What is exposure therapy?

Exposure therapy, as its name implies, involves exposing a patient to something that would normally provoke fear, stress, anxiety, or other negative emotions.

How does exposure therapy work?

The idea is that by exposing a patient to the anxiety-producing stimulus in gradually increasing increments (ranging from slight exposure and working up to full exposure), they will become more comfortable with the item in question and overcome their fears and anxieties.

What is exposure therapy used for? What problems does it treat?

Exposure therapy is a common treatment for things like fears and phobias, anxiety disorders, obsessive compulsive disorder, and is often used to treat symptoms of PTSD.

The purpose of exposure therapy

The goal of exposure therapy is not to erase all fear of anxiety; these emotions serve us in various ways and we experience them for a reason. It’s only meant to overcome irrational fears and trauma-induced reactions, such as preventing a person from becoming paralyzed in fear whenever a car backfires or a loud noise startles them.

Exposure therapy methods

Exposure therapy generally starts off small and then progresses onto more and more intense exposures. For example, someone with an obsessive fear of snakes might be asked to read stories about snakes or be shown pictures of snakes at first. Next might come videos, then sessions where the patient spends time in a room with a caged snake. Then they’ll be asked to stay in the room while someone takes the snake out and holds it, getting closer each time and then touching it, until finally they are able to pick up a snake and hold it without freaking out. The idea is that as the patient is gradually exposed to the anxiety-inducing stimulus in a safe environment where nothing bad happens, they learn to overcome their paralyzing fears.

Exposure therapy has been found to be the most effective under the following conditions:

  • Clients must remain in the feared situation until they notice a significant reduction in anxiety symptoms (usually at least 50%).

  • They must refrain from using safety or avoidance behaviors, such as looking away or closing their eyes, and…

  • They must engage in anxiety provoking situations often in order to best eliminate their fear. (Curtis, Kimball & Stroup, 2004)

In addition, it’s best that these sessions be followed up with some type of cognitive therapy or discussion of what occurred in order to counteract any irrational beliefs or self-scrutinizing thoughts. If participants leave exposure at the height of their anxiety or if they engage in a lot of negative self-talk afterwards, this will only serve to reinforce their fears.

The effects and benefits of exposure therapy

Unlike many of the other forms of therapy we discuss, exposure therapy has a sound, research-backed premise and a good track record. It is usually effective when conducted properly with a cooperating patient. “If someone with genuine PTSD goes to the people who do this really well, they have a good chance of getting better,” says Richard J. McNally, a leading authority on memory dynamics and trauma. (Dobbs, 2009)

The drawbacks of exposure therapy

  1. Its uses are limited to specific phobias or particular symptoms, and therefore it’s not really a broad-based therapy that works for general problems.

  1. It’s frequently overused and applied to situations for which it doesn’t really help. Because mental health practitioners monumentally over-diagnose PTSD, (in part because it’s easy to get reimbursed from insurance companies for a PTSD diagnosis), therapists may view a patient’s struggles through the lens of trauma when they really should be helping them confront irrational beliefs or adopt a healthier attitude towards their experiences. “If a depressed person takes on a PTSD interpretation of their troubles and gets exposure-based CBT, you’re going to miss the boat,” says McNally. “You’re going to spend your time chasing this memory down instead of dealing with the way the patient misinterprets present events.” (ibid, p. 67)

  1. Used improperly, exposure therapy can harm rather than help. If you’re not properly building up immunity through these sessions, you’re simply offering more opportunities for the underlying fear to be reinforced.