Exposure Therapy for Anxiety Disorders: How It Works
Clinically Reviewed by: Leigh Hall, LMFT
Written by: Janelle Martel
If you experience anxiety, you’re not alone. Anxiety is the most common mental health condition and impacts nearly 30% of adults in their lifetime. Many therapies and medications can help with anxiety. However, exposure therapy, which is a kind of cognitive-behavioral therapy, is widely considered to be the most effective treatment for anxiety disorders. In this article, we’ll explain how exposure therapy works and why it is an effective treatment option.
What is Exposure Therapy?
Exposure therapy is a type of cognitive-behavioral therapy (CBT). It involves gradual, controlled exposure to a feared stimulus. Your therapist will teach you coping methods to use during the exposure that will help reduce the anxiety that you feel. You’ll start with less anxiety-provoking situations, working until you feel comfortable, before progressing to more challenging situations. For example, an individual who has a fear of heights might progress from looking out the window on the second floor of a building to stepping out onto the balcony.
Types of Exposure Therapy
While all exposure therapy involves exposure to a feared stimulus, there are several different ways that you can be exposed to these anxiety-provoking situations or feelings. These include:
In Vivo Exposure: In vivo exposure means that you are experiencing the trigger in real life. For example, an individual with a fear of spiders might safely handle one, or an individual with social anxiety might make small talk with a stranger.
Imaginal Exposure: With imaginal exposure, the individual uses their imagination to picture the situation that is causing them fear. For example, someone with a fear of public speaking might imagine themselves giving a speech.
Virtual Reality Exposure Therapy (VRET): VRET is growing in use. Using virtual reality, you can be exposed to the sights and sounds of a feared situation while you remain in the safety of your therapist’s office or your own home. For example, a person with a fear of flying might use virtual reality to make them feel like they are on an airplane. One specific benefit of VRET is that it makes it easy to control the exposure and progress gradually as the client is ready.
How Exposure Therapy Works
When you have anxiety, it can seem overwhelming—and impossible—to confront your fears. But exposure therapy isn’t about throwing you into the deep end. Instead, exposure therapy works gradually to help you feel more comfortable in feared situations. In this section, we’ll talk about how exposure therapy for anxiety works so that you understand what to expect.
1) Assessment and Identification of Triggers
When you first meet with your therapist, they will help you explore your anxiety. You’ll discuss what makes you anxious, the symptoms you feel, and how anxiety affects your daily life.
From here, you’ll identify triggers that you can tackle in exposure therapy. While exposure therapy will be tailored to your unique fears and anxieties, some commonly addressed triggers include:
Specific phobias, like a fear of heights or spiders
Social anxiety, such as public speaking
Physical sensations associated with anxiety and panic, like shortness of breath and dizziness
Stimuli associated with the memory of a traumatic event
Obsessions driven by obsessive-compulsive disorder (OCD), such as a fear of germs or intrusive thoughts
2) Development of a Fear Hierarchy
Once your fears have been identified, your therapist will work with you to develop a fear hierarchy. You’ll create a list of feared situations and rank them based on how distressing or anxiety-provoking they might be. For example, for someone with a fear of spiders, holding a spider might be ranked high, whereas watching a video of a spider might be ranked low. These ranked items will then be listed from least anxiety-provoking to most anxiety-provoking.
3) Gradual and Systematic Exposure
Next, you’ll progress through the hierarchy gradually and systematically, from the least anxiety-provoking situation to the most. Sometimes, these exposures will be combined with relaxation techniques to make them more manageable. This is called systematic desensitization. Over time, the feared situation can even be associated with feelings of relaxation.
4) Repeated Practice and Reinforcement
Exposure therapy involves repeated exposure to each situation. As you are repeatedly exposed to each situation, your anxiety will naturally reduce over time. Each situation will be repeated until you’re able to feel comfortable in the situation, meaning that you don’t have significant anxiety. The speed at which you progress through your fear hierarchy depends on how you are feeling. Some individuals require only a few sessions of exposure therapy, while others need a slower and more gradual approach.
Why Exposure Therapy is Effective
Exposure therapy is an evidence-based therapy that has been shown to be effective in 90% of cases. Repeated exposure to a feared stimulus in a controlled way leads to habituation, which means that the emotional response to the stimulus decreases. In simpler terms, the feared situation doesn’t cause as much anxiety. Over time, this can lead to the extinction of the fear response, meaning that you no longer have fear or anxiety about the situation.
Addressing Common Concerns & Myths
While exposure therapy is a well-known treatment for anxiety disorders, it's normal to feel worried about facing situations that trigger anxiety. In this section, we’ll discuss some common myths and concerns that individuals have about exposure therapy.
Will it make my anxiety worse?
Because you’re confronting your fears, there can be an increase in the amount of anxiety that you feel initially. However, this is temporary, and anxiety usually decreases over the long term. While exposure therapy is effective, it’s important to work with a professional, as improper exposure therapy can increase anxiety.
Is it safe and supervised?
Yes, exposure therapy is safe and supervised. Exposure takes place in a safe, controlled environment. While there may be some discomfort as you confront feared situations, exposure therapy is not designed to cause harm.
What if I can’t handle the exposure?
If you’re feeling overwhelmed with the exposure, it’s important to let your therapist know. They can adjust your therapy so it’s more manageable, such as breaking down a situation into smaller steps, making it less intense, or reducing the duration. They can also help you practice self-regulation techniques so that you feel more comfortable during the exposures.
Octave’s Approach to Exposure Therapy
It’s natural to feel nervous about exploring exposure therapy, but it is an effective therapy that can help you feel better. Octave offers a caring, tailored approach to help you with exposure therapy. Our skilled therapists are trained to help you move through exposure therapy at a pace that suits you. They can also combine exposure therapy with other therapies to offer a holistic, customized approach for managing anxiety.
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