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In Vivo Exposure Therapy is a form of Cognitive Behavior Therapy that is used to reduce the fear associated with these triggers. There are two different kinds of Exposure Therapy, including: Flooding — this type of Exposure Therapy involves rapid exposure to feared situations.
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- Overview
- Types of Exposure Therapy
- Techniques
- What Exposure Therapy Can Help With
- Benefits of Exposure Therapy
- Effectiveness
- Things to Consider
- How to Get Started
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Exposure therapy is a form of behavioral therapy designed to help you face your fears.
When you’re scared of a specific object or activity, you may avoid it. For instance, if you’re afraid of enclosed spaces, you may avoid taking the elevator, especially if it’s crowded. While avoiding it can help keep your fear at bay in the short term, it can cause your fear and anxiety to worsen in the long term.
Exposure therapy can help break this cycle of fear and avoidance. It involves exposing you to the source of your fear in a safe environment. Exposure therapy aims to help you overcome your fear so that the object, activity, or situation doesn’t cause anxiety, and you can engage with it meaningfully.
“A motto of exposure therapy is ‘Let's get comfortable with being uncomfortable,’” says Courtney DeAngelis, PsyD, a licensed clinical psychologist at Columbia University Medical Center who specializes in this form of therapy.
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Exposure therapy can help treat several conditions, including phobias, generalized anxiety disorder, and social anxiety disorder. However, there is a specialized form of exposure therapy, known as exposure and response prevention therapy (ERP or Ex/RP), that can help treat obsessive-compulsive disorder (OCD).
According to DeAngelis, ERP helps individuals with OCD face uncomfortable situations and reduce compulsions, which they might engage in to relieve anxiety. “By preventing the compulsion or ritual, you can build insight so that individuals learn that bad things do not happen, even when they do not follow the OCD ‘rule,’” says DeAngelis.
A 2015 study notes that ERP has shown great success in reducing the symptoms of OCD, a condition that was once considered untreatable.
Treatments for Obsessive-Compulsive Disorder
Exposure therapy can progress at different paces. Per DeAngelis, your therapist will guide you to face your fears according to a fear hierarchy or "ladder" that serves as a roadmap for treatment. They can also help you cope with the trauma and anxiety that each step of the process involves.
•Graded exposure: This involves exposing you to the source of your fear gradually by going up the ladder one step at a time. So, for instance, if you are afraid of needles, the steps could include looking at a picture of a needle, having a covered needle near you, holding a needle, etc., until you’re able to do what you fear most, which is getting an injection.
•Systematic desensitization: Your therapist may employ systematic desensitization methods to help you relax and get comfortable with each step of this process. These methods can include relaxation exercises like meditation, deep breathing, guided imagery, and progressive muscle relaxation.
•Flooding: This method involves exposing you to the highest level of the ladder all at once. Therapists may use flooding if your fear interferes with your ability to go about your daily life. While this approach can help you overcome your fear faster, flooding can be traumatic to experience. A therapist may consider this method only after your anxiety has decreased significantly.
How PTSD Is Treated
Therapists who practice exposure therapy may draw upon a variety of techniques, which DeAngelis outlines below.
According to DeAngelis, exposure therapy is particularly helpful when treating conditions that can cause anxiety. She explains that anxiety can prompt you to overestimate the threat of danger/discomfort and underestimate your ability to cope with the danger/discomfort.
“Exposