Exposure Therapy

Do you have fear that disrupts your life? Exposure Therapy is an effective strategy for a variety of anxiety problems, including PTSD, Obsessive-Compulsive Disorder, and Phobias.  The core of most exposure therapy strategies consists of reducing anxiety by overcoming avoidance, and learning new “safety” ideas.

Learning to be Afraid:  Anxiety often is the result of learning to become upset by situations, triggers, or memories. As the anxiety takes hold, the feelings become a source of stress in addition to the situations, triggers or memories–you become afraid of theanxiety emotions. As a result, the anxiety becomes even more rooted as you avoid not only the triggers or memories, but you work hard to escape the feelings of anxiety. In other words, you reward your avoidance by reducing your exposure to both situations and your own feelings. 

How Anxiety Thinking Starts: Eventually you develop not only avoidance, but ideas that make both triggers and feelings seem very risky. Thinking, and sometimes images in your mind, become prone to frightening material. These are often called distorted thinking–and in anxiety, these distorted thoughts usually tell you that a horrible catastrophe is certain to occur, and you won’t be able to do anything about it. 

Only Noticing Fear:  Unfortunately, as the anxiety becomes solidified, your avoidance and escape deny you the chance to see if a) the catastrophe actually occurs, and/or b) you could have actually coped with whatever actually happened. Typically, if you do have to face a fear, you quickly forget that your predictions didn’t come true–you don’t re-examine your fearful thoughts to see if they made any real sense or not.

The Fire Extinquisher for Anxiety: Exposure therapy causes what is called “extinction,” or the removal of the rewards from avoidance or escape.  As you “sit” with your anxiety, it reduces naturally (through a process known as habituation) and you end the constant avoidance. Once you go through exposure repeatedly, your therapist helps you learn new thoughts that focus on remembering that things are actually safe and that you can cope with problems.  These knew “safety” ideas become stronger over repeatedly exposing yourself to your fears.

Overcoming Fear for the Long Haul: The end of exposure therapy is intended to make your new learning “stick” through something known as “inhibitory conditioning.” What your therapist will do is teach you ways to keep using exposure, and find related situations or memories to the ones targeting in treatment–and apply exposure to those as well.  Using a sort-of self-administered booster to the treatment has been shown to improve the longterm outcome of exposure work.

Some forms of exposure therapy are very specific in their methods, like the treatment for obsessive-compulsive disorder. Others are more straightforward and can be done in one single treatment episode (like those for phobias). Others might include exposure to emotions coupled with direct efforts to change anxiety-based beliefs (for example, Cognitive Processing Therapy). 

For an illustration of exposure therapy for a snake phobia, check out this YouTube. It’s pretty amazing. https://youtu.be/zKTpecooiec

For more information, visit

APA Div. 12 Fact Sheet on Exposure Therapy

Article on Exposure Therapy reprinted at Univ of Penn

Dr. Craske on Inhibitory Learning