Understanding Exposure Therapy: How It Works and Why It Helps?

Therapy is a process where individuals work together with trained professionals such as psychiatrists, psychologists and mental health workers to address mental health issues, emotional challenges and life difficulties. It seeks to enhance the mental health and build resilience of individuals. There are various types of therapies the most popular ones include cognitive behavioural therapy (CBT), which addresses negative thought patterns; psychodynamic therapy; which inquiries into the unconscious mind and childhood traumas; others include humanistic therapy, family therapy, group therapy, exposure therapy, art therapy and play therapy and so on.

Each type has unique approaches and is more effective and relevant for specific issues or individuals. Even though in today’s time mental health professionals often use a combination of them as they have become more eclectic. However, all share the goal of helping individuals understand themselves better and improve their quality of life. In this article exposure therapy is explored in detail.

What is Exposure Therapy

Exposure therapy is a form of cognitive behavioural therapy (CBT) that has been scientifically proven to be effective in treating different types of mental health problems such as anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD). The principle behind exposure therapy is the gradual desensitization of individuals through controlled exposures to the objects, situations or activities they fear intending to reduce their fear and anxiety with time. Thus, in other words, it is about gradually exposing clients to fear-inducing stimuli to subsequently reduce their fear.

Types of Exposure Therapy

Several forms of exposure therapy have been developed depending on the needs, preferences and requirements of the individual;

• In Vivo Exposure: In vivo, exposure entails confronting the feared object, situation, or activity directly in real life. For example, a person with a fear of snakes could be asked to handle one, and someone with social anxiety may be told to make a speech publicly.
• Imaginal Exposure: Imaginal exposure involves vividly visualizing oneself encountering the feared object, event or situation. It is commonly used for people who are suffering from trauma or posttraumatic stress disorder where it allows them to face their fears without reenacting the traumatic events.
• Virtual Reality Exposure: When it is not practical or possible for in vivo exposure to happen, computer technology can be used to create feared environments. For example, someone with a fear of flying might experience a virtual reality flight in the therapist’s office.
• Interoceptive Exposure: Interoceptive exposure focuses on inducing harmless physical sensations that are feared. For instance, someone with panic disorder may be told to jog in place to increase their heartbeats per minute and know that this feeling is safe. ·

How Exposure Therapy Works

Exposure therapy is believed to help people confront and overcome their fears by addressing multiple mechanisms. The first is habituation over time. Repeated appearances of the phobic stimulus cause a less emotional reaction in the individual involved with time. For example; for a person learning to ride a bicycle, the tenth day would be less scary than the first. Repeated exposure creates a sense of familiarity and hence reduces the feelings of uncertainty and threat. Another is extinction, in exposure therapy, the aim is to weaken earlier associations between feared objects, activities, or situations and negative outcomes.

It is a process of unlearning the dysfunctional associations that have been due to traumatic experiences. The third comes self-efficacy, by confronting what they are afraid of, individuals learn how to deal with anxiety and overcome phobias. It helps individuals realize and believe that they are capable of managing their negative or unpleasant responses associated with fear.

The last is emotional processing, during exposure, individuals can learn new beliefs, and attach new or even more realistic beliefs concerning fearful stimuli which will help them feel more comfortable when faced with such situations as the new memories will make the older ones fade. Similarly, a newly explored emotional process of meaning-making will make the feared one less relevant in due course of time.

Effectiveness of Exposure Therapy

Numerous researches have indicated that exposure therapy is effective in treating various mental health conditions. The most successful treatment for a wide range of phobias seems to be in vivo exposure, with 80-90% of patients responding positively to the method (Joscha et al, 2020). With anxiety disorders in children in 91% of cases involving children, anxiety disorder treatment was accomplished through exposure therapy (Thng et al,2020).

In the case of OCD, it has been found that exposure therapy can be used effectively alongside response prevention indicating that they are considered one of the primary or most effective treatment options for OCD, often recommended as the first approach to take before trying other treatments. Also, exposure therapy is among the most supported treatments for PTSD by research and is strongly recommended by the Veterans Health Administration, Department of Defence, and American Psychological Association guidelines (2017). According to an analysis carried out on studies by Gould et al (2017), the inclusion of this strategy when dealing with aged people saw a significant anxiety reduction significantly.

What to Expect During Exposure Therapy

As a starting point initially, your psychologist will educate you on how being exposed can help you overcome your fears. After that, you and the therapist can both develop a fear hierarchy in which the different circumstances are rated according to their stressfulness. You will then be exposed to the feared stimuli gradually in ascending order, beginning with the least distressing ones and advancing to more difficult situations over time much like systematic desensitization.

It can be conducted in vivo, through imagination or virtual reality technology. Then you subsequently learn the ways of coping. For example, your therapist could teach you how to relax using techniques such as deep breathing exercises or progressive muscle relaxation when you find yourself becoming distressed during exposure. Finally, the psychologist may also aid you in determining any irrational beliefs that might pertain to your phobia and then help you challenge them.

The duration of exposure therapy is individualized depending on the progress and severity of the condition but it often comprises weekly sessions usually lasting about 60-90 minutes per session. Sometimes though, like in PTSD cases; these sessions may take longer (up to two hours) at the initiation phase.

Choosing a therapist

When choosing a therapist for exposure therapy, it is vital to choose an experienced professional with expertise in this form of treatment. Search for a therapist who belongs to a recognized association. It is also necessary to find a therapist that you are comfortable working with since the therapeutic relationship is an important part of successful treatment. Do not hesitate to interview prospective therapists or get another opinion in case you are uncomfortable with the treatment approach or feel threatened by your mental health care provider. You’ll always have the option to opt out of the therapy if you believe it’s not working out for you as it’s not a ‘person-therapy fit’.

Exposure therapy is highly effective for various mental health issues including anxiety disorders, OCD, and PTSD. Through gradual exposure in safe environments over time exposure therapy helps reduce fear and anxiety responses. Although difficult at times, overcoming severe phobias and regaining control over one’s life makes this therapy prudent when dealing with psychological problems. While the process can be challenging, the potential benefits of overcoming devastating fears and regaining control over one’s life make exposure therapy a valuable tool in the treatment of mental health conditions.

Further Readings

• Böhnlein, J., Altegoer, L., Muck, N. K., Roesmann, K., Redlich, R., Dannlowski, U., & Leehr, E. J. (2020). Factors influencing the success of exposure therapy for specific phobia: A systematic review. Neuroscience & Biobehavioral Reviews. https://doi.org/10.1016/j.neubiorev.2019.12.009
• Wald, J., & Taylor, S. (2005). Interoceptive Exposure Therapy Combined with Trauma-related Exposure Therapy for Post‐traumatic Stress Disorder: A Case Report. Cognitive Behaviour Therapy. https://doi.org/10.1080/16506070510010648
• Ford, J. D. (2009). Treatment of Adults with Traumatic Stress Disorders. Elsevier eBooks. https://doi.org/10.1016/b978-0-12-374462-3.00007-1
• Beidel, D. C., Neer, S. M., Bowers, C. A., Newins, A. R., Tuerk, P. W., Cunningham, C. A., Mooney, S., Hauck, H. N., & Jett, M. (2020). Trauma Management Therapy and Prolonged Exposure Therapy for PTSD in an active duty sample: Design and methodology of a randomized clinical trial. Contemporary Clinical Trials Communications. https://doi.org/10.1016/j.conctc.2019.100491
• American Psychological Association. (2017). What Is Exposure Therapy? Retrieved from https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy