Exposure Therapy

Confronting fears and anxieties head-on with evidence-based support.

What is exposure therapy? 

Exposure therapy helps individuals overcome their fears through different levels of confrontation (or exposure). It’s best suited for anxiety- and trauma-related disorders such as phobias or post-traumatic stress disorder (PTSD). 

While this method may sound intimidating, studies show that this practice is incredibly effective in decreasing depressive symptoms and improving the quality of life for adolescents. One of the primary purposes of exposure therapy is to break the cycle of avoidance that often accompanies fear. Exposure therapy involves the practitioner creating a safe environment for the individual to face their fear or anxiety.

Whether the fear is a situation or a physical object, the goal is for the individual to get more comfortable and lower their avoidance of that fear. Our clinicians create a safe environment for clients to progress through exposure therapy at a comfortable pace. 

A young woman going through exposure therapy stares out of her window during sunset
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Types of exposure therapy

The American Psychological Association describes five different types of exposure through this type of treatment. Practitioners create a customized approach that is appropriate for each patient. 

1. Imaginal exposure

In this type of exposure therapy, the patient uses his or her imagination to recall a traumatic event or imagine themselves in a situation that causes fear or anxiety

2. In vivo exposure

This gives the patient real-life exposure to a specific fear, such as touching a spider. 

3. VR exposure

Using virtual reality is an increasingly common way to expose a patient to fear while replicating the sights and sounds in a safe environment. 

4. Interoceptive exposure

This strategy aims to increase exposure to fear in terms of the physical feelings associated with it, such as an increased heart rate (in this case, caused by brief exercise). 

5. Prolonged exposure therapy

This type of weekly therapy takes place over the course of several months to help individuals face trauma-related fears. The goal is to gradually face triggering situations and discuss the associated emotions in order to reduce the anxiety attached to those situations. Over the course of these sessions, the practitioner may guide you using both imaginal and in vivo exposure techniques. 

What conditions is exposure therapy used for?

Exposure therapy helps you overcome things in life that you’ve avoided out of fear. There are a number of conditions that can be treated with exposure therapy techniques. 

Exposure therapy can support you with:

  • Panic disorders
  • Phobias
  • Post-traumatic stress disorder (PTSD)
  • Obsessive-compulsive disorder (OCD)
  • General anxiety
  • Social anxiety
  • Panic attacks

How does exposure therapy work?

There are multiple exposure therapy examples that your clinician may use to help you overcome your challenges. Our clinicians who use exposure therapy will tailor levels of exposure based on your specific needs. In most cases, you’ll start off small, then progressively work up to greater challenges. 

You may work on a fear hierarchy to reduce anxiety and identify a flow of progression. This process involves listing out your triggers and ranking each one in order of most triggering to least triggering.

A young adult woman with curly hair learns about an exposure therapy example

Depending on your needs, exposure therapy could take anywhere from weeks to months to be effective. Here are some common strategies to expect at different times throughout the process:

Graded exposure

Together with your clinician, you’ll rank your fears and start addressing each one in progressive order. As you tackle minor fears, you’ll gain the confidence to tackle more entrenched fears. This strategy uses both behavioral and cognitive therapy techniques.

Flooding

In this process, you’ll start with the biggest fear on your hierarchy list first. After that, more moderate fears may not feel so overwhelming. There’s no gradual exposure here. The goal is to desensitize you towards your fear while exhausting your fight-or-flight response.

Systematic desensitization

This strategy pairs exposure with relaxation techniques to disassociate feelings of fear or anxiety. You’ll typically focus on relaxing the breath and muscles. For instance, for a patient who is afraid of dogs, exposure may start with pictures, then progress to listening to barking sounds while practicing relaxation exercises.

How long should someone do exposure therapy?

In most cases, exposure therapy is completed as weekly sessions over a period of three months. The goal is to reach 8-15 sessions in total. The patient may be assigned homework in between sessions, such as practicing coping techniques. 

Benefits of exposure therapy

It may seem scary to get started with exposure therapy, but there are a number of direct benefits associated with this type of practice. Over time you may begin to notice positive changes, such as:

  • A decrease in habituation (defined as a decrease in certain mental health symptoms based on repeated exposure to a specific stimulus) 
  • A lower level of learned associations that have been attached to a specific fear or anxiety
  • Increased confidence in your own ability to manage your fears
  • Increased comfort level with fears paired with newfound realistic beliefs surrounding those objects or activities 

Numerous studies demonstrate the efficacy of exposure therapy. In a 2008 study, exposure therapy outperformed both a placebo group and alternative forms of active psychotherapy for individuals with phobias.

In another study from 2013, military veterans with combat-related PTSD no longer met the diagnostic definition of PTSD after exposure therapy treatment. 84 veterans participated in the study and experienced a 42% reduction in PTSD symptoms as well as a 31% decrease in depression symptoms. Participants also rated a better quality of life after prolonged exposure therapy. 

What success with exposure therapy looks like

Individuals with phobias who experience success with exposure therapy typically see reduced fear and anxiety over their fears. They are better able to cope with triggers and are less likely to engage in avoidance behaviors.

For teens and young adults with PTSD, there’s typically a reduction in intrusive thoughts, flashbacks, and other symptoms related to their traumatic event.

Can you do exposure therapy virtually?

Yes, exposure therapy can be successful when done virtually. Your practitioner may use computer-generated simulations and other technology to create the appropriate level of exposure in an online capacity.

One of the major benefits is that the patient is at home and feels like they’re in a safe space throughout the treatment process. 

Other types of therapy at Charlie Health

At Charlie Health, teens and young adults gain access to a comprehensive suite of modalities. We create a customized care plan with our virtual IOP program based on your specific mental health. Exposure therapy may be paired with other types of therapies to make real progress in whatever challenges you face. Get started today.

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