Exposure therapy is a type of behavioral therapy that is designed to help people manage problematic fears. Through the use of various systematic techniques, a person is gradually exposed to the situation that causes them distress. The goal of exposure therapy is to create a safe environment in which a person can reduce anxiety, decrease avoidance of dreaded situations, and improve one's quality of life.

How Does Exposure Therapy Work?

When people experience anxiety due to a fear, phobia, or traumatic memory, they often avoid anything that reminds them of it. This avoidance provides temporary relief but ultimately maintains the fear and pattern of avoidance. In some cases, the avoidance can actually make things worse and give more power to the feared entity. Exposure therapy is designed to reduce the irrational feelings a person has assigned to an object or situation by safely exposing him or her to various aspects of that fear.

For example, while working with someone who has a fear of spiders—arachnophobia—an exposure therapist might first ask the person to picture a spider in his or her mind. This might lead to several sessions in which the therapist asks the person to imagine more intense scenes with the spider, all while teaching coping skills and providing support. Once the anxiety response is reduced, the therapist may progress to real life exposure. In this type of exposure, the therapist might start by placing a contained spider at the far end of the room and lead up to placing the spider in the person's hand.

History of Exposure Therapy

Exposure therapy originated from the work of behaviorists like Ivan Pavlov and John Watson in the early 1900s. Its roots trace back to principles of Pavlov's classical conditioning. Probably the most famous example of classical conditioning is Pavlov's dog experiment in which he methodically trained a dog to salivate at the sound of a bell. In 1924, behaviorist Mary Cover Jones shifted the field closer to exposure therapy with her studies on counter-conditioning: the process of changing an unwanted, learned response to a more desirable learned response. Cover Jones used comfort food and pleasurable experiences to gradually “erase” a little boy's fear of rabbits.

Years later, in 1958, behaviorist Joseph Wolpe developed systematic desensitization, a technique in which relaxation training, anxiety hierarchy (listing anxiety-producing triggers from most to least), and exposure are used to reduce one's sensitivity to situations he or she dreads. Later in the 1970s, Stanley Rachman developed exposure and response prevention while working with people experiencing obsessions and compulsions. In this method, people were encouraged to conjure up obsessive thoughts and then refrain from performing anxiety-reducing compulsions or behaviors.

Over the last 30 years, exposure therapy has continued to expand and both exposure and response prevention (ERP) and systematic desensitization are still used today.

What Techniques Are Used in Exposure Therapy?

Exposure therapy employs several methods to support the reduction of troubling emotional responses. Exposure therapists will conduct assessments to determine what combination of techniques will prove most effective.

Types of Exposure:

Specific Exposure Therapy Techniques:

Supplemental Techniques:

What Mental Health Issues Are Treated with Exposure Therapy?

A number of mental health issues can be treated with exposure therapy. Many people with anxiety and trauma-related issues have found exposure therapy to be helpful. Applicable mental health issues include but are not limited to:

How Effective Is Exposure Therapy?

The benefits of exposure therapy have been well documented and many studies cite exposure therapy as a first-line treatment for several mental health concerns.

Exposure Therapy Concerns and Limitations

Although there is a great deal of research to support the efficacy of exposure therapy, there are some notable limitations of the treatment. Sources report that in spite of the well-documented success rate of exposure therapy, many professional counselors and therapists do not implement it. Some speculate that this is because the availability of specialized training is limited. Additionally, a survey of psychologists who treat PTSD revealed that many believe exposure therapy may exacerbate symptoms. Beliefs that exposure therapy might make things worse may prevent many professionals from using it.

According to Mark Pfeffer, director of the Panic and Anxiety Center in Chicago, IL, exposure therapy is difficult work that causes people to feel things they have worked hard to avoid. Because of this, if not implemented properly, exposure therapy's positive effects can wane. That is why, even if you start to feel better, it is important to participate in treatment to the fullest extent and follow the prescription of a well-trained therapist. For many people, the effects of exposure therapy are lasting, and research continues to support its efficacy for treating anxiety, phobias, and many other mental health issues.

References:

  1. Cognitive Behavior Therapy. (n.d.). In International OCD Foundation. Retrieved January 19, 2015, from http://iocdf.org/about-ocd/treatment/cbt
  2. Comer, R. J. (2001). Abnormal Psychology (4th ed., pp. 143-168). New York, NY: Worth Publishers.
  3. Corey, G. (2009). Theory and Practice of Counseling and Psychotherapy (8th ed., pp. 245-248). Belmont, CA: Thomson Brooks/Cole.
  4. Exposure and Response Prevention for Obsessive-Compulsive Disorder. (2013). In American Psychological Association Division 12. Retrieved from http://www.div12.org/psychological-treatments/treatments/exposure-and-response-prevention-for-obsessive-compulsive-disorder/
  5. Exposure Therapies for Specific Phobias. (2013). In American Psychological Association Division 12. Retrieved from http://www.div12.org/psychological-treatments/treatments/exposure-therapies-for-specific-phobias/
  6. Kaplan, J. S., & Tolin, D. F. (2011, September 6). Exposure Therapy for Anxiety Disorders. In Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/anxiety/exposure-therapy-anxiety-disorders
  7. Kassin, S. (1998). Psychology (2nd ed., pp. 657-660). Upper Saddle River, NJ: Prentice Hall.
  8. Lebrun, N. (2011, October 20). Exposure Therapy Rescues Woman From Vomit Phobia. In ABC News. Retrieved from http://abcnews.go.com/Health/MindMoodResourceCenter/exposure-therapy-rescues-woman-vomit-phobia/story?id=1476421
  9. Porter, R. S., Kaplan, J. L., & Homeier, B. P. (Eds.). (2009). Anxiety Disorders. In The Merck Manual Home Health Handbook (3rd ed., pp. 853-862). West Point, PA: Merck & Co
  10. Rauch, S. A., Eftekhari, A., & Ruzek, J. I. (2012). Review of exposure therapy: a gold standard for PTSD treatment [Electronic version]. Journal of Rehabilitation Research and Development, 49(5), 679-688. doi:10.1682/JRRD.2011.08.0152
  11. What Is Exposure Therapy?. (2013). In American Psychological Association Division 12. Retrieved from http://www.div12.org/sites/default/files/WhatIsExposureTherapy.pdf