Type of Therapy – Exposure Therapy

What Is Exposure Therapy?

Exposure therapy is a type of cognitive-behavioral therapy that is used to treat a variety of anxiety-related disorders, including phobias, obsessive-compulsive disorder, social anxiety disorder and post-traumatic stress disorder or PTSD. A therapist uses exposure therapy to carefully and systematically expose a person to feared situations without any danger present. The purpose of this is to help extinguish fear surrounding the situation or object. The goal of this type of therapy is to help the person reduce anxiety and fear associated with certain objects or events.

The Origins of Exposure Therapy

The origin of exposure therapy dates back to the 1900s. It is related to classical conditioning, which was studied extensively by Ivan Pavlov. Pavlov discovered that behavior could be changed using conditioning. In the early 1920s, psychologist Mary Cover Jones, who was known as the “mother of behavior therapy”, used conditioning to help one of her clients get rid of his fear of rabbits.

South African Psychiatrist Joseph Wolpe developed systematic desensitization in 1958. This is a type of exposure therapy in which people are first taught relaxation methods and then systematically exposed in increasing frequency or intensity to situations or things that they fear or that cause anxiety. They then use the relaxation methods that they were taught to cope with the anxiety.

Since the 1950s, exposure therapy has continued to expand and grow. It is now even used with virtual reality to help combat PTSD and other anxiety-related disorders.

How Does Exposure Therapy Work?

Usually, when someone is afraid of something, they will avoid that situation, event or object. For instance, if you are afraid of being in a small enclosed area, you might naturally avoid riding in an elevator and take the stairs instead. Avoiding the feared situation or object will help reduce anxiety—but only in the short term—eventually, it causes a pattern of behavior that can interfere with daily life. Avoidance keeps you trapped in your anxiety, and it is the biggest obstacle to getting over an anxiety disorder. So, when a person has an anxiety disorder, a therapist might recommend exposure therapy to help the person combat avoidance and reduce fear.

During exposure therapy, a psychologist or therapist will slowly introduce the person to situations, objects and events that incite fear. They confront these things in a safe environment where there is no actual danger present. The person will usually be taught relaxation skills that they can use to cope with the anxiety that they experience during exposure. Exposure therapy has been found to be effective for a range of issues including:

• Posttraumatic stress disorder
• Phobias
• Social anxiety disorder
• Panic disorder
• Agoraphobia
• Generalized anxiety disorder
• Obsessive compulsive disorder

Exposure Therapy Methods and Techniques

Several different methods can be used to expose a person to anxiety-provoking stimuli during exposure therapy sessions. Here are the most common:

• Virtual reality Exposure - This method uses technology to expose the person to imaginal stimuli. The person is put into realistic situations that evoke anxiety through the use of virtual reality. For example, a person that is afraid of water might be put through a virtual simulation where they have to walk over a bridge.
• In Vivo Exposure - In this method, a person faces a feared object or situation in real life. So, with this type of exposure, a person that has a fear of spiders might hold a spider.
• Imaginal Exposure - In this type of exposure, a person might be asked to imagine a situation that they are afraid of and picture themselves in the situation.

Specific Exposure Therapy Techniques

A variety of therapeutic methods can be used to help the person overcome their anxiety and fears. Here are some of the most common methods.

Graded Exposure

During this method, a person is exposed to the feared situation or event small, manageable steps. At each step, the individual learns to control their fear. Once they control fear in situations that cause mild anxiety, they are exposed to more intense situations until they are are finally able to overcome the anxiety associated with objects and situations that are greatly feared.

Systematic Desensitization

This type of therapeutic technique is similar to graded exposure in that individuals are slowly exposed to feared situations in a step wise manner. However, they also learn relaxation training methods to help combat the fear. Examples of relaxation training include:

• Progressive muscle relaxation - This method involves tensing and then slowly relaxing various parts of the body. This helps you learn to relax your muscles when they become tense.
• Deep breathing - Practicing deep breathing helps elicit feelings of relaxation. Concentrating on your breathing also helps refocus your thoughts away from things that cause anxiety.
• Meditation - Many therapists use mindfulness meditation which involves bringing your mind’s attention away from the past or future and to the present. This works well as most fears involve thoughts about something bad that might happen in the future.
• Guided imagery - During this type of relaxation training, a person is guided into relaxing through visualization.

During systematic desensitization, a person will use any of the above relaxation methods at each step of exposure to cope with the anxiety that results from being exposed to a feared stimuli.

Flooding

This technique is typically not used until the anxiety is significantly reduced first. It involves “flooding” a person with their feared stimuli all at once. This method is sometimes used because it works much faster than systematic desensitization. Although flooding might be traumatic for the person, it can be helpful if the anxiety is significantly interfering with their daily life. The therapist would help the person cope with the anxiety using the same relaxation methods that are used in systematic desensitization.

Prolonged Exposure

Prolonged exposure is often used to treat post traumatic stress disorder. The person re-experienced the event in a controlled, safe way by remembering it and engaging with it. This helps them cope with triggers or reminders of the trauma rather than avoiding them.

Expectations and Limitations of Exposure Therapy

Exposure therapy has been proven to be very effective by numerous research studies. In fact, it has been shown to be the most effective way to treat fear. However, exposure therapy does have its limitations. Here are a few of the drawbacks of this type of therapy:

• Not widely used- In spite of the fact that exposure therapy is very effective, very few therapists used it in practice. This might be because of the fact that many therapists do not have formal training in exposure therapy.
• Symptoms can return - Another limitation is that symptoms can come back—this is especially true if therapy is ended prematurely.

In spite of the limitations, exposure therapy is worth serious consideration when it comes to treating many forms of anxiety. Research continues to support the use of this treatment for overcoming fear and phobias.