How Does Exposure Therapy Work?

Table of ContentsView AllTable of ContentsHow It WorksTypesProcessTechniquesUsesBenefitsEffectivenessLimitationsGetting Started

Table of ContentsView All

View All

Table of Contents

How It Works

Types

Process

Techniques

Uses

Benefits

Effectiveness

Limitations

Getting Started

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Exposure therapy is a form ofbehavioral therapydesigned to help people overcome their fears. If you’re afraid of enclosed spaces, for instance, you may avoid taking the elevator, especially if it’s crowded. But what if you work on the top floor of a tall building? Finding a way to overcome this fear can make it easier to get to and from your office.

If you’re interested in exposure therapy or it has been recommended to you, it helps to know the types available, techniques used, and the conditions it can help treat. It’s also beneficial to understand what research says about the effectiveness and limitations of exposure therapy so you can decide if it’s the right approach for you.

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How Exposure Therapy Works

The goal of exposure therapy is to help you overcome your fear so the object, activity, or situation doesn’t cause anxiety, and you can engage with it meaningfully. “A motto of exposure therapy is ‘Let’s get comfortable with being uncomfortable,’” saysCourtney DeAngelis, PsyD, a licensed clinical psychologist at Columbia University Medical Center who specializes in this form of therapy.

Types of Exposure Therapy

Exposure therapy can help treat several conditions, including phobias,generalized anxiety disorder, andsocial anxiety disorder. There is also a specialized form of exposure therapy, known as exposure and response prevention therapy (ERP or Ex/RP), that can help treatobsessive-compulsive disorder (OCD).

According to DeAngelis, ERP helps individuals with OCD face uncomfortable situations and reduce compulsions they engage in to relieve anxiety. “By preventing the compulsion or ritual, you can build insight so that individuals learn that bad things do not happen, even when they do not follow the OCD ‘rule,’” says DeAngelis.

Studies indicate that ERP has great success in reducing thesymptoms of OCD, a condition that was once considered untreatable.Research published in 2021 further suggests that when exposure occurs using virtual reality, it may help people engage more fully in this therapy type.

Treatments for Obsessive-Compulsive Disorder

The Exposure Therapy Process

Exposure therapy can progress at different paces. Per DeAngelis, your therapist will guide you to face your fears according to a fear hierarchy or “ladder” that serves as a roadmap for treatment. This can help you cope with the trauma and anxiety that each step of the process involves.

The process can include:

How PTSD Is Treated

Exposure Therapy Techniques

Therapists who practice exposure therapy may draw upon a variety of techniques, which DeAngelis outlines as including:

In Vivo Exposure

In vivo exposure involves directly approaching a feared stimulus or situation in real time. For instance, if an adolescent isafraid to be away from their parents, this would mean practicing to gradually separate from the parents in various situations (with guidance from a clinician and consent from the parents).

Imaginal Exposure

Imaginal exposure involves imagining the feared situation coming true in great detail. For instance, if you have aphobia of vomiting, you probably would not be encouraged to eat something to intentionally vomit as an exposure. Instead, a therapist may ask you to describe in a written narrative what you imagine would happen if you did vomit, perhaps in public.

The therapist may ask you to reread or listen to this imagined script repeatedly. The general idea is to help bore you of these feared situations rather than bring about the same level of anxiety.

Interoceptive Exposure

Interoceptive exposure can help tackle a feared physical sensation; it is generally employed when treatingpanic attacks. For instance, your therapist may ask you to do jumping jacks for one minute to increase your heart rate. You will eventually learn that this is not dangerous nor a sign of a heart attack.

Virtual Reality Exposure

Virtual reality exposure is a more novel approach that allows you to confront your fears using virtual reality devices. If, for example, you have afear of flying, you may benefit from videos that simulate flying before going on a vacation that involves air travel.

List of Phobias: Common Phobias From A to Z

Conditions Exposure Therapy Can Help Treat

According to DeAngelis, exposure therapy is particularly helpful when treating conditions that can cause anxiety. She explains that anxiety can prompt you to overestimate the threat of danger or discomfort, also causing you to underestimate your ability to cope with the danger or discomfort.

“Exposure therapy works to address both of these challenges," says DeAngelis, “so that you can realize that your anxiety will naturally fade over time when facing an uncomfortable or scary situation and that you can handle that anxiety.”

