Exposure Therapy for Anxiety Backfires in Study

Corrective learning is a process that occurs when existing conceptions and beliefs are replaced by more adaptive ones. For individuals with anxiety, panic, and phobias, exposure therapy is a common form of treatment that aims to produce corrective learning.

During exposure therapy, individuals are exposed to things they fear or that threaten them. Because these situations or things are usually avoided as a result of anxiety, the theory behind exposure therapy posits that being confronted with the feared item or event in a controlled environment will allow the individual to realize that his or her fears surrounding that item or event will not be realized. It is also believed that the level of fear or anxiety that is experienced during the exposure directly predicts the level of reduction in anxiety at treatment outcome. In other words, the more fearful or anxious someone is during a session, the more he or she will be able to overcome that fear in the long run.

This theory has been tested at length. However, Alicia E. Meuret of the Department of Psychology at Southern Methodist University in Texas wanted to examine this further. In a recent study, Meuret assessed the physiological and emotional responses of 34 participants with agoraphobia and panic as they underwent either a cognitive behavioral or breathing-based exposure therapy. She found that the participants all experienced increases in panic and anxiety during the sessions, as evidenced by physiological markers and emotional responses, but that these increases did not lead to better outcomes. In fact, the more panicked and fearful the individuals were, the worse their treatment outcomes. Additionally, in contrast to existing research, Meuret found that symptom reduction during treatment did not predict treatment outcome. In other words, even if the individuals experienced spikes in treatment severity during exposure and then were able to reduce their anxiety as the session continued, this drop did not lead to better overall outcome.

It has been suggested that allowing a client to experience symptom reduction during exposure provides a sense of self-control and mastery for the client and accomplishment for the therapist. And although this may indeed be true, the reduction of symptoms after exposure does not seem necessary for treatment success. In fact, the treatment outcomes were similar for those who left sessions with symptoms that were elevated as well as with symptoms that were diminished. Meuret believes that these results contradict the theory that fear reactivity is an indicator of treatment outcome, although her study was limited by sample size and the fact most of the participants were well-educated white females. “More research is needed to examine the underlying mechanism of corrective learning during exposure across therapy types,” she said.

Reference:

  1. Meuret, Alicia E., Anke Seidel, Benjamin Rosenfield, Stefan G. Hofmann, and David Rosenfield. Does fear reactivity during exposure predict panic symptom reduction? Journal of Consulting and Clinical Psychology 80.5 (2012): 773-85. Print.

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  • Russell

    Russell

    November 8th, 2012 at 11:38 PM

    Well if you are bringing someone face to face with their worst fears it is important to ensure they are mentally prepared and ready for it.Otherwise it can have negative consequences.And although I certainly agree that facing your fears will help you overcome them,the encounter should take place in the mind first and then in the real world.

  • Leigh

    Leigh

    November 9th, 2012 at 4:03 AM

    I have never understood anyway why the thinking that exposing us to our fears will help us get beyond them. Not for me that’s for sure. If I am afraid of something then why in the world would I want to confront it time and again? I mean, I get it that this is in a controlled environment and that I should feel pretty safe from it, but really, it doesn’t change that fear that I am feeling when I am face to face with those fears.

  • Boyd

    Boyd

    November 9th, 2012 at 8:35 AM

    I have always been intrigued by this sort of therapy. One of my greatest fears is falling from a high distance. Sort of like that man did last month when he free fell and then parachuted from 28 miles up. I guess you couldn’t really do anxiety exposure for that type of fear. Then again, maybe that is a legitimate fear and doesn’t need to be cured!

  • Eugene K

    Eugene K

    November 9th, 2012 at 8:37 AM

    I also have a fear that would be difficult to cure with exposure therapy-being kidnapped!! I guess a therapist could hide in my house, jump out, and kidnap me, but I think that would be crossing an ethical line or two. Or three.

