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Exposure Therapy

Exposure Therapy is one of the most effective treatments for anxiety problems, with up to 80% of patients experiencing a significant reduction in anxiety after only a few sessions. It is based on the fact that anxiety is maintained by avoidance of what is feared. The more the client avoids what they fear, the greater the fear becomes. Furthermore, as the avoidance continues, the fear “generalizes” to other areas of the person’s life, meaning more and more things become the objects of fear and avoidance. Exposure works by allowing the patient to come into contact with what he/she fears long enough for the patient to learn the negative consequences the patient expects does not occur, and the anxiety diminishes. This diminishing anxiety is called habituation. 

In Exposure Therapy, clients can work at their own pace, not engaging in any exposure assignments that feel too aversive or overwhelming. This made possible by the development of a fear hierarchy, which is a list of feared activities or situations arranged in order from least anxiety-provoking to most. The fear hierarchy is the blueprint for treatment in exposure therapy, with the patient beginning with the least anxiety-provoking exercise, and not moving onto the next until she has mastered it, meaning there is no longer fear or anxiety associated with it. By relying on this step-wise approach, each exposure assignment never feels too anxiety provoking or overwhelming due to the mastery of the previous assignment.  

Exposure can be used for a number of fears. For instance, with a dog phobia, the feared object is dogs. For social anxiety, the target of exposure is the triggering social situations. For OCD, the feared cues can be intrusive thoughts or situations that spark obsessive fears. In panic disorder, patients are exposed to bodily sensations associated with panic attacks. In posttraumatic stress disorder, the feared stimulus is memories of the trauma.Click for more information on trauma-focused CBT. Exposure can be imaginal exposure, meaning the feared situations are imagined by the patient, or in vivo exposure, in which patients come into contact with feared objects in real-life situations.