Exposure Therapy

By Sarah Fader |Updated August 15, 2022

What Is Exposure Therapy?

Exposure Therapy for PTSD is a form of treatment that helps people face, manage, and overcome their fears from trauma. This treatment has been found to be useful for people with PTSD (Post Traumatic Stress Disorder), as well as people who have anxiety disorders, such as OCD (Obsessive Compulsive Disorder). Exposure therapy can ease the anxiety that somebody with PTSD feels because of their trauma. PTSD is a condition that people can have after they've lived through a traumatic event in their life, whether that be a natural disaster, assault, or experiencing combat or war. PTSD has been called many things in the past, such as shell shock, war neurosis, and combat fatigue, but we have now settled on the name posttraumatic stress disorder to describe the effects of these traumatic experiences. 

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Learn More About How Exposure Therapy Can Help With PTSD

What Is PTSD?

Many people believe that PTSD exclusively affects people who have fought in wars. That's not the case, and trauma isn't only related to combat, but many other things. People who have experienced a natural disaster, seen a violent act, gone through an assault such as a rape survivor, or endured domestic abuse can all develop PTSD. It's a widespread condition and touches people of all races and genders. PTSD affects 3.5 percent of adults, and one in 11 people. Women are twice as likely to get develop PTSD than men are. Anyone who has survived significant trauma can develop the condition. If you believe that you have PTSD, it's essential to seek treatment in the form of therapy, and (if necessary) medication. First, let's look at the symptoms of PTSD and identify them.

According to the National Center for PTSD, the primary symptoms of PTSD include:

  • Intrusive or disturbing thoughts
  • Visual, auditory, or emotional flashbacks of a traumatic experience
  • Nightmares and trouble sleeping
  • Frequent negative feelings such as anger and rage
  • Avoidance of places and topics that revive trauma related memories
  • Anxiety, panic attacks, and feeling on edge

When a person has a shocking episode of trauma, it can leave a lasting effect on their memories, disturb their emotional processing, and impact their emotional wellbeing. They can feel powerless to fight these changes. However, there is effective treatment for this condition. Peer reviewed studies have found that exposure therapy for PTSD can help people heal.   

Exposure Therapy And PTSD

Exposure therapy is a psychological treatment that helps people gradually confront trauma related memories and feared stimuli while in a safe space, and it is an effective therapy for PTSD and other anxiety disorders. It's essential to remember that avoiding situations that provoke anxiety can make your worries grow, and exposure therapy can help. Avoidance of a situation that's anxiety-provoking makes the trauma have more power, and it doesn't help you get well. PTSD symptoms will make you feel powerless at times, and that's where exposure therapy can help.

The Goal Of Exposure Therapy

The goal of exposure therapy is to help a person significantly reduce their fear of a situation, feared objects, or a traumatic event that hurt them.  The goal of exposure therapy is to decrease the intense anxiety associated with their trauma through different types of exposure, including in vivo exposure. These techniques can help the person learn distress tolerance and how to better manage anxiety by being gradually or rapidly exposed to situations that bring on anxiety. Exposure therapy is a way that you can confront your trauma safely and start working on techniques to reduce anxiety and panic that come along with surviving a traumatic episode. Exposure therapy can bring great relief.

Here are some commonly asked questions about the topic:

Can exposure therapy be used to treat PTSD?
Is Prolonged exposure effective for PTSD?
Can exposure therapy make PTSD worse?
How does prolonged exposure therapy work for PTSD?
What is the best therapy for PTSD?
How long does exposure therapy take for PTSD?
How long should exposure therapy last?
Is EMDR prolonged exposure therapy?
Can you give yourself exposure therapy?

Exposure Therapy Methods

There are different kinds of exposure therapy methods depending on what your condition is and how much panic or anxiety you're managing. For a person who is having intermittent flashbacks and nightmares, they might be in a state where they're not able to handle direct contact yet. They may need to try a different technique that has a gradual introduction to what they're afraid to confront, such as cognitive behavioral therapy or other treatments such as medication. The various methods of exposure therapy range from being intense, where the individual faces their fear head-on, to more prolonged or gradual exposure to their fear. There are four types of exposure therapy that are commonly used: in vivo, imaginal, interoceptive, and prolonged exposure.

