Exposure therapy has been found to effectively address the symptoms of post-traumatic stress disorder (PTSD), as well as symptoms of other anxiety disorders. With this roundup of different forms of exposure therapy, find out which treatment is right for you.
Overview of Exposure Therapy for PTSD
Exposure therapy is considered a behavioral treatment for PTSD. This is because exposure therapy targets learned behaviors that people engage in (most often the avoidance) in response to situations or thoughts and memories that are viewed as frightening or anxiety-provoking. For example, a rape survivor may begin to avoid relationships or going out on dates for fear that she will be attacked again.
It is important to recognize that this learned avoidance serves a purpose. When a person experiences a traumatic event, he may begin to act in ways to avoid threatening situations with the goal of trying to prevent that traumatic experience from happening again.
Avoidance is a safety-seeking or protective response. However, as this avoidance behavior becomes more extreme, a person’s quality of life may lessen.
He may lose touch with family or experience difficulties at work or in relationships.
In addition, avoidance can make PTSD symptoms stick around longer or even intensify. That is because a person is avoiding certain situations, thoughts, or emotions, he doesn’t have the opportunity to learn that these situations may not be quite as threatening as they seem. In addition, by avoiding thoughts, memories, and emotions, a person doesn’t let himself fully process those experiences.
The goal of exposure therapy then is to help reduce a person’s fear and anxiety, with the ultimate goal of eliminating avoidance behavior and increasing quality of life. This is done by actively confronting the things that a person fears. By confronting feared situations, thoughts, and emotions, a person can learn that anxiety and fear will lessen on its own.
So, how does a person actively confront feared situations, thoughts, and emotions during exposure therapy? A number of methods may be used by a therapist. These are described below.
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Methods of Exposure Therapy
In Vivo Exposure
In vivo exposure refers to the direct confrontation of feared objects, activities or situations by a person under the guidance of a therapist. For example, a woman with PTSD who fears the location where she was assaulted may be assisted by her therapist in going to that location and directly confronting those fears (as long as it is safe to do so).
Likewise, a person with social anxiety disorder who fears public speaking may be instructed to directly confront those fears by giving a speech.
Imaginal Exposure
In imaginal exposure, a client is asked to imagine feared images or situations. Imaginal exposure can help a person directly confront feared thoughts and memories.
Imaginal exposure also may be used when it is not possible or safe for a person to directly confront a feared situation.
For example, it would not be safe to have a combat veteran with PTSD to directly confront a combat situation again. Therefore, he may be asked to imagine a feared combat situation that he experienced.
Interoceptive Exposure
Interoceptive exposure was originally designed to treat panic disorder. However, there is evidence that interoceptive exposure may be successful in the treatment of PTSD as well. It is designed to help people directly confront feared bodily symptoms often associated with anxiety, such as an increased heart rate and shortness of breath. The therapist may assist this by having a person (in a controlled and safe manner) hyperventilate for a brief period of time, exercise, breathe through a straw or hold his breath.
Prolonged Exposure
Prolonged exposure therapy is a combination of the above three methods. Prolonged exposure has been found to be very effective for PTSD sufferers. It involves an average of 8 to 15 sessions for about 90 minutes per session.
Prolonged exposure therapy consists of education about trauma and what you will be doing, learning how to control your breathing (interoceptive exposure), practicing in the real world (in vivo exposure), and talking about your trauma (imaginal exposure).
Finding a Therapist for PTSD
Exposure therapy has been found to be a very effective treatment for PTSD. In addition, methods for delivering exposure therapy to people is continuing to advance. In particular, some therapists are beginning to use virtual reality technology to help people confront the things they fear most.
Yet, it is important to recognize that some people are hesitant to go through exposure therapy because it might sound scary to confront fears. Exposure therapy is like any other treatment for PTSD. It requires a tremendous commitment and can be difficult at times. A major part of most treatments for PTSD is confronting and connecting with feared situations, thoughts, and feelings. The way in which this is done in each treatment simply differ.
Therefore, it is very important to find the right therapist and treatment for you. You can find out more information about treatment providers in your area who might offer exposure therapy through the Anxiety Disorder Association of America.
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Exposure therapy is a type of therapy that helps people overcome things, activities, or situations that cause fear or anxiety. It’s used by therapists and psychologists to help treat conditions such as post-traumatic stress disorder (PSTD) and phobias.
