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It's the most effective treatment.
By Paul Greene — Last updated on Nov 26, 2022
We all get anxious sometimes. For some people, however, anxiety can be a big problem.
Fortunately, some effective treatment options, including medications and therapy, are available for those who need them.
And there's one form of therapy that's quite effective for people with anxiety, specifically.
What is exposure therapy?
Exposure therapy is a psychological treatment that is used to help people confront their fears. It is a part of a family of psychotherapies known as Cognitive-Behavioral Therapy (CBT).
CBT focuses on helping you make changes to your thought patterns and habits in ways that help improve depression, generalized anxiety disorders, substance abuse, and other problems.
Exposure therapy helps you gradually improve your ability to cope with things that scare you. By practicing exercises called "exposures," you gradually become less reactive to things that contribute to anxiety.
During an exposure, you spend time imagining — or are in the presence of — something that causes you significant anxiety. The longer the exposure lasts, the more your anxiety will subside. This is a form of systematic desensitization.
Doing exposures regularly is a scientifically proven way to improve the symptoms of various anxiety disorders.
Types of Exposure Therapy
There are four types of exposure therapies to explore. These types of behavior therapies usually involve several months of weekly therapy sessions.
1. In vivo exposure
An in vivo exposure exercise is one that involves being physically present with something that scares you.
For example, if you’re afraid of heights, going on a Ferris wheel might be an in vivo exposure exercise for you.
2. Imaginal exposure
An imaginal exposure exercise is one where, instead of seeing or touching something that scares you, you imagine it as vividly as you can. Similar to in vivo exposures, these exercises can last several minutes or much longer.
Exposure therapy will typically involve many repetitions of either in vivo or imaginal exposure exercises.
For example, if you are scared of elevators, imagining you are trapped in one might be an imaginal exposure exercise for you.
3. Virtual reality exposure therapy
Virtual reality is a technology that was first used in exposure therapy in the 1990s. Early applications involved using it to help people with a fear of flying, or veterans with post-traumatic stress disorder. It's a hybrid of imaginal and in vivo exposures.
This type of exposure therapy re-creates sights, sounds, and other sensations of a feared situation in ways that seem quite real. This way you can experience real-life exposure in a safe environment.
For example, if you are scared of flying, using a VR exposure exercise could put you on a plane with real sounds, smells, and feelings of one taking off.
4. Interoceptive exposure therapy
Interoceptive exposure exercise creates the symptoms one has when encountering fear. The exercise induces somatic symptoms that are associated with a threat (i.e., the fear they have).
It encourages the patient to maintain contact with that fear. It essentially gets them used to the feeling enough to conquer it.
For example, spinning in circles will make you feel dizzy or light-headed, and fast breathing can increase your heart rate to mimic a racing heart as the result of anxiety.
Exposure Therapy for Anxiety Disorders
1. Exposure therapy for OCD
When used to treat obsessive-compulsive disorder, a form of therapy called Exposure and Response Prevention (ERP) is a frequently used and effective treatment. It helps people build their ability to tolerate obsessions without giving in to compulsions.
An example of this would be someone with contamination obsessions; through the effects of ERP, they gradually improve their ability to touch things that feel contaminated without washing their hands.
2. Prolonged exposure therapy for PTSD
Exposure therapy for post-traumatic stress disorder (PTSD) is also known as Prolonged Exposure (PE) therapy.
This therapy typically involves both imaginal and in vivo exposures. It can be helpful for survivors of sexual assault, traffic accidents, violent crimes, military combat, and other traumatic events.
3. Exposure therapy for social anxiety
Exposure therapy can be very helpful for those with a social anxiety disorder.
Relevant exposure exercises might involve talking to someone you’d rather avoid, reading something in front of others, or making small talk when you normally wouldn’t.
Typically, people find that the more they practice doing the exercises their therapist recommends, the less anxiety they have in the situations they used to dread!
4. Exposure therapy for phobias
What does exposure therapy look like for specific phobias?
For example, if you have a snake phobia, it might mean going to the pet store to look at snakes for 20 minutes. If you have a driving phobia, it might be taking a brief drive around your neighborhood.
With steady repetition, exercises like these — conducted under the guidance of a behavior therapist — are often sufficient to cure a phobia.
Does exposure therapy work?
There are people who wonder about the effectiveness of exposure therapy. However, exposure therapy is highly effective for the problems described above. For this reason, it is considered a first-line treatment for these disorders.
For example, approximately two-thirds of patients receiving exposure and response prevention therapy for OCD show significant improvement.
Exposure therapy is more effective than traditional talk therapy for anxiety-related problems.
Although it’s true that talking about the things that make you anxious can feel somewhat helpful, decades of research show that traditional therapy is less effective at improving anxiety symptoms than exposure therapy.
A Final Word
If you’re looking for help with anxiety, consider seeking out a therapist trained in exposure therapy.
If you suffer from one of the forms of anxiety described above, the idea of doing exposure therapy probably sounds like the last thing you’d want to do!
Please understand that therapists trained in these types of exposure therapy work together with you to determine which exercises you feel you’re ready to do.
They don’t force you to do anything. Instead, they understand that exposure therapy works best when you only take on challenges you’re ready to tackle.
Exposure therapy is a collaborative process and, although it can feel daunting, it's effective. The research is conclusive on this point.
If you think you might have one of the anxiety disorders described above, consider meeting with a cognitive-behavioral therapist to see if exposure therapy might help you.
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Dr. Paul Greene is a clinical psychologist with expertise in the treatment of posttraumatic stress disorder (PTSD), OCD, anxiety, trichotillomania, panic attacks, hypochondria, and the applications of mindfulness and meditation in the treatment of anxiety. He's the director of the Manhattan Center for Cognitive-Behavioral Therapy.