Exposure therapy is an evidence-based therapy that falls under the behavioral school of psychology as it believes that any behavior can be corrected by altering the stimulus and providing appropriate reinforcements. This particular form of behavioral therapy originated from the works of Pavlov and Watson and it deals with prolonged phobias and feared stimuli.
Meaning of exposure therapy
To understand what is exposure therapy we need to understand the meaning of the terms separately. According to the dictionary, ‘Exposure’ is a state in which the person is placed in such a situation where they get no protection from any harmful or unpleasant stimulus. The word ‘therapy’ refers to the treatment of the physical symptoms but without any medicines.
Combined ‘Exposure therapy’ means the treatment of mental disorders by putting the individual in anxiety-provoking situations but without any protection.
Humans tend to avoid their fears to avoid dealing with situations but this makes the feared stimulus stronger than before. To avoid such a situation, psychological treatment of exposure therapy is provided, whereby, the individual is exposed to the unwanted stimuli, in a safe environment, so that one can face it instead of avoiding it together.
Example of Exposure therapy
We have looked at the meaning of the term above. To clarify it further let’s understand this behavioral therapy, with the help of some examples
- A person is fearful of spiders, she would avoid the places and situations where any encounter with the spider is possible. The presence of spiders will evoke anxiety and panic, leading to anxiety disorder and arachnophobia. In this case, the goal of exposure therapy would be to introduce these feared stimuli in a safe environment to reduce the associated fear and panic. The practitioner might start with imaginal exposure, slowly moving towards a living spider, i.e. in vivo exposure.
- A person has survived through extreme war conditions whereby, he had lost his fellow soldiers to war. This person will suffer from a post-traumatic stress disorder and anxiety disorders. To treat anxiety disorders and PTSD symptoms, his therapist would use imaginal exposure combined with virtual reality exposure therapy.
- Individuals facing social anxiety disorder will find social situations like family gatherings, parties at friends’ houses, prom nights, making small talks, etc. very stressful. To reduce their anxiety levels they would be introduced to different social situations in a graded exposure format so that they can overcome their fear through anxiety disorders exposure therapy.
How does exposure therapy work?
To understand the working of exposure therapy, we have to understand the process by which fears and anxiety occur in the first place. An unconditioned stimulus elicits an unconditioned response.
Say, a person got hurt in her room ( unconditioned stimulus) and cried (unconditional response). Now, the time when the incident happened, a spider(neutral stimulus) was present in the room. This person associates her crying with the presence of a spider, instead of her carelessness.
The next time, she sees a spider, she might cry due to this established association between a neutral stimulus and an unconditioned stimulus. But it will occur only when both stimuli have occurred together on several occasions. This will lead to phobia creation and to treat this, we might use exposure therapy.
Here, exposure therapy can help by breaking the association between the unconditioned and neutral stimulus. The person will be exposed to this fearful stimulus in a safe environment so that they can face their fears, knowing nothing harmful will occur.
What happens in exposure therapy?
Exposure therapy can take place anywhere, depending on the type of fear being addressed and the techniques being used. It can happen in a closed room, on open ground, on a beach, or any other place for that matter. The basic premise of exposure therapy is being immersed in a situation that creates fear.
The person has to put themselves in the situation, either virtually or in reality, to overcome it. The basic assumption of this therapy is to face your fear, to be exposed to it in totality. One has to fight their fears. The practitioner can only guide you through the process and provide a safe environment.
The fear-producing neurons are present in the amygdala. When undergoing exposure therapy, these neurons are silenced and as a result, they become less active. This leads to a reduction in the fearful response generated by the stimuli.
Even small progress in defeating their fear can boost their self-esteem. Once they start believing in their capability to defeat their phobias, anxieties, and fears their self-efficacy improves. Thus, exposure therapy works through the person’s efforts, under guided supervision.
Which mental health disorders can be treated via exposure therapy?