Specific conditions and anxiety disorders exposure therapy can help treat include:

How to Manage Public Speaking Anxiety

Benefits of Exposure Therapy

Exposure therapy offers many benefits, such as:

Courtney DeAngelis, PsyDExposure therapy can significantly reduce an individual’s anxiety symptoms, increase a person’s ability or willingness to approach uncomfortable situations, and strengthen learning that individuals can handle hard things.

Courtney DeAngelis, PsyD

Exposure therapy can significantly reduce an individual’s anxiety symptoms, increase a person’s ability or willingness to approach uncomfortable situations, and strengthen learning that individuals can handle hard things.

What You Can Do to Cope With Anxiety

Exposure Therapy Effectiveness

“Exposure therapy is anevidence-based treatment, which quite simply means that the research has shown us that it works,” says DeAngelis. Empirical evidence has shown that exposure therapy can help treat anxiety disorders, including phobias, panic disorder, social anxiety disorder, GAD, PTSD, and OCD.

One study found that people who received exposure therapy totreat phobiashad fewer symptoms not only immediately after treatment but eight years later as well.This suggests that exposure therapy has long-term benefits.

Limitations of Exposure Therapy

Facing your fears can be difficult. So, exposure therapy can be uncomfortable and challenging. When undertaking this therapy, DeAngelis says, “It’s important to understand that the clinician’s goal is not to torture you, and to feel willing totolerate uncomfortable situationsor stimuli that you have been avoiding.”

Exposure therapy can also have occasional drawbacks:

Despite these limitations, exposure therapy is worth considering as a treatment option as research supports its effectiveness. In fact, one of its limitations is that it is not utilized enough. Many therapists do not have formal training in exposure therapy and therefore cannot practice it to help people with anxiety disorders.

How to Get Started With Exposure Therapy

Once you find a qualified professional, make an appointment with them and ensure they accept your insurance. Your first appointment will probably involve filling out the necessary paperwork, which can include details regarding your symptoms, medical history, and insurance plan.

Work with the mental healthcare provider on mapping out your goals for therapy and strive to build a strong, collaborative rapport with them.Therapeutic rapportis vital to exposure therapy because you need to feel safe and supported as you confront your fears.

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Summary

If you have a fear that is getting in the way of you living your life, exposure therapy MAY help treat it. While the prospect of facing your fears can be daunting, A therapist can guide you through the process and equip you with tools to cope with the anxiety you experience. “There is great reward for those who are willing to ride the wave of anxiety and start to feel better again in their daily life,” says DeAngelis.

7 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Pittig A, Treanor M, LeBeau RT, Craske MG.The role of associative fear and avoidance learning in anxiety disorders: Gaps and directions for future research.Neurosci Biobehav Rev. 2018;88:117-140. doi:10.1016/j.neubiorev.2018.03.015Hezel DM, Simpson HB.Exposure and response prevention for obsessive-compulsive disorder: a review and new directions.Indian J Psychiatry. 2019;61(Suppl 1):S85-S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18Cullen AJ, Dowling NL, Segrave R, Carter A, Yücel M.Exposure therapy in a virtual environment: Validation in obsessive compulsive disorder.J Anxiety Disord. 2021;80:102404. doi:10.1016/j.janxdis.2021.102404Kaczkurkin AN, Foa EB.Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence.Dialogues Clin Neurosci. 2015;17(3):337-346. doi:10.31887/DCNS.2015.17.3/akaczkurkinLange I, Goossens L, Leibold N, et al.Brain and behavior changes following exposure therapy predict outcome at 8-year follow-up.Psychother Psychosom. 2016;85(4):238-240. doi:10.1159/000442292Markowitz S, Fanselow M.Exposure therapy for post-traumatic stress disorder: factors of limited success and possible alternative treatment.Brain Sci. 2020;10(3):167. doi:10.3390/brainsci10030167Reid AM, Guzick AG, Fernandez AG, et al.Exposure therapy for youth with anxiety: Utilization rates and predictors of implementation in a sample of practicing clinicians from across the United States.J Anxiety Disord. 2018;58:8-17. doi:10.1016/j.janxdis.2018.06.002Additional ReadingAmerican Psychological Association.What is exposure therapy?