  • Helen k garber

    Helen k garber

    November 9th, 2012 at 2:45 PM

    If done correctly, exposure therapy works very well. I have personal experience dating back to my behavioral mod therapy with the organization Terrap in the late 1970’s. they gave me the tools to deal with phobia, panic attacks and agoraphobia. I have not suffered a setback since and have gone on to a successful career as a fine artist..which includes speaking engagements and festival appearances, large crowd gatherings. Still feel more comfortable sitting on an edge of a cliff than sitting in the middle of an auditorium, but have stopped allowing fear control my life.

  • Mark C.

    Mark C.

    April 22nd, 2017 at 7:57 AM

    Your therapy worked because it was NOT Exposure Therapy…Not even close…If you don’t come close to committing sucide or becoming a dangerous psychopath–or something close–which is what I did, due to late but adequate and competant care… It doesn’t qualify as true “exposure therapy” There have been some modifications made in an attempt to “fix” or “soften” Exposure Therapy to make it less lethal and therefor at least somewhat defend-able … That is what is called… pissing into the wind!!

  • molly

    molly

    November 10th, 2012 at 8:57 AM

    it may be a great thing and all,but if my fears do not come in the way of my daily life then why do it at all?if I have a fear of water bodies,I would rather stay away from them than to go out and face my fears,risking a forgetful event.now if the fear was of a group of people then that could be beneficial but I don’t think this is really the way ahead for everybody!

  • Mark C.

    Mark C.

    July 25th, 2017 at 10:12 AM

    I’VE BEEN FREE FROM PTSD SOME TIME NOW WITH MY OWN “THERAPY” WORKING EXTRAORDINARILY WELL HERE IT IS.. STEP ONE-MAKE IT CLEAR THAT IF THEY EVER TRY EXPOSURE THERAPY ON ME AGAIN THERE IS GOING TO BE A DEAD PSYCHIATRIST TO DISPOSE OF. 2. BE NICE TO THE SWEET LITTLE OLD LADY THEY ASSIGN TO YOUR CASE AND TELL HER HOW MUCH YOU APPRECIATE NOT HAVING TO RESORT TO KILLING HER TO SURVIVE HER TREATMENT. TAKE THE MEDS AS SCHEDULED–THEY REALLY WORK “SERETONIN REUPTAKE INHIBITORS. MY PTSDIS AN EFFECT OF BRUTAL PARENTING, WHEN YOU ARE YOUNG. IN MY CASE A MOTHER WHO WHIPPED ME SAVAGELY WITH A BELT WITHOUT EVER TELLING ME WHY–SHE WAS ALWAYS SO MAD THE FROTH IN HER MOUTH MADE IT IMPOSSIBLE TO UNDERSTAND WHAT SHE WAS SAYING.(SCREAMING, ACTUALLY..}.

  • Jay

    Jay

    August 6th, 2017 at 7:51 PM

    What I think Mark is unless someone has dealt with extreme trauma like you have they don’t know what it is like. To use Exposure Therapy on what you experienced is just plain idiocy. Ludicrous in my eyes.

  • Smoky

    Smoky

    November 11th, 2012 at 7:08 AM

    From my own experience, all it takes is to push through. Really. Just go for it, man. Flood yourself with anxiety to the point you can’t take it anymore and then just push it a little further. It’s just an emotional state, after all. It’s just a perceived dangerous reality. The only way to understand the danger isn’t real, is to inspect it as though it’s real. If you want to prove something wrong, observe the evidence for why it’s right, and if it is indeed wrong the evidence will prove inconclusive. If you keep running away from the evidence, however, you’ll just live in fear of something that probably isn’t even real. And if it is real, well, … you better be aware of it, then, so you can take steps to prevent it. Also, I’ve learned that the greatest fear of all is the fear of fear itself. It’s what kept my anxiety clock ticking day after day, night after night, for an entire year. The moment you lie down in your bed with your eyes closed and realize that you’ve been afraid for years and you don’t even know what you’re scared of, and it has ruined everything you hold dear and will ruin it throughout eternity, and you ACCEPT that, and tremble through the ensuing fear. That’s when you take the first step to realizing it was all just a big hoax and a couple of months later you’ll be laughing about how stupid you were and how beautiful life is. It’s just anxiety. Face it. That’s why I believe in exposure therapy and why lying to yourself and hiding from your fears, in my opinion, is never going to work.

