Does Exposure Therapy Lead to Reduction or Avoidance of Anxious Symptoms?

Exposure therapy is one of the most common forms of therapy to address symptoms of anxiety and panic. The goal of exposure therapy is to expose a client to cues that will induce fear and anxiety and help them experience those symptoms until they have reached a point of symptom reduction. At the conclusion of the exposure, the client will have a better sense of control over their own emotions and will eventually experience decreased fear of stimuli that induce anxiety and panic. However, according to a recent study led by Alicia E. Meuret of the Department of Psychology at Southern Methodist University, exposure to fearful situations may actually cause clients to avoid their anxious symptoms and may create a false sense of mastery.

Meuret measured the physiological responses of 34 clients who suffered with agoraphobia and panic. The participants underwent 3 weeks of exposure therapy involving either cognitive or breathing exercises. They completed a fourth session 2 months later. Meuret assessed the heart rates, respiratory rates, carbon dioxide levels, and external anxiety and panic symptoms of all the participants during their sessions and at the conclusion. She also evaluated their avoidant behaviors and overall functionality. Contrary to research that suggests exposure therapy aids in the management of anxious symptoms, Meuret found that elevated heart rates were present in both groups of participants during and after their sessions. Although some of the participants did experience decreased outward anxiety symptoms, this did not predict the overall outcome of their treatment.

Meuret believes that this could be due to the anticipatory anxiety that was evident in the participants. Prior to being exposed to fearful stimuli, the participants had elevated levels of anxiety because they were worried about the impending events. Additionally, the breathing techniques used by the respiratory group did lower their respiratory rates in response to fearful stimuli but did not decrease their heart rates. Meuret did find that overall, the panic symptoms of all the participants decreased at follow-up. Despite the mixed physiological findings, these results could imply that clients who are instructed to wait until their fear subsides before they finish their exposure may gain a false sense of empowerment and mastery over their symptoms, which leads to a reduction in symptoms of panic. Meuret added, “Willingness to experience and tolerate anxiety symptoms, rather than trying to reduce or eliminate them, may provide the necessary space for learning new aspects and values of the feared situation.”

Meuret, A. E., Seidel, A., Rosenfield, B., Hofmann, S. G., Rosenfield, D. (2012). does fear reactivity during exposure predict panic symptom reduction? Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0028032

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  • cristen


    April 17th, 2012 at 3:43 PM

    I would hope that it teaches you how to reduce the symptoms, not just to avoid them. Assuming that the whole point of this kind of therapy is to keep you cool headed even when you don’t have that much control over your environment is going to be the most beneficial to any patient. You can’t always avoid a certain situation that may cause you stress and anxiety; but if you are given the right coping tools, then that won’t matter. That does not have to socially paralyze you anymore.

  • james T

    james T

    April 18th, 2012 at 4:13 AM

    have always kind of been leary of exposure treatment
    i know that it could help you face your fears
    but it could also set you up to be even more stressed out about them when you know that they are going to be confronting you

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