What Is Exposure Therapy
Exposure therapy is a type of treatment that assists people in overcoming fears or anxieties that are triggered by activities, objects, or circumstances. Psychologists and therapists utilize it to manage post-traumatic stress disorder (PTSD) and phobias.
People have the propensity to avoid objects and situations that they fear. Based on the American Psychological Association, exposure therapy is founded on the belief that exposing people to distress-inducing stimuli in a safe atmosphere helps them overcome their apprehensions and reduce avoidance.
This article explains all you need to learn about exposure treatment, including how it works, what it serves to treat, and what research shows about its efficacy.
Therapists employ exposure therapy to help individuals in conquering their anxieties and fears by disrupting the cycle of avoidance and fear. In a secure setting, you are exposed to fear-inducing stimuli.
An individual with social anxiety may, for instance, avoid crowded locations or parties. A psychotherapist would subject the individual to certain social situations as part of exposure treatment to assist them to feel more comfortable in them.
Exposure treatment developed in the early 1900s with the work of behaviorists Ivan Pavlov and John Watson. Its origins can be traced back to Pavlov’s classical conditioning concepts. Probably the most well-known illustration of classical conditioning is Pavlov’s dog test, in which he conditioned a dog to salivate at the ringing of a bell through systematic training. Mary Cover Jones, a behaviorist, moved the science closer to exposure therapy in 1924 with her research on counter-conditioning: the act of transforming an undesirable learned response into a more desired one. Cover Jones progressively “erased” a young boy’s fear of bunnies through the use of comfort food and joyful experiences.
Years down the line, in 1958, behaviorist Joseph Wolpe created systematic desensitization, a method in which relaxation practice, anxiety hierarchy (ranking anxiety-inducing stimuli from most to least), and exposure are employed to lessen a person’s sensitivity to feared events. Eventually in the 1970s, when dealing with individuals with obsessive-compulsive disorder, Stanley Rachman created exposure and response prevention. In this technique, individuals were instructed to generate obsessive thoughts and then resist engaging in anxiety-reducing compulsions or activities.
Exposure therapy has remained popular over the past three decades, and Systematic desensitization and Exposure and response prevention (ERP) is still employed today.
It is believed that exposure therapy can help in four basic ways:
Processing of emotions. Exposure treatment aids in the formation of realistic ideas concerning a fearful stimulus.
Extinction. Exposure therapy can assist individuals in unlearning bad associations with a feared stimulus or scenario.
Habituation. Over time, prolonged exposure to phobic situations diminishes a person’s reaction.
Self-efficacy. Exposure treatment demonstrates that you can overcome your fear and control your anxiety.
There are numerous exposure therapy variants. Your psychologist can assist you in determining the optimal approach. Among these are:
In vivo exposure: It is the confrontation with a feared object, circumstance, or activity in the actual world. For instance, a person with a phobia of snakes may be taught to handle a snake, or a person with social anxiety may be encouraged to deliver a speech before a public audience.
Imaginal exposure: It involves vividly visualizing the feared situation, object, or behavior. To alleviate emotions of terror, a patient with Posttraumatic Stress Disorder may be requested to recall and explain a traumatic event.
Virtual reality exposure: In some situations where in vivo exposure is impractical, virtual reality technology could be utilized as an alternative. A person with a fear of flying, for instance, may have a virtual trip to the psychologist’s office, utilizing equipment that simulates the sounds, sights, and smells of an airplane.
Interoceptive exposure: It is the intentional induction of harmless but feared physical sensations. For instance, a person with Panic Disorder may be encouraged to run at a pace to increase their heart rate and learn that this feeling is harmless.
Specific Exposure Therapy Techniques:
Systematic Desensitization: This strategy combines relaxation training, the creation of a pyramid of anxiety, and gradual exposure to the fearful object or situation. Progressive muscular relaxation, calming sounds and sights, and/or guided imagery could be incorporated into the relaxation training.
The anxiety hierarchy may employ Wolpe’s Subjective Units of Discomfort Scale (SUDS) to produce a list of anxiety-producing situations on a 0-100 scale. Then, throughout the continual exposure to the graded items, the taught relaxation techniques are used to alleviate anxiety and stress.
Graded Exposure: This technique is comparable to systematic desensitization, but does not include relaxing techniques.
Flooding: In this method, exposure may be in vivo or simulated. A person is strongly exposed to experiences that induce anxiety. Typically, flooding is performed until the anxiousness has significantly subsided.
Prolonged Exposure (PE): Similar to flooding, but also incorporating cognitive processing and psychoeducation, Prolonged Exposure (PE) is useful for trauma-related disorders.
Exposure and Response Prevention (ERP): It is an effective strategy for those suffering from obsessions and compulsions that aims to lessen the connection between the two. A therapist will trigger a patient’s obsessions before requesting that they refrain from engaging in their rituals or compulsions.
Cognitive Restructuring: Numerous therapists augment exposure treatment procedures with a cognitive aspect to encourage further development. Therapists help in reframing the flawed mental patterns that maintain a phobia or fear.
Medication: Psychotropic drugs, such as benzodiazepines and antidepressants, have been demonstrated to be useful in lowering the physiologic symptoms of anxiety. Nevertheless, in the majority of cases, medication and exposure therapy are recommended.
The exposure therapy techniques employed by a therapist vary on the problem being treated.
Here are some potential outcomes.
- After identifying the source of your anxiety or fear, your psychologist or therapist will begin treatment by subjecting you to the fearful stimulus.
- Frequently, they employ a graded approach in which you are initially exposed to moderately feared stimuli or a mild replica of your trigger.
- Your therapist will gradually expose you to increasingly unpleasant stimuli in a secure environment.
