Exposure Therapy

When people have an anxiety disorder such as social anxiety disorder, posttraumatic stress disorder, OCD, specific phobia, or panic disorder, they avoid the object or situation that triggers anxiety such as: 

• meeting new people or having a conversation
• giving a presentation
• flying or driving on the freeway
• touching surfaces 
• distressing memories, thoughts or feelings 

When you avoid the things you are afraid of, you experience relief in the moment. 

Unfortunately, in the long-term anxiety gets worse over time the more a person avoids. When you avoid feared objects or situations, your brain is reinforced to have fear. Essentially, avoiding teaches your brain to be more afraid. 

Exposure treatment works through gradual exposure

By gradually exposing yourself to the thing you are afraid of, your brain learns not to be afraid. 

The way it works is through a process called habituation. 

If you've ever watched a scary movie, you are familiar with this. The first time you watch it, you feel terrified. The next few times, you start to notice it's a bit less scary. After watching it several times, you start to notice how fake and unrealistic the props are. 

Exposure therapy involves exposing yourself gradually in just the same way. The more you do an exposure, the less scary it gets. This is the first goal of exposure therapy. 

Therapy teaches you that you can cope and fear or anxiety is not necessarily accurate. 

Secondly, in exposure, you unlearn the connection between what anxiety predicts will happen and what actually happens. Anxiety predicts a worst case scenario will happen if you do something scary. With exposure, you actually test the theory. 

For example, let's say you fear having a panic attack while exercising. You can begin by going for a short walk out the door. Then gradually moving up to a short walk down the block. In doing so, you learn 1) you can cope with uncomfortable feelings of anxiety, 2) exercising does not necessarily lead to a panic attack. 

When you face your fears you can overcome them. 

In therapy sessions, you will begin with your therapist learning more about the thoughts, feelings and situations that make you anxious. 

Next, you will learn relaxation techniques such as progressive muscle relaxation that will help when feeling anxious. 

You will make a list of things that trigger your anxiety. You'll rank the list from least anxiety provoking to most. These things are referred to as feared stimuli - the objects or situations that trigger your anxious thoughts, feelings or behaviors. 

In session, you will start with imaginal exposures or in vivo exposures that trigger a small amount of anxiety. Over time you will slowly work up to things higher on the list. Eventually you will practice exposure to these feared situations outside of the therapy office. 

For example, you might begin by having a conversation with your therapist, then saying hello to a familiar person and gradually working your way up to a conversation with another person. 

Physical sensations may also be an anxiety trigger, especially in the case of panic. In these situations a type of exposure referred to as interoceptive exposure might be used. This means, you are exposed to a mild level of the physical sensations in the safe environment of the therapist's office. 

Therapy for anxiety disorders typically takes 16-20 weeks, meeting once weekly for a successful outcome. This may vary based on client factors and symptom severity. 

Exposure and response prevention is a type of exposure therapy for OCD specifically. In ERP, you are exposed to the thing that is triggering your anxiety and then choosing not to engage in compulsive behavior once your anxiety has been triggered.

Over time, this changes your brain's response to triggers and reduces your anxiety. 

Prolonged exposure is a type of exposure therapy for PTSD.