In vivo Exposure

In vivo exposure means direct confrontation of the person's fear in the present tense. For example, in this kind of exposure therapy, a person who has had a traumatic episode on a train will directly deal with their fear by going to the train station and riding the train. A person with social anxiety might be afraid to do public speaking. Using the in vivo method of exposure therapy, they could overcome their fear by writing and delivering a speech in front of a crowd. They will inevitably have a high level of anxiety when they first stand up in front of a room full of people. However, when they realize that nothing terrible is going to happen, the anxiety will decrease. In vivo exposure therapy can be an intense endeavor, but it can also be instrumental in treating debilitating anxiety. When a person realizes that they can conquer their fear, it's empowering. Their quality of life is going to improve from exposure therapy, and they learned that they're in control of their emotions.

Imaginal Exposure

Imaginal exposure is a form of exposure therapy when a person imagines the thing they're fearful of in a therapy session. The imaginal exposure occurs during visualization exercises of the disturbing memories. They envision in their mind something they're afraid of and work through the trauma. For example, a person may have survived a violent attack on a dirt road. They're scared to travel on country roads now. They could work with a therapist and imagine walking down the road in exposure therapy. When they start to feel distressed, the therapist helps them work through those emotions using breathing techniques and positive self-talk. In exposure therapy, they might imagine that the person tries to attack them, and they can fight back. It's imperative to do this kind exposure therapy exercise with a trained professional because it can trigger anxiety or panic attacks. And you don't want to attempt exposure therapy alone.

Interoceptive Exposure

Interoceptive exposure is targeted explicitly at panic disorder, but it can also treat PTSD. It is a form of exposure therapy which helps people confront symptoms in their body. Whether you're feeling heart palpitations, shortness of breath, sweating, or shaking, anxiety can create some uncomfortable feelings within your physical being. A person might believe they're having a heart attack, and find out that it, in reality, was a severe panic attack. Their bodily reactions can create more anxiety within them. They begin to panic because they're having physical symptoms due to their anxiety. That's where a therapist and exposure therapy can help. In interoceptive exposure therapy, the therapist works with a client's physical anxiety symptoms to help calm them down, for example, by using a breathing technique. In exposure therapy, they might give a client a straw to breathe through to practice slowing their breathing down. It helps the person manage their anxious symptoms, and it calms down their body. The client might try holding their breath and releasing it. Interoceptive exposure therapy teaches people to be aware of how their body reacts when they feel panicked. 

Prolonged Exposure Therapy

Prolonged exposure therapy is a combination of three types of treatment. It integrates in vivo exposure, imaginal, and prolonged exposures. The person who's engaging in prolonged exposure therapy is going to get a well-rounded episode rather than focusing on one type of therapy. PTSD prolonged exposure therapy is useful and helps a person to get over their fears. People with PTSD usually do 8-15 sessions of this exposure for 90 minutes a session. Prolonged exposure therapy provides a unique integrated approach. The client doesn't have to face their deepest fear in each session but rather practices different techniques during each meeting with their therapist.

Learn More About How Exposure Therapy Can Help With PTSD

Find A Therapist

If you're living with PTSD and you're ready to face the fears that are holding you back from fully experiencing life, exposure therapy or cognitive behavioral therapy could help you. You don't have to continue to live life in a constant state of fight or flight. You have the right to live in happiness. Part of getting to a place of balance is allowing yourself the opportunity to work through your trauma, starting with what scares you. And you don't have to do that alone. There are mental health professionals who are trained in exposure therapy for PTSD who can help you understand your fears, process the trauma you've lived, and help support you as you heal.  Many of these therapists use techniques described in a book published by Guilford Press called A Clinician’s Guide to PTSD. You can find a therapist for exposure therapy either in your local area or online like the ones here at BetterHelp. Exposure therapy is beneficial for PTSD, and some therapists are beginning to use virtual therapy to do imagined exposure. It's important to for people with PTSD to recognize that their symptoms can be challenging, and there's going to be anxiety along the way, but that they're not alone and exposure therapy can help.

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