Exposure therapy

Medically reviewed by Andrea Brant
Updated January 4, 2024by BetterHelp Editorial Team

A certain category of mental illnesses may be classified as fear- or anxiety-based, which includes everything from generalized anxiety disorder to phobias to post-traumatic stress disorder (PTSD). For conditions like these, a mental health provider may recommend exposure therapy as a way to decrease stress and/or panic when the client is exposed to the trigger. Here’s what you need to know about about exposure therapy for fear. 

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Overcome debilitating fears and phobias

What is exposure therapy?

Generally, exposure therapy helps people confront and overcome certain mental health conditions that are primarily characterized by a sense of fear and is designed to prevent further trauma. According to the American Psychological Association (APA), a therapist-guided exposure therapy treatment is performed by qualified treatment providers in which psychologists create a safe environment where they can ‘expose’ people to feared objects, activities, and other things they avoid.

Exposure therapy is a psychological treatment that aims to break negative cycles of avoidance, which may cause a person to feel chronic or intense pain and suffering and may impact their daily functioning due to a specific phobia.

There are specific ways to conduct exposure therapy—which qualified exposure therapists will have learned in specific training—so that participants are gradually exposed to become more acclimated to stimuli they perceive as threatening. In vivo exposure therapy and imaginal exposure therapy are two of these specializations. 

As people experience the same sounds and sights that they have previously associated with danger or specific phobias, they may become less sensitive to them and will ideally experience a reduction in fear through repeated exposure. Exposure therapy work is often considered to be the first line of treatment for several fear-based disorders, and it can significantly change the life of a person who is experiencing one.

How this therapy works

In exposure therapy, participants are presented with stimuli that they typically associate with danger in tiny, incremental steps called an exposure fear hierarchy, which starts with small less intense exposures and moves to moderately difficult exposures before confronting more realistic, real-world exposures. A therapist may continue with a systematic review of fear, having participants rank their fear for different feared objects or stimuli. These references may eventually help them decrease their sensitivity to the triggers, enabling them to break the negative associations. 

Each feared stimulus is ranked according to the intensity of anxiety the participant feels when they experience it, known as the fear hierarchy. In terms of the order, stimuli on the fear hierarchy may be presented in one of three ways in exposure therapy: via flooding, graded exposure, or systematic desensitization therapy. Exposure therapy techniques include:

  • Flooding is a technique where the provider will present the most intense or feared version of the stimulus or stimuli first. As participants continue with this intervention, the most anxiety-provoking stimuli will often tend to cause less intense reactions over time.

  • Graded exposure therapy involves exposing the fear-inducing stimuli in order of least to most fear-inducing. For example, if a participant feels extreme anxiety when they have to fly on a plane, the therapist might begin by taking them to sit in an empty plane on the ground. Next, they might prompt the participant to sit on a plane full of people. Eventually, they'll increase the exposure until, ideally, the participant can take flight without debilitating fear.

  • Systematic desensitization combines either flooding or graded exposure therapy techniques with relaxation exercises. Because participants are more relaxed before and during the exposure, the sights and sounds that they once associated with fear may become more associated with a state of relaxation.

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Types of therapeutic exposure

There are several types of exposure therapies, each of which involves unique methods for helping people overcome mental health challenges. These include:

In vivo exposure therapy

takes place in the actual location the participant fears, or with the actual stimulus, they fear, or feared object, being physically present. The scenario about the fear of flying mentioned earlier is an example of in vivo exposure therapy because it takes place inside an airplane, which is what was provoking anxiety in the individual and providing realistic beliefs about the danger present. Treating anxiety in this way is not always possible if fears are not concrete. 

Imagined exposure therapy

in which the participant is not actually, physically exposed to stimuli that they perceive as dangerous. Instead, they’re guided in imagining being exposed to it—in great detail. This technique may help them confront the fear and eventually overcome it. Imagined exposure therapy is especially helpful for unusual fears or fears based on specific incidents and can be used to treat anxiety disorders.

Interoceptive exposure therapy

is effective at treating panic attacks this is because it helps participants have a physical experience of the feared stimuli without actually being exposed to them. In the case of panic disorder, for example, an individual may be asked to exercise vigorously to induce the physical sensations of a racing heart and difficulty breathing. The more they’re exposed to this set of sensations in a safe, guided setting, the less anxious they may become when they feel similar sensations during a panic attack.

Virtual reality exposure therapy (VRET)

presents the stimuli a participant associates with life-threatening situations through computer-generated sights and sounds which may produce a physical sensation similar to a real life situation. The exposure may occur via a desktop computer display, virtual reality technology, or what’s called a "CAVE environment": a cube-like compartment where projectors and audio equipment provide the stimuli.

Prolonged exposure therapy

has successfully helped people who experience PTSD due to past combat experiences or other life-threatening situations. Because the traumatic event caused great fear, avoidance of situations that act as reminders of that event may cause distress. This extended and consistent exposure works to decrease avoidance behaviors and speed up cognitive processing.

