-related conditions.

What Is Exposure Therapy?

Pop culture can poke fun at common fears — television shows and films with snakes, planes, sharks and tornadoes have all had particular popularity. For individuals who have true phobias, however, their fears are no laughing matter. Phobias can cause immense distress in people’s lives, and exposure therapy can help individuals to overcome them. But exactly what is exposure therapy?

One exposure therapy definition describes it as a type of behavioral therapy that helps people manage their fears by controlling them. In a safe environment, patients are gradually exposed to what they claim to fear. The primary goal of exposure therapy is to create safety so that fears can be meaningfully acknowledged and managed.

History and Development

The history of exposure therapy is complex, due to its roots in classical conditioning.  In the late 1800s, Ivan Pavlov created the basis of exposure therapy with his classical conditioning experiments. He found that he could train dogs to salivate when a bell was rung, even if they weren’t rewarded afterward. Starting in the 1920s, Mary Cover Jones and other behaviorists began to understand that behavioral responses could not only become “learned,” but also “unlearned.”

In the 1950s, a treatment strategy called systematic desensitization deliberately exposed people to their fears, which helped reduce sensitivity. In the 1970s, treatments for obsessive-compulsive disorder used exposure therapy in a new way. These treatments allowed patients to be exposed to obsessive thoughts but stopped them from acting out the anxiety-relieving compulsive behavior. Now, exposure therapy, desensitization and “unlearning” are used to treat many anxiety disorders.

How Exposure Therapy Works

How does exposure therapy work, and how does exposing someone to their fears help them heal?

First, it must be conducted by an experienced, licensed therapist with training in exposure therapy. The therapist can explain the steps of the exposure and give their client the opportunity to decide if they want to use this form of treatment.

Before the exposure, the therapist must train the client in coping techniques, such as mindfulness, guided imagery, meditation, rhythmic breathing and relaxation techniques. This process can take several weeks, but it is an important step. Clients may be re-traumatized by exposure to the fear-inducing situation if they haven’t learned how to properly manage their feelings.

Over a number of sessions, the therapist will carefully help the client visualize the trauma and talk about it. The therapist can monitor the client for signs of distress and help them use coping strategies as the exposure takes place.

Types of Exposure Therapy

There are many types of exposure therapy that are used in different situations.

• In vivo exposure therapy utilizes real-life situations or objects to confront their fears. For example, a person with a fear of dogs might be exposed to a trained therapy dog.
• Imaginal exposure therapy asks clients to address their fears by imagining a fearful situation. This allows them to have more control over the situation in their mind. A person with a fear of public speaking might be asked to imagine giving a brief presentation.
• Virtual reality exposure therapy exposes people to things that might appear real but are only simulations. For example, someone with a fear of flying may be able to use a virtual reality simulation of a flight.
• Interoceptive exposure therapy uses exercises to recreate undesired physical sensations in a controlled setting. This safely helps remove a client’s conditioned, expected response. For example, a person who fears vomiting may be asked to recreate the sensation of vomiting.
• Graded exposure therapy asks a client to rank the aspects of a fearful situation that cause the most discomfort. Then, they are gradually exposed to those aspects, starting from the least discomforting to the most.
• Flooding is long-term exposure to the anxiety-provoking event, object or situation. Since anxiety eventually diminishes, flooding is performed until anxiety is reduced. Flooding is also typically used in vivo and imaginal exposure therapy.
• Prolonged exposure therapy is similar to flooding and involves long-term exposure to the anxiety-inducing situation. Before, during and after the exposure, the client is encouraged to process what they are thinking and feeling with the therapist.

Benefits of Exposure Therapy

Though exposure therapy can be difficult, its benefits can be life-changing. Patients often gain:

• Ability to directly confront fearful situations that have caused distress
• New insight into how their body reacts to specific things (or their thoughts and expectations of these things)
• Control over distressing and overwhelming situations
• Access to new relaxation techniques

Effectiveness of Exposure Therapy

Exposure therapy is proven to be effective in virtually all of the recognized major anxiety orders. Studies dating back to the 1970s cite exposure therapy as particularly effective for obsessive-compulsive disorder and post-traumatic stress disorder.

Issues Treated With Exposure Therapy

Exposure therapy is considered a first-line treatment for a number of mental health conditions:

• Post-traumatic stress disorder
• Panic disorder
• Obsessive-compulsive disorder
• Specific phobias
• Social anxiety disorder
• Generalized anxiety disorder

Exposure Therapy in Addiction and Mental Health Treatment

Anxiety disorders are particularly common in those who suffer from addiction. The skills and techniques learned in exposure therapy can be used to manage addictive disorders. For example, the ability to be exposed to a craving (an obsessive thought) without acting on it (using a substance) is a key part of recovery and relapse prevention. People who go through exposure therapy learn valuable and lifelong anxiety-management skills.

The Recovery Village can help you find the support you need to manage a co-occurring chronic anxiety disorder, an addictive disorder and many other conditions. Our network of experienced clinicians can guide you to the appropriate treatment and get you well on your way to sustainable recovery. Call us today to get started.

Editor – Jonathan Strum

Jonathan Strum graduated from the University of Nebraska Omaha with a Bachelor's in Communication in 2017 and has been writing professionally ever since. Read more

Medically Reviewed By – Dr. Kevin Wandler, MD

Kevin Wandler holds multiple positions at Advanced Recovery Systems. In addition to being the founding and chief medical director at Advanced Recovery Systems, he is also the medical director at The Recovery Village Ridgefield and at The Recovery Village Palmer Lake. Read more