7 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Pittig A, Treanor M, LeBeau RT, Craske MG.The role of associative fear and avoidance learning in anxiety disorders: Gaps and directions for future research.Neurosci Biobehav Rev. 2018;88:117-140. doi:10.1016/j.neubiorev.2018.03.015Hezel DM, Simpson HB.Exposure and response prevention for obsessive-compulsive disorder: a review and new directions.Indian J Psychiatry. 2019;61(Suppl 1):S85-S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18Cullen AJ, Dowling NL, Segrave R, Carter A, Yücel M.Exposure therapy in a virtual environment: Validation in obsessive compulsive disorder.J Anxiety Disord. 2021;80:102404. doi:10.1016/j.janxdis.2021.102404Kaczkurkin AN, Foa EB.Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence.Dialogues Clin Neurosci. 2015;17(3):337-346. doi:10.31887/DCNS.2015.17.3/akaczkurkinLange I, Goossens L, Leibold N, et al.Brain and behavior changes following exposure therapy predict outcome at 8-year follow-up.Psychother Psychosom. 2016;85(4):238-240. doi:10.1159/000442292Markowitz S, Fanselow M.Exposure therapy for post-traumatic stress disorder: factors of limited success and possible alternative treatment.Brain Sci. 2020;10(3):167. doi:10.3390/brainsci10030167Reid AM, Guzick AG, Fernandez AG, et al.Exposure therapy for youth with anxiety: Utilization rates and predictors of implementation in a sample of practicing clinicians from across the United States.J Anxiety Disord. 2018;58:8-17. doi:10.1016/j.janxdis.2018.06.002Additional ReadingAmerican Psychological Association.What is exposure therapy?

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Pittig A, Treanor M, LeBeau RT, Craske MG.The role of associative fear and avoidance learning in anxiety disorders: Gaps and directions for future research.Neurosci Biobehav Rev. 2018;88:117-140. doi:10.1016/j.neubiorev.2018.03.015Hezel DM, Simpson HB.Exposure and response prevention for obsessive-compulsive disorder: a review and new directions.Indian J Psychiatry. 2019;61(Suppl 1):S85-S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18Cullen AJ, Dowling NL, Segrave R, Carter A, Yücel M.Exposure therapy in a virtual environment: Validation in obsessive compulsive disorder.J Anxiety Disord. 2021;80:102404. doi:10.1016/j.janxdis.2021.102404Kaczkurkin AN, Foa EB.Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence.Dialogues Clin Neurosci. 2015;17(3):337-346. doi:10.31887/DCNS.2015.17.3/akaczkurkinLange I, Goossens L, Leibold N, et al.Brain and behavior changes following exposure therapy predict outcome at 8-year follow-up.Psychother Psychosom. 2016;85(4):238-240. doi:10.1159/000442292Markowitz S, Fanselow M.Exposure therapy for post-traumatic stress disorder: factors of limited success and possible alternative treatment.Brain Sci. 2020;10(3):167. doi:10.3390/brainsci10030167Reid AM, Guzick AG, Fernandez AG, et al.Exposure therapy for youth with anxiety: Utilization rates and predictors of implementation in a sample of practicing clinicians from across the United States.J Anxiety Disord. 2018;58:8-17. doi:10.1016/j.janxdis.2018.06.002

Pittig A, Treanor M, LeBeau RT, Craske MG.The role of associative fear and avoidance learning in anxiety disorders: Gaps and directions for future research.Neurosci Biobehav Rev. 2018;88:117-140. doi:10.1016/j.neubiorev.2018.03.015

Hezel DM, Simpson HB.Exposure and response prevention for obsessive-compulsive disorder: a review and new directions.Indian J Psychiatry. 2019;61(Suppl 1):S85-S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18

Cullen AJ, Dowling NL, Segrave R, Carter A, Yücel M.Exposure therapy in a virtual environment: Validation in obsessive compulsive disorder.J Anxiety Disord. 2021;80:102404. doi:10.1016/j.janxdis.2021.102404

Kaczkurkin AN, Foa EB.Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence.Dialogues Clin Neurosci. 2015;17(3):337-346. doi:10.31887/DCNS.2015.17.3/akaczkurkin

Lange I, Goossens L, Leibold N, et al.Brain and behavior changes following exposure therapy predict outcome at 8-year follow-up.Psychother Psychosom. 2016;85(4):238-240. doi:10.1159/000442292

Markowitz S, Fanselow M.Exposure therapy for post-traumatic stress disorder: factors of limited success and possible alternative treatment.Brain Sci. 2020;10(3):167. doi:10.3390/brainsci10030167

Reid AM, Guzick AG, Fernandez AG, et al.Exposure therapy for youth with anxiety: Utilization rates and predictors of implementation in a sample of practicing clinicians from across the United States.J Anxiety Disord. 2018;58:8-17. doi:10.1016/j.janxdis.2018.06.002

American Psychological Association.What is exposure therapy?

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