  • Smoky

    Smoky

    November 11th, 2012 at 7:37 AM

    I have to add, in my experience exposure of the fear was merely the first step. What eventually pulls the trigger on your anxiety is wisdom. Expansion of knowledge. To quote Timothy Leary – perhaps to the dismay of some people who were taking me seriously – it is the ignorant person who damages himself or his environment. This is also a very pronounced concept in Eastern philosophy and even the Western cognitive behavioral therapy (CBT). Gain rational insight into reality, and dissolve your irrational fears. Beware of forced insight, however. The belief in your new vision of reality has to be genuine. I’ve noticed that people who do CBT often ‘pretend’ – including myself, at first – to believe in positive thoughts because they want to get rid of anxiety. Fuck that. Plunge straight into reality, or more precisely the way you look at reality, however fearful that might be. Trust that your worldview will eventually evolve into something less fearful. Why? Because from an objective point of view, there really isn’t that much to be afraid of in a Western society. And when you notice that the fear of fear – phobophobia, to throw a more sophisticated term at it – is a major theme in your life, the trick is to understand that the fear you’re afraid of is not “normal” fear but an “abnormally” large and omnipresent fear of fear, although both are indistinguishable at a more basic level. In other words, the phobophobia isn’t really afraid of fear, it’s afraid of a distinct subgroup of fear, namely itself, although it isn’t aware of that. The moment it does become aware of that, and of the fact that fear as a general concept is completely harmless, it will dissolve. It’s also quite a boost to your self esteem. Hey, I have an anxiety disorder, but guess what, I have the balls to confront it day after day and some day not too far away from now I’ll be wise and free. Talking about your fears, especially at the moments when you feel you absolutely shouldn’t talk about your fear, even looking people in the eye and knowing that they can see the terror in your facial expression and accepting that, does a great deal for your social life and ideas about yourself in a social environment. Anxiety is just a big part of who you are at the moment, and whoever can’t live with that, or understand that this is merely temporary, is just plain wrong.

  • Mark C.

    Mark C.

    April 22nd, 2017 at 7:38 AM

    In my experience there is no such thing as “irrational fear” only sometimes you are blessed with a fear that will likely save your life if you let it. The only time this was not the case for me was when I was subjected to phony, un-necessary and pathological fear by a shrink at a va clinic abusing me with something called “exposure therapy” I did, in fact get an almost crippling fear based psychotic reaction as the result of this so-called “therapy” I'”m now on a mission to expose this deadly form of psychiatric malpractice for what it is….the sadistic use of veterans to supply psychopaths employed by the VA with victims they crave for their own demonic satisfaction. The only rational response to these demonic monsters is the nasal death blow your gunny in the USMC taught you in boot camp or Navy hospital Corps school. In court it will be a clear cut case of self defense from a lethal attack upon your life that you fortunately prevented,

  • Nate

    Nate

    November 11th, 2012 at 11:33 AM

    Well,unless you face your fears there is no getting over them,simple.If I’m afraid of riding a horse then will I better go out there and try to do that with some assistance and a professional.Now if you say why go out at all,then yeah you can stay the way you are creating a shell around you and never stepping out of it.But I guess for some people that just doesn’t make the cut.

  • Jerry Duvinsky, PhD

    Jerry Duvinsky, PhD

    November 19th, 2012 at 1:01 PM

    I would hate to see this study dissuade people from utilizing exposure based psychotherapies. Years have research have consistently shown the effectiveness of exposure therapies in helping people with a wide variety of emotional disorders: panic, agoraphobia, PTSD, phobias, etc. I personally use it to address a host of other presenting issues with my clients including chronic pain, depression and so on. I have not read the study in question however I can say that it was published in a very reputable journal. I can say, however, that often times, therapies conducted for research purposes are done in a very different way than would be conducted in a clinical setting. So for example, in the interest of maintaining standardization and experimental control, one has to have fixed number of treatment sessions, standardized treatment protocols etc. Thus, you might have to terminate a session before anxiety had a chance to habituate to a specific provoking stimulus for an example. Again, I did not read this study so I cannot comment on its design or execution. All I can say is that one should simply regard it as one study of many studies, the vast majority of which have produced different outcomes from the present one.