Exposure therapy can help in the effective treatment of various mental health disorders. Empirical evidence supports the claim that prolonged exposure and repeated exposure to fear-inducing stimuli can result in a significant reduction of the symptoms. The various mental health disorders that can be treated are :
- Post-traumatic stress disorder
- Social anxiety disorders
- Obsessive-compulsive disorder
- Panic disorder
- Generalized anxiety disorder
- Traumatic stress disorder
Types of exposure therapy
Exposure therapy is a broad term used to refer to different types of therapies within it. It can be performed using different methods, depending on the situation. As is said ‘ A single frame doesn’t fit all’, similarly a single form cannot be used for all kinds of anxieties and PTSD symptoms. It will vary as per the type of fear, the time for which it has been present, the circumstance i\of its occurrence, etc.
Say, a man who has experienced sexual assault as a child, cannot be exposed to that experience directly. So, every situation will demand a different type of treatment.
The various types of exposure therapy are as follows:
1. Flooding exposure therapy
In this technique, the individual is exposed to an intense anxiety-provoking situation with no effort to minimize the feared stimulus during the exposure. It is done to decrease avoidance and treat anxiety.
2. Systematic desensitization exposure therapy
In this technique, exposure therapists focus on progressive muscle relaxation. The aim is to associate the feared stimulus with relaxation exercises and break its link with specific phobias. It is done by providing gradual exposure to the feared object through relaxation techniques, guided imaginal exposure, pleasant sights, etc.
3. Graded exposure therapy
Exposure therapist creates a hierarchy of feared stimuli, ranging from least feared stimuli to most feared stimuli. They start with the least feared one and gradually move up the ladder.
For example, you fear dogs. In this situation, you will be shown the pictures of dogs first, moving to videos, then imagining yourself with them. The therapist might also start with puppies instead of grown-up dogs. The hierarchy that will be developed will depend on the severity of fear and your capability to deal with them.
Techniques for Exposure therapy
Exposure is not simply being placed in an unpleasant situation without support. It differs in kind. Not every technique of giving exposure is the same as not every situation is the same. Individuals can be exposed to fear-inducing stimuli through a variety of techniques, whichever is found appropriate by the practitioner. The selection of a particular technique depends on the nature of the problem.
The above-mentioned exposure therapies can be done using different exposure techniques, which are as follows:
1. Imaginal exposure therapy
This kind of exposure therapy can help through imagination. The individual is told to imagine the stimulus vividly in their minds so that they can relive that particular experience. It might exacerbate symptoms and cause further trauma, but it will help the person to face their specific phobia. If the person is fearful of heights, they have to imagine standing on a mountain or sitting on a cliff.
2. In Vivo exposure therapy
This kind of exposure therapy can help through real-life objects. The dictionary meaning of ‘in vivo’ is ‘performed or taking place in a living organism’. Thus in this exposure therapy, the person is exposed to real-life stimuli in real settings. Taking the same example as above, the person will have to stand on a mountain or sit on a cliff.
3. Virtual reality exposure therapy
Sometimes it is not possible to face the feared stimulus in reality, so virtual reality can help in such cases. For example, it might not be possible to go on a mountain, in such cases virtual reality can be created whereby both imaginal exposure and real-life exposure can be combined through virtual exposure.
4. Interoceptive exposure therapy
This exposure therapy works by exposing the individual to harmless physical sensations that induce anxiety or panic attacks. The wellness professionals bring in a different stimulus causing the same physical symptoms as the feared object.
For example, a person facing social anxiety feels sweaty palms, a racing heartbeat, etc. The interoceptive exposure will use a different stimulus, say running to cause the same physical responses. It provides empirical evidence to the person that these physical responses are not harmful and thus fears response can be prevented.
Effectiveness of Exposure therapy
Prolonged exposure therapy is an evidence-based treatment that has proved effective in treating anxiety disorders, posttraumatic stress, PTSD symptoms, etc. It has been chosen as a first-line treatment for various mental disorders.