People have a tendency to avoid things and situations they’re afraid of. According to the American Psychological Association, the idea behind exposure therapy is exposing people to stimuli that cause distress in a safe environment helps them decrease avoidance and overcome their fear.
In this article, we break down everything you need to know about exposure therapy, including what it’s used to treat, how it works, and what the research says about its effectiveness.
What exactly is exposure therapy?
Exposure therapy is a technique used by therapists to help people overcome fears and anxieties by breaking the pattern of fear and avoidance. It works by exposing you to a stimulus that causes fear in a safe environment.
For example, a person with social anxiety may avoid going to crowded areas or parties. During exposure therapy, a therapist would expose the person to these types of social settings to help them become comfortable in them.
It’s thought that there are four primary ways that exposure therapy may help:
- Emotional processing. Exposure therapy helps you create realistic beliefs about a feared stimulus.
- Extinction. Exposure therapy can help you unlearn negative associations with a feared object or situation.
- Habituation. Repeated exposure to a feared stimulus over time helps decrease your reaction.
- Self-efficacy. Exposure therapy helps show you that you’re able to overcome your fear and manage your anxiety.
Are there different types of exposure therapies?
According to the American Psychological Association, some of the potential variations of exposure therapies include:
- In vivo exposure. It involves facing your fear in real life. For example, someone with arachnophobia may interact with a spider.
- Imaginal exposure. A thing or situation is imagined vividly. For example, a person who’s afraid of birds might be asked to picture being on a beach filled with seagulls.
- Virtual reality exposure. Virtual reality technology may be used in situations when it’s difficult to experience the cause of fear in reality. For example, somebody with a fear of flying may use a flight simulator.
- Interoceptive exposure. This type of exposure triggers a physical sensation to show that it’s harmless, even if it’s feared. For example, somebody who’s afraid of lightheadedness because they think it means they’re having a stroke may be instructed to stand up quickly.
How does exposure therapy work?
The techniques a therapist uses during exposure therapy depend on the condition being targeted.
Here’s what you may experience.
- Once the cause of your fear or anxiety has been identified, your therapist or psychologist will start the process by exposing you to the feared stimulus.
- Often, they use a graded approach, where they start by exposing you to a mildly feared stimulus or a mild version of your stimulus.
- Over time, your therapist will expose you to more feared stimuli in a safe environment.
- The number of sessions and length of time your treatment will take depends on your progress.
For example, if you’re afraid of mice, the therapist might start by showing you pictures of mice during your first session. In the next session, they might bring a live mouse in a cage. In a third session, they might have you hold a mouse.
How do I choose a specialist for exposure therapy?
Exposure therapy is a type of cognitive behavioral therapy normally conducted under the supervision of a therapist, psychologist, or psychiatrist.
Here are some tips to choose the right specialist:
- Start your search from reliable sources such as the American Psychological Association website.
- Check the national association or network that deals with your specific condition, such as the National Center for PTSD.
- Look for reviews from other people who’ve worked with the specialist.
- Ask people you trust if they can recommend a mental health specialist that they’ve worked with. You can also try asking a primary care physician for referrals.
- Ask questions such as:
- How much experience do you have working with [your issue]?
- What is your area of expertise?
- What can we do if exposure therapy doesn’t work?
If you’re paying through your insurance, take a look at your provider’s directory or look at whether they cover out-of-network therapists in cases where exposure therapy is not covered by your insurance plan.
Can I do exposure therapy on myself?
Exposure therapy is normally conducted under the supervision of a therapist or other medical expert. A small 2018 review of studies found evidence that therapist-directed exposure therapy was more effective than self-directed treatment for treating OCD symptoms.
Improperly trying to perform exposure therapy without help from a trained professional can lead to further trauma or fear. You shouldn’t try to treat a serious condition like PTSD yourself.
You can incorporate aspects of exposure therapy into your daily life to help you overcome mild phobias.
It’s a natural human tendency to avoid things and situations that you’re afraid of. Forcing yourself to experience your phobias may help you step outside of your comfort zone.
For example, if you have mild social anxiety, you might feel anxious being around crowds of people or parties. You can try to force yourself to spend time in progressively more crowded places.
The takeaway
Exposure therapy is a technique that therapists use to help you overcome fear. Research has found that exposure therapy can be effective at treating a variety of types of anxiety disorders including PTSD and phobias.
It’s best to undergo exposure therapy under the supervision of a trained professional. One place you can find specialists in your area is from the American Psychological Association website.