  • Anonymous

    Anonymous

    December 21st, 2015 at 7:48 PM

    I know from experience that exposure doesn’t work, because I’ve faced my fear thousands of times, and it still terrifies me. Going to work every day fills me with anxiety and dread, but the feeling never stops. I’ve been going to work for years, and I’m even more terrified now than when I started! It does not work.

  • MARK C.

    MARK C.

    July 10th, 2017 at 12:32 PM

    YOU SHOULD THANK ALMIGHTY GOD FOR YOUR FEAR- IT AS LIKELY ALREADY SAVED YOUR LIFE. IT CERTAINLY HAS MINE. RENEMBER THIS ANYONE, I MEAN ANYONE!!!! WHO WANT TO “CURE” YOU OF WHAT THEY CALL IRATIONAL FEAR IS DOING IT TO MAKE YOU EASIER TO KILL!! THIS IS ESPECIALLY TRUE IF YOU ARE IN A VA CLINIC. ALL THEY WANT IS FOR YOU TO GO AWAY SO THEY CAN TAKE A COFFEE BREAK. IF THEY HAVE TO DRIVE YOU TO SUICIDE TO DO THAT SO BE IT. EXCEPT FOR THE USUAL ACADEMIC STUPIDITY FOUND IN GOVERNMENT PROGRAMS THAT IS THE ONLY RATIONAL EXPLANATION FOR THE EXISTANCE OF EXPOSURE THERAPY. LET ALONE ITS INSANE SUPPORT STRUCTURE.

  • Foots

    Foots

    March 19th, 2015 at 8:58 AM

    It’s been three years since Smoky’s comments – I found this page as a result of a Google search. I’ll never look at it again, and possibly nobody will ever read my comment, but I couldn’t let it go. Smoky, I’m glad your persistence worked for you. But please don’t generalize. I, too, face my anxiety and fear every single day – and I have not ended up ‘wise’ or ‘free’. I have tried exposure therapy and, for me, it just does not work. For anyone else out there brave enough to confront their fears and saddened by the fact that their anxiety doesn’t lessen as a result – please know, you’re not alone. You’re also the bravest person I know, because you and I keep going on, as well as we are able, even though nothing has been found to help us yet. I’m not at all surprised at the results of this study – personally I believe there is a big difference between neurotypical people who have one specific fear or phobia, and people with a pervasive anxiety disorder, and of course not every therapy is going to work for every person, or group of people. So, Smoky – I’m truly happy for you, but please don’t suggest we all ‘flood ourselves with anxiety until we can’t take it anymore and then just push it a little further’ – that sounds like a recipe for attempted suicide to me.

  • Mr Heathcliff

    Mr Heathcliff

    March 30th, 2015 at 8:00 AM

    I agree with Foots. And, in my opinion, anyone who advises to “flood yourself with anxiety to the point you can’t take it anymore and then just push it a little further” has not experienced a genuine, full-blown panic attack.

  • Jack

    Jack

    October 29th, 2015 at 12:19 PM

    I agree with Foots too.
    Anxiety and panic disorder surface in people who, perhaps from exposure to prolonged periods of stress & disruption, are mentally exhausted. Mental exhaustion is absolutely the one big thing that needs to be addressed – and it takes time. My preferred route is a combination of physical exercise, good diet, progressive relaxation and proper sleep. Once exhaustion has become expunged, there is nothing to become “exposed to” as all OTT fears are automatically dissolved when restoration eventually takes place.
    “Exposure therapy” my big fat A! :-)

  • Daniel

    Daniel

    December 6th, 2015 at 6:26 AM

    Exposure therapy is not what its cracked up to be.It is NOT by any stretch of the imagination a garauntee of reducing anxiety.For example,it calls for the patient to remain in the anxious situation untill the anxiety reduces,yet anxiety often does not reduce regardless of how long the individual stays in the situation.I certainly dont feel less anxious after 2 hours in a minefield.Your still in a minefield after all!
    I know I still feel very anxious in any situation where I am at risk of being negatively judged,yet I have spent hundreds if hours in situations which provoked this anxiety.So why do I still hate being judged,despite fronting up to these situations so very many times before?
    Im sorry,but exposure is overrated.There are theoretical flaws with the concept,and in my experience there are great limitations of this therapy.

