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What Is Exposure Therapy?

Exposure Therapy is a form of Cognitive Behavioral Therapy (CBT) that can help individuals recover from anxiety-related mental health disorders. It is based on the principle that exposing individuals to the very thing they fear and seek to avoid will help them overcome their anxiety surrounding it. Often, when people come face-to-face with their fears and phobias, they realize that there is no danger at all. Due to the periods of intense stress that often accompany exposure to one’s fears, never conduct Exposure Therapy without the support of a licensed therapist.

The 4 Main Theories of Exposure Therapy

Exposure Therapy operates on several core principles that guide the treatment process and contribute to its effectiveness. Understanding these principles can help individuals grasp the rationale behind Exposure Therapy and its potential benefits. The four fundamental principles of Exposure Therapy are:

Habituation

Habituation is the process of reducing fear and anxiety responses through repeated and prolonged Exposure Therapy using feared situations or stimuli. Gradually exposing individuals to their fears in a controlled and supportive environment helps people become less sensitive to anxiety-provoking triggers over time.

Extinction

Extinction theory addresses the weakening and eventual elimination of learned fear responses. It is based on the belief that an original conditioning event caused the fear or phobia and through Exposure Therapy a ‘reverse’ conditioning can take place to show patients that there is nothing to fear (eg. being around dogs without being bitten). The more frequently individuals experience previously triggering situations without the accompanying stress, the weaker the connection becomes.

Emotional Processing

The emotional processing theory suggests that fear is stored in memory by combining physical responses to stressful situations with negative beliefs. Repeated exposure to stressful stimuli can help people discover beneficial outcomes from situations despite the anxiety that may accompany it. For example, Exposure Therapy for Obsessive Compulsive Disorder (OCD) may help people feel less anxious when exposed to triggers as they build memories to diminish their emotional reaction.

Self-Efficacy

Self-efficacy theory focuses on how individuals can develop skills to cope with anxiety-inducing situations rather than the fear response itself. As people with anxiety disorders may underestimate their capabilities, they avoid and withdraw from situations. Exposure to these situations, accompanied with tools and tips to help them navigate it, can help people overcome their disorders.

What Is Involved in Exposure Therapy?

Assessment

The therapy begins with an assessment phase, where the therapist works closely with the individual to understand their specific fears, triggers, and the impact of these fears on their daily life. This assessment helps the therapist tailor the Exposure Therapy to the individual’s needs.

Collaborative Treatment Planning

Based on the assessment, the therapist and individual collaborate to create a treatment plan. This plan outlines the specific fears or triggers to be addressed, the hierarchy of exposure (from least to most anxiety-provoking), and the strategies to be used during the sessions.

Gradual Exposure

Exposure Therapy involves systematically exposing the individual to their fears or triggers in a gradual and controlled manner. The exposure may be in the form of imaginal exposure (imagining the feared situation), in vivo exposure (directly confronting the feared situation), or a combination of both. The therapist guides and supports the individual throughout the exposure process.

Sustained and Repeated Exposure

Exposure sessions are designed to be sustained and repeated over time. This repetition helps individuals habituate to the feared stimuli and reduce their anxiety response. The duration and frequency of exposure sessions will depend on the individual’s progress and treatment goals.

Emotional Regulation Techniques

Throughout Exposure Therapy, therapists teach individuals various techniques to manage and regulate their emotions during exposure. These techniques may include deep breathing exercises, relaxation techniques, mindfulness practices, or cognitive restructuring strategies to challenge negative thoughts and beliefs.

Homework Assignments

Individuals are often given homework assignments to practice exposure techniques outside of therapy sessions. These assignments help reinforce the learning and provide opportunities for individuals to generalize their skills to real-life situations.

Ongoing Support and Monitoring

The therapist provides continuous support and monitoring throughout the course of Exposure Therapy. As exposure to a stressful situation is often distressing, having a therapist’s guidance is essential.

Which Disorders Can Exposure Therapy Help?

Exposure Therapy can be effective in treating a wide range of anxiety and related disorders. It is commonly used to treat:

Prolonged Exposure Therapy

Prolonged Exposure Therapy (PE) is a specific evidence-based treatment approach primarily used to address Post-Traumatic Stress Disorder (PTSD). It was developed as a Cognitive-Behavioral Therapy (CBT) technique for individuals who have experienced traumatic events and continue to experience distressing symptoms related to those events. The primary goal of prolonged exposure therapy is to help individuals process and overcome the negative impact of trauma.

In prolonged exposure therapy, individuals work with a trained therapist over a series of sessions. The treatment typically involves the following components:

  1. Psychoeducation: The therapist provides education about PTSD, its symptoms, and how trauma can affect individuals. This helps individuals gain a better understanding of their experiences and the rationale behind the treatment.
  2. Breathing Retraining: Individuals are taught diaphragmatic breathing techniques to manage anxiety and distressing symptoms that may arise during therapy sessions.
  3. In Vivo Exposure: In this phase, individuals gradually confront situations or activities they have been avoiding due to fear or anxiety related to the traumatic event. By facing these situations in a controlled and safe manner, individuals can reduce avoidance behaviors and learn that they can tolerate and manage their anxiety.
  4. Imaginal Exposure: Individuals are guided through repeated, detailed, and prolonged retelling of the traumatic event(s) in a structured and controlled manner. This helps individuals process and integrate the traumatic memories, reduce emotional distress, and challenge maladaptive beliefs associated with the trauma.
  5. Processing and Cognitive Restructuring: Following the imaginal exposure, individuals work with the therapist to process the emotions, thoughts, and beliefs that arise during the exposure. Cognitive restructuring techniques are used to challenge and modify maladaptive beliefs related to the trauma and promote more adaptive thinking patterns.

Through these components, prolonged exposure therapy aims to reduce avoidance behaviors, alleviate distressing PTSD symptoms (such as intrusive thoughts, nightmares, and flashbacks), and promote emotional processing and recovery.

Prolonged exposure therapy is typically conducted over a specific number of sessions, with each session lasting approximately 60-90 minutes. The duration of treatment may vary depending on individual needs and progress.

Who Can Conduct Exposure Therapy

Both Exposure Therapy and Prolonged Exposure Therapy are specialized treatment approaches that require the expertise of trained mental health professionals. Several types of doctors and clinicians are qualified to conduct Exposure Therapy and provide effective treatment for anxiety and related disorders. These professionals include therapists, psychiatrists, and psychologists.

photo of LifeStance provider Nicholette Leanza, LPCC-S
Medically Reviewed By:
Nicholette Leanza, LPCC-S
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Nicholette is a faculty member at John Carroll University’s Clinical Counseling program, and she is also the host of the LifeStance podcast, Convos from the Couch.