Exposure Therapy

What is exposure therapy?

Exposure therapy is a type of cognitive behavioral therapy in which your therapist creates a safe environment to expose you to your fears. Fears may be things, situations and/or activities.

When we’re afraid of something, we tend to avoid the objects, activities or situations related to it. While this can help manage panic in the short term, over time, it can make our fears worse. In addition, avoiding certain places, situations and activities can interfere with your quality of life.

Exposure therapy helps show you that you’re capable of confronting your fears. You’ll learn to attach new, more realistic beliefs to the things you’re afraid of. You’ll become more comfortable with the experience of fear.

What specialist should I see for exposure therapy?

Several mental health professionals have training in exposure therapy. You may see a psychologist, therapist or counselor.

What conditions can exposure therapy help manage?

Exposure therapy is a helpful treatment for several mental health conditions, including:

• Acute stress disorder.
• Agoraphobia and other phobias.
• Complex post-traumatic stress disorder (PTSD).
• Generalized anxiety disorder (GAD).
• Obsessive-compulsive disorder (OCD).
• Panic disorder.
• Post-traumatic stress disorder (PTSD).
• Social anxiety disorder.

Exposure therapy may also help treat certain eating disorders.

You may need additional treatments for some of these conditions, like EMDR, other psychotherapy or medication.

What are the types of exposure therapy?

There are a few different ways to do exposure therapy, including:

• Imaginal exposure therapy: This therapy involves vividly imagining the thing, situation or activity you fear. For example, if you have PTSD, your therapist may ask you to describe aspects of the trauma.
• In vivo exposure therapy: “In vivo” means “in real life.” This type of therapy involves directly facing a thing, situation or activity you fear. For example, if you have a fear of heights (acrophobia), your therapist might have you safely walk across a bridge or look out a window of a tower.
• Interoceptive exposure therapy: This therapy involves triggering physical symptoms that develop when you experience intense panic or fear, like a pounding heart or shaking. You learn that while the symptoms may be uncomfortable, they aren’t harmful. This approach is especially helpful for people who fear the physical sensations that happen when they panic more than the specific thing or activity.
• Virtual reality exposure therapy (VRE): This therapy uses virtual reality technology to simulate things, situations or activities you fear. It’s helpful for situations in which in-person (in vivo) exposure isn’t practical, like if you have a fear of flying on airplanes (aerophobia).

There are also different types of exposure therapy based on the timing of it:

• Graded exposure: Your therapist asks you to list your feared objects, activities and situations in order of intensity. You start with mild to moderately difficult exposures and progress to more difficult ones over time.
• Flooding: This has the same approach as graded exposure, but you start with the most difficult and intense exposures first.
• Prolonged exposure therapy: This approach involves gradually coming closer to trauma-related memories, feelings and situations. It typically lasts about three months with weekly individual sessions, resulting in eight to 15 sessions. Therapists most often use this approach for people with PTSD.
• Systematic desensitization: This approach involves combining exposure activities with relaxation exercises. This can help the exposure experiences feel more manageable. It also helps you associate your fears with positive and calming activities.

How does exposure therapy work?

Your therapist will ask questions about your fears and anxiety to better understand your experiences. Together, you’ll come up with a plan for your exposure therapy.

The details of your treatment will vary based on the type of exposure therapy you’re doing and your specific type of fear or anxiety. Your therapist may assign you homework to do in your own time. Or you may work with them in their office, such as with imaginal exposure therapy or virtual reality exposure therapy.

During the exposures, you’ll seek out and confront what you fear. You’ll remain near it or in contact with it until your anxiety gradually goes away. You’ll experience several exposure activities over time to work on this process.

Therapists typically begin with mild to moderate exposure and build to more intense exposure. For example, if you have a fear of heights, you may first look at pictures taken from significant heights. Once you feel comfortable at that level of exposure, you may then look out of a window on the third floor of a building and gradually go higher and higher.

Your therapist will teach you strategies to manage your feelings of fear and anxiety in these situations. For example, if you experience an increased heart rate and shortness of breath when you face your fear, your therapist will teach you how to respond with slow, controlled breathing or other relaxation strategies.

Your therapist will continue to increase the intensity of exposure until you experience healthy interactions with the originally feared situation, activity or object.

How long will I need exposure therapy?

The length of exposure therapy varies based on:

• The severity of your fear or anxiety.
• The complexity of your mental health condition.
• Your willingness to commit to the therapy.

In general, exposure can increase as rapidly as you can tolerate it. Some people may need only a few sessions, whereas others may need several.

Try not to get discouraged by how long it may take to better manage your fears. The important thing is that you’re seeking help. Any progress is good progress.

Does exposure therapy work?

Studies show that exposure therapy helps over 90% of people with a specific phobia who commit to the therapy and complete it. It’s often the only kind of therapy necessary for a specific phobia.

It’s more difficult for researchers to measure the effectiveness of exposure therapy for more complex conditions (like PTSD and OCD) that may need other forms of treatment. However, several studies show that exposure therapy helps manage these conditions.

What are the risks of exposure therapy?

Exposure therapy can be distressing at first, as you’re directly facing your fears. But know that this therapy is safe and effective. Your therapist will be with you each step of the way to support you.

When should I call my healthcare provider?

It’s normal to feel uncomfortable during exposure therapy because it can be painful to explore negative emotions, fears and past experiences. If your symptoms get worse or you experience more severe fear or panic, contact your mental health professional.

If you’re experiencing thoughts of suicide or self-harm, call 911, go to the nearest emergency department or call 988 to reach the Suicide and Crisis Lifeline.

A note from Cleveland Clinic

While it can be overwhelming to seek help for a mental health condition, it’s important that you do. Exposure therapy can help you learn to cope with things and situations that you fear or cause you panic. Mental health professionals are experts in their field and have up-to-date knowledge of research and therapy strategies that can help you. Your mental health professional will tailor the therapy to your situation and needs.