  • Mark C

    Mark C

    December 10th, 2015 at 12:55 PM

    The advocates of this therapy are no different than the zoologist who tried to teach a bullfrog to jump on command.
    After trying 3 times and failing to get a frog with all it’s legs cut off to jump by yelling..”Frog…JUMP” He wrote in his notebook… “Frog fails to jump. Conclusion: Frog is deaf.
    Frog fails to jump on command…Frog is obviously deaf.

  • Mike

    Mike

    February 27th, 2016 at 7:34 PM

    I have Panic Attacks and my anxiety comes from the Panic. This has been going on for almost 11 months. Beforehand I never knew anxiety, nothing about it at all. To treat it I’ve dabbled a bit with CBT and I’ve studied the H3ll out of ACT therapy. As far as exposure therapy goes I do it every day. Most days are fine but I have those days where I feel like my head is about to explode.

    I can stay in a situation until I feel better but it’s the sting of being pushed too far that keeps my anxiety and panic around. It’s almost impossible to think outside of the lens of those Physical sensations. Even more so after I’ve had a Panic attack.

    I really think it comes down to how well we think we can cope. Which in turn this determines how willing we are to face anxiety.

    Obviously I don’t know everything since I still panic, I have my good and bad weeks. I can calm down a little quicker these days. Beforehand if I had a panic attack it would take a week before I calmed down.

    I think the coping skills need to be taught first. Also different things work for different people. In my experience it seems a person needs to come to terms with their anxiety and panic, maybe some kind of understanding with it. It can’t be avoided.

    I can tell you that Defusion and Willingness have helped but they haven’t gotten me over the hump.

  • Mark C.

    Mark C.

    March 31st, 2017 at 1:32 PM

    I have beating this issue to smitherereeeens on line for the better part of a year now and have now taken some satisfaction o rendering the backers of this obvious psychiatric malpractice. I now go to a a va clinic with a sweet little old lady who renews my meds, “seratonin reuptake inhibitors” and as a consequence realizes she is in no danger of being killed by me while reacting to “exposure therapy”
    There’s only one cure for this debacle called “exposure therapy” but it consists of 2 possible outcomes….
    lot’s of well educated psychiatrists who are convinced that “exposure therapy” is dangerous quackery or, a cemetary full of dead psychiatrist, killed by patients reacting appropriately to their therapy,

  • Jay

    Jay

    August 6th, 2017 at 6:16 PM

    Sorry to hear you’ve had some bad experiences Mark with exposure therapy. I have also been exposed but not in environments of safety and have been humiliated publicly by this therapy and although I don’t tell anyone, I still suffer from severe anxiety but now worse than before. I sleep in a chair as I can’t sleep and it is debilitating to say the least at the hands of people that take things into their own hands that don’t really know what they are doing. I see it as a form of therapy that is used by people that lack total empathy. I read somewhere it is a hard therapy to watch. I have a lot of stress inside and I sniff continuously but I hide it well and have learnt to work with it for fear of being put into situation after situation that is really draining me which is making me feel worse. I tell everyone I feel better literally and keep it all to myself and I see it as the only way to keep going.

  • Jay

    Jay

    August 5th, 2017 at 3:01 PM

    It’s harmful and not a practice I see as being noteworthy in any way shape or form. The exposure is definitely overrated and can exacerbate ones issues and cause long term problems if exposed to situations they are not ready for. It took one smart person to tell me to work on my strengths that helped me more than anything.