Exposure and response prevention therapy (ERP)

Is used when treating obsessive compulsive disorder, or OCD. A therapist may begin exposure by presenting a stimulus that normally triggers a compulsive behavior, the therapist directs the patient not to respond the stimuli, which is the response prevention component. 

Conditions this therapy may be used for

Exposure therapy can be used to treat a wide variety of fear- and anxiety-based mental health conditions. It may be a helpful treatment for emotional processing and symptom reduction for those with disorders such as:

  • post-traumatic stress disorder (PTSD)
  • obsessive-compulsive disorder (OCD))
  • phobias
  • panic disorder
  • generalized anxiety disorder
  • social anxiety disorder
  • trauma

According to a recent study with an exploratory multiple baseline design, it may also be beneficial for people who experience social anxiety disorder (SAD) that is paired with stuttering. Exposure therapy can help people who stutter due to social anxiety because they can have opportunities to be exposed to social situations and make a plan with their speech language pathologist on how to manage their stutter in these situations. 

Potential benefits of exposure treatment

The benefits of exposure therapy depend on factors such as therapist specialization, the condition being treated, and a participant’s willingness to engage in the therapy. At it’s best, exposure therapy can be a powerful tool to help with anxiety and fear-based mental conditions by working to decrease both avoidances of the fear and any symptoms associated with facing it. A recent meta-analysis shows that it can be an effective treatment for conditions involving post-traumatic stress and others. It can have many important benefits. 

First, it can decrease sensitivity to sights and sounds that can trigger someone into feeling that danger is nearby breaking negative associations. It may also help an individual learn to accept fear when it’s natural and learn how to live with it without becoming paralyzed or panic-stricken (especially in the case of panic disorders). This type of therapy can help build personal agency too because participants often realize that they have control over their thoughts which can impact their feelings. Finally, it can decrease anxiety and help improve daily functioning. 
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Overcome debilitating fears and phobias

Seeking prolonged exposure and other treatments for fear-based disorders

Fear- or anxiety-based mental health disorders such as PTD, OCD, and others mentioned here can negatively impact a person’s daily functioning and cause significant distress. While your primary care physician may be able to provide you with resources on these conditions, they do not have expertise in clinical psychology. Finding a licensed therapist that fits with your personality and needs is a good place to start. Exposure therapy is one potential treatment option that may help. If you are or suspect you may be experiencing a disorder like this, speaking with a mental health professional  can help. They can evaluate your specific situation and recommend treatment accordingly, whether that includes exposure therapy or other types. General cognitive behavioral therapy (CBT), for example, is also commonly used to treat a variety of anxiety disorders by helping the individual learn to recognize and shift flawed or unhealthy thought patterns that are causing distress. Exposure therapy falls under the CBT umbrella. Depending on your situation, various aspects of CBT may be used in exposure therapy.

Certain types of exposure therapy may be performed with equal effectiveness in person or virtually, as suggested by research. Online therapy may be an option if you’re interested in seeking treatment from the comfort of your own home. Some studies propose that online CBT in particular can be an effective treatment for generalized anxiety disorder, social anxiety disorder, and others. Meeting with a qualified professional to evaluate and discuss options is typically a helpful first step. For instance, with a virtual therapy platform like BetterHelp, you can get matched with a licensed therapist who suits your needs and preferences and who you can speak with via phone, video call, and/or online chat. Read on for client reviews of BetterHelp counselors.

Counselor reviews

"Dr. Broz is a brilliant, kind-hearted woman. She listens to everything I have to say and responds promptly. We're in contact constantly with each other. Her worksheets are very helpful and I'm starting to work my way towards being able to better handle my anxiety and panic attacks. She is very relatable and often chimes in with stories of her own that relate to what I am experiencing as well. I would definitely recommend Dr. Broz to anyone in need of help or someone to talk to."

"Kara has provided a safe environment for me to express my fears and anxiety. She has provided me tools to help manage my anxiety and continues to support me."

"Dr. Broz is a brilliant, kind-hearted woman. She listens to everything I have to say and responds promptly. We're in contact constantly with each other. Her worksheets are very helpful and I'm starting to work my way towards being able to better handle my anxiety and panic attacks. She is very relatable and often chimes in with stories of her own that relate to what I am experiencing as well. I would recommend Dr. Broz to anyone in need of help or someone to talk to."

"Kara has provided a safe environment for me to express my fears and anxiety. She has provided me tools to help manage my anxiety and continues to support me."

Takeaway

Exposure therapy is a process that can help lessen the symptoms of many different types of mental health conditions. When used properly, exposure therapy can lessen the intensity and decrease the frequency of fearful and stressful reactions to situations that may have troubled someone in the past. If you're living with extreme fears that affect your daily life, contact BetterHelp. With the right tools, it's possible to have a fulfilling life that's free from fear. Take the first step today.

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