- The number of visits and duration of your treatment will vary according to your progress. For instance, if you have a fear of mice, the therapist may begin your first session by showing you images of mice. In the following meeting, they may bring a live mouse in a cage. In the third session, you may be asked to use a mouse.
One of the primary issues regarding exposure has always been “does exposure therapy work?” Detailed research confirms the efficacy of exposure therapy in the treatment of anxiety disorders, particularly phobias.
Here are a few important findings:
Phobias. A brief assessment of research published in the year 2020 revealed that in vivo exposure is likely the most successful therapy for a variety of phobias. According to some research, eighty to ninety percent of individuals reacted favorably to treatment.
Anxiety problems in children. In 91% of children with anxiety disorders successfully treated in the year 2020, exposure therapy was utilized.
OCD. A 2019 review of studies endorsed exposure therapy as a treatment for OCD. Exposure and response prevention is among the first-line interventions for obsessive-compulsive disorder. This treatment entails exposing an individual with OCD to their unwanted obsessive thoughts and instructing them to avoid acting on them.
PTSD. A 2016 assessment of evidence demonstrated that exposure therapy is among the most supported therapies for PTSD. For the treatment of PTSD, the Veterans Health Administration, the American Psychological Association, and the Department of Defense, all prescribe cognitive processing therapy, prolonged exposure therapy, and trauma-focused cognitive behavioral therapy.
Anxiety issues in older persons. Exposure therapy was proven to reduce anxiety in older persons, according to a review of research published in 2017.
Anxiety attacks. A 2018 small study indicated that a three-session exposure treatment directed by a therapist was effective in alleviating panic attacks in a group of eight individuals. Six members of the group reported a reduction in symptoms, and four reported remission.
Social anxiety. A group of six individuals who stutter demonstrated substantial drops in social anxiety in a 2019 study. After six months, the benefits were generally maintained.
One of the reasons exposure treatment is best left to professionals is because psychologists are experienced, qualified, and skilled to calm you down if your anxiety becomes too intense and to make sure you don’t give up. Additionally, if the anxiety becomes too intense and you stop the exposure before you have settled down, you might increase your likelihood of experiencing anxiety in the future and therefore make exposure therapy more challenging.
Nevertheless, it can be performed at home. Consider the following if you are going to proceed:
Learn as much as you can about your anxiety. Many websites have a test for anxiety and a plethora of data related to your condition and its symptoms. You must comprehend the origin of your condition to ensure that you are treating the proper factors.
Create a list of incremental techniques to alleviate anxiety about a specific situation. With OCD and panic disorder, it may not be possible to gradually build up to it. With phobias and PTSD, however, it is best to start slowly and gradually increase your exposure. In the instance of phobia, the incremental exposures consisted of contemplating the stimuli, viewing photographs of the stimulus, remaining within the same room as the stimulus, and physically touching the stimulus. After photographs, you can also explore movies and other resources.
Start with exposure therapy. Remember that you can’t stop a stimulus until it no longer causes you concern. If a photo of a spider causes you to feel uncomfortable, you should not proceed to the next photo until the spider photo no longer causes you to feel anxious. You may even wish to test yourself later to ensure that the image continues to not induce anxiety, and then proceed to the following image. If you are making yourself dizzy to alleviate panic attack-related anxiety, you can wait until you are no longer dizzy, but you should not stop until being dizzy produces less anxiety.
You need not complete everything in one day. Once you have determined that you are no longer worried in response to a stimulus, you can stop and attempt it again the following day. Allow yourself a brief respite. But before you return to it, ensure that you are no longer nervous from the stimulation before proceeding. If viewing photographs of spiders continue to induce anxiety, you must continue doing so until you are ready to move on to other methods, such as watching films.
Continue until you have conquered your anxiety-producing stimuli.
Don’t overlook evaluating yourself more on different days after completion. It’s one thing to conquer anxiety, but it’s another to keep it at bay. Do not let yourself be “done” simply because you have overcome it. Remember that you continue exposure therapy even when it has ceased to cause anxiety so that the fear never returns.
Long-term treatment: Exposure Therapy is a lengthy treatment that cannot be done immediately. It requires more time than other trauma-focused therapies, like eye movement desensitization and reprocessing.
Traumas are tough to overcome with exposure: It is hard for anyone to address painful or traumatic events and confront these issues head-on. However, this is required for Exposure Therapy, and if it works, it will be valuable!
Difficult to put in practice: Technically, Exposure Therapy appears straightforward, but its application is challenging. However, it is difficult to put into reality, particularly when it entails the physical treatment, such as meeting others. There is a significant difference between considering doing something and carrying it out.
It is not strong and rigorous in some cases: Exposure Therapy might not be intensive enough for individuals who have severe PTSD symptoms or other problems.
Not a one-size-fits-all strategy: Sadly, Exposure Therapy will not be beneficial for everyone. Some individuals will not experience any alleviation.
Short-term pain: Since sessions will involve reliving traumas, they can raise short-term anxiety. However, the objective is a long-term gain.
- Exposure therapy. GoodTherapy. Available at: https://www.goodtherapy.org/learn-about-therapy/types/exposure-therapy (Accessed: December 25, 2022).
- What is exposure therapy? Verywell Mind. Available at: https://www.verywellmind.com/exposure-therapy-definition-techniques-and-efficacy-5190514.
- How to perform exposure therapy for anxiety at home. Calm. Available at: https://www.calmclinic.com/anxiety/treatment/exposure-therapy.
- What is exposure therapy? American Psychological Association. Available at: https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy.
- The advantages and disadvantages of exposure therapy. Mental Health General. Available at: https://www.mentalhealthgeneral.com/the-advantages-and-disadvantages-of-exposure-therapy.
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