  • Alex

    Alex

    August 6th, 2017 at 5:40 AM

    Couldn’t agree more, Jay :)

  • Jay

    Jay

    August 7th, 2017 at 1:32 AM

    I have gone through exposure therapy but of not my own accord. It was done without my consent. Unfortunately I suffer more severe anxiety now than I have before. I have been publicly humiliated and it has caused a lot of pain and I feel worse about myself than I did before. This has been ongoing for 4 years and the pressure has been a lot and increased a lot. I have been to see people but I am now at the point I tell people I feel better even though i don’t because I don’t get any resolve. I am trained therapist and would not use this therapy myself. I feel scarred and put on a false face. I’m working on my own strengths to get through my anxiety. It is quite brutal therapy and if you’ve not had any consent to it or put into situations you’re not ready for it can cause a lot of scarring. I would not opt for this therapy by choice.

  • JM

    JM

    August 13th, 2018 at 12:17 PM

    Although this page is old, this therapy is still very much in practice, and I hope it gets re-evaluated. I believe for some this may very well work, whether their experiences were severe I do not know. From my personal experiences from 2004 to 2018. I have repeatedly tried to comply with therapies. I had some horrible councilors (some might know the ones that put you in group when youre not close toready for it or tell you well you got a prescription now so I probably wont see us anymore… EXCUSE ME? never been addicted to drugs, no offense to anyone who has) and doctors and I have had some really amazingly kind. For me this means the relationship of therapist doesn’t always equal good therapy. I had a psychiatrist, therapist, and doctors that to this day I dont think they fully understand or are up to date on education. At first I thought I was doing something wrong, thats the way they made me feel. I wasn’t functioning to the standards or ‘normal’. It got to a point where to no longer hear them tell me to do things that caused me horrible triggers and anxiety.. and not without repetitively trying for years and punishing myself internally for not being able to do it… I started telling them that I was making small progresses that were untrue. Everytime I confronted my fears if thats what we call it some of my panic doesnt feel like fear at all. It spiraled into days or longer of not functioning at my normal. When they thought I was doing good enough to stop therapy, I chose acceptance and work life around my anxiety to function. not avoidance in my opinion so much as a more comfortable way to function without being spaced out full of physical and emotional pain from exposure. One thing I did learn from therapy, people can pretend to listen but they’re happier when they hear what they want to hear no matter whom they are. Exposure therapy taught me, I wasnt afraid of crowds it was how busy things were it didnt matter the size of crowd. Calmer the environment the better I can function, so I go when smaller quieter crowds, but it doesnt always work. I do ‘chicken out’ and try again another day but my way. I dont need to socialize and make new friends to feel confident. (one of many things they wanted me to do) If anything exposure therapy put doubt of self and lowered my confidence for a time… sometimes still does as family /support systems fail to understand as well. Again these are my experiences, and I was exposed repeatedly throughout my life to trauma, so maybe the level of trauma does have something to do with success or not. All I know is, if a councilor, therapist or doctor shows any disinterest or belittles an issue or pressures their veiws on me, I shut down, I am polite, I let them think they’ve won and excuse them from my life without word. I seek help, so its not avoidance. So many times they use special words to manipulate if you dont comply, its unhealthy and I think whether on purpose or the way they were taught unwittingly cause more harm than good psychologically.

  • JM

    JM

    August 13th, 2018 at 12:41 PM

    I would also like to add, if it helps anyone out there… behaviors of others whether doctors, councilors, family, friends can be a trigger. We can’t change them but we can feel sorry for them that they are not capable of understanding at our level. Also that calming peaceful places are extremely helpful in getting out more. I dont force myself to mingle and there is grocery delivery or pickup. I chose to garden, go to quiet parks and camping. Things that keep me at peace and boost my sense of well-being. It may not be someones idea of fun, but I thought I would put that out there incase someone does need it. Oh and it is okay to not talk to someone if they dont treat you well. professional or personal. It is okay and not your fault. All humans have emotions and will. Use your will to thrive your way as long as it doesnt harm your self or others, there is no harm in it.

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