- Lemmon (2002) found that cognitive-behavioral treatment was effective in the treatment of PTSD symptoms of sexually assaulted women.
- Reger (2011) reports that virtual reality exposure therapy proved an effective treatment for the active-duty soldiers posted in Iraq and Afghanistan.
- International OCD Foundation reports that 7 out of 10 people facing OCD go through a 60-80% decrease in their symptoms through exposure, response prevention, and cognitive restructuring.
- As per EBBP.org, people face a 60-90% decrease in their symptoms after participating in exposure therapy.
The article ‘Exposure therapy: walk through your fear‘, published in Deccan Chronicle on 25 May 2022 points to the fact that during the Covid times, this will work as the best therapy for people who are fearful of the virus, are depressed from death news, are scare to step out, etc. Anisha Jain, a senior psychologist at Mindtemple assures that exposure therapy is the best option available in this situation to deal with stress, fear, anxiety, etc.
How is exposure therapy helpful?
Various studies have shown that exposure therapy can reduce fear response. It has helped people deal with their phobias and lead pleasant life. The various ways in which it can help an individual are as follow:
Prolonged involvement in the therapy develops a reduced reaction to the feared stimulus. The individual gets habituated with the situation, object or idea and this helps them deal better with their fear and anxiety.
As discussed above, the link between conditioned and unconditioned stimulus needs to be broken to eliminate the fear. When an unconditioned stimulus occurs without the conditioned stimulus, extinction takes place. The fearful response gets extinct in this situation.
Exposure to unpleasant stimuli is stressful but when a person faces it successfully, it builds up their confidence of facing a similar situation in the future without any fear. This faith in themselves develops their self-efficacy.
Facing one’s fear in a safe environment provides space to explore them further. A person gets to know the origins of their fear. When a source is identified, it becomes easy to attach new emotions to the same phenomenon. Associating new feelings will help reduce the previous association, thus reducing the anxiety further.
Do not forget to check out the article: ‘5 reasons why expressive art as therapy is useful’.
Things to keep in mind
Falling within the realm of clinical psychology, this cognitive processing therapy should be administered by trained clinicians. Some things to keep in mind are :
- It might take a lot of emotional processing as it makes you vulnerable while facing the fear-inducing stimulus. The success rate will depend on the strengths of the person itself.
- Since behavior modification is not a simple procedure, therefore, post-treatment follow-up should not be missed.
- It should not be administered without expert supervision. Only trained therapists should use this technique.
- One should not forget that it does not guarantee any positive change so do not get your hopes very high.
- Symptom reversal can occur, therefore be careful once you have stopped the therapy.
Is exposure therapy harmful?
Different therapists have different views on this. Some believe that intense exposure to fear-inducing stimuli can result in extreme symptoms. When a person facing mental health disorder is made to go through their fears again, they tend to become violent, depressed, and even suicidal. It is not easy to face emotional trauma again and again.
It makes one irritable and vulnerable in front of some unknown practioner. This process takes up a lot of trust on part of the person going through the therapy as they have to be open to every emotion and situation that might occur.
Since it takes a lot of effort many people are likely to drop the therapy midway. This does more harm than good. A few sessions have exposed you completely to your fears, but you haven’t learned how to deal with them. This incomplete process will make you more confused and more fearful than before. So, it is important to complete the process once you have started and if you wish to stop midway, then do it with proper guidance from your therapist.
How to get started
The first-line treatment will involve consulting your primary care physician. You will get a better understanding of your symptoms and your physician will guide you in the right direction.
Once the physician has identified your problem, then you need to look for professional and licensed therapists. You can ask your physician for recommendations or can surf the internet for available options. Look for certified sites to find a licensed practitioner.
After identifying your therapist, reach out to them. Contact details can be obtained from the source itself. First, you might be asked to fill out the basic details like your medical history, current symptoms, etc. Also, do not forget to check for insurance coverage.
Once all this has been done, book an appointment as per your suitable time and reach there. You are good to go.