Exposure Therapy: What Is It and What to Expect

Exposure therapy is a type of behavioral therapy that can help treat various phobias and anxiety disorders.

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 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 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.

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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)
• generalised 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 troup, the first group to receive the treatment had a significant reduction in

• PTSD symptoms
• anxiety
• depression
• mental stress

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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 the 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.

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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 the 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 to build their confidence 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.

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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 escenarios that may trigger fear and anxiety – for example, a soldier with previous trauma of roadside bombing may being 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-on-one with a therapist for around 90 minutes for a course of eight to 15 sessions.

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CREDIT
Author: Beth Sissons
Medically Reviewed: Timothy J. Legg, Ph.D., CRNP
Publication: Medical News Today
Title: Exposure therapy: What it is and what to expect