Exposure therapy

Three exposure therapy techniques

Clinicians implement exposure therapy using the following techniques:

• Graded exposure: Although exposure can be very anxiety-provoking, graded exposure uses a gradual approach to allay fears. The therapist first helps the client establish a fear hierarchy of a certain situation or object. Then, they expose the client over time to the feared stimuli from least to most anxiety-provoking. This gives people the opportunity to cope with less fearful events before they have to tackle situations that elicit high levels of anxiety.

As an example, let’s look at Joe, who suffers from ophidiophobia, or a fear of snakes. Joe starts to get scared when snakes are even mentioned but that is at the low end of his hierarchy. In the middle of his hierarchy is when he sees a movie or photos with snakes in them. At the top of his hierarchy is being left alone with a live snake. As such, the therapist would begin the treatment by simply talking to Joe about snakes. After he has gotten used to that, they would move up the hierarchy and maybe watch a video with snakes in them. Eventually, the hope would be that Joe could be left alone with a snake and endure it without crippling anxiety.

• Flooding: Flooding is when a person is introduced to an anxiety-provoking stimulus at the highest levels of their fear hierarchy. For example, this would involve leaving Joe in a room with a live snake at the beginning of treatment instead of waiting until he has coped with less fear-inducing stimuli. Flooding is a controversial technique. Although it can speed up the exposure process, it may also cause so much fear that the whole treatment is sabotaged. As a result, it is not often used compared with graded exposure.

• Systematic desensitization: Systematic desensitization—pioneered by psychiatrist Joseph Wolpe - is the pairing of relaxation methods with exposure techniques, most commonly graded exposure. The underlying premise of the approach is that if you are relaxed you can’t also feel anxious. The therapist will first have the client undergo a relaxation exercise, such as deep breathing, imagery, or progressive muscle relaxation. Then they will introduce the anxiety-producing stimuli. It is hoped that in a relaxed state, the stimuli will not produce as much fear. Eventually, through classical conditioning, the client begins to associate the stimuli with relaxation rather than fear.

Does exposure therapy work?

There is abundant research in support of exposure therapy but that doesn’t mean it is for everyone. By its very design, it will make clients feel anxious and uncomfortable, which may act as a deterrent for certain people.

In any case, here are a few of the many studies supporting its efficacy:

• Exposure therapy was found to help treat multiple anxiety disorders, including specific phobia, panic disorder, generalized anxiety disorder, and social anxiety disorder, along with OCD and PTSD.

• Exposure therapy decreased PTSD and depressive symptoms in veterans.

• Exposure therapy was effective in the treatment of specific phobia at the time of intervention and the eight-year follow-up.

Exposure therapy training resources:

• The University of Pennsylvania Perelman School of Medicine is offering a two-day workshop using exposure therapy in the treatment of PTSD. For clinicians experienced in dealing with trauma only.

• PESI offers a two-day comprehensive online seminar for incorporating prolonged exposure therapy into your clinical practice.

• Here is a quick video explaining exposure therapy from the Anxiety and Depression Association of America.

• For those who prefer the written word, Exposure Therapy for Anxiety: Principles and Practice, is a clinician’s best friend for implementing exposure therapy in their practice. It comes complete with case studies and sample treatment plans.

Exposure Therapy is one of the principal behavioral treatments for PTSD, OCD, and anxiety. Although not for the faint of heart, its effectiveness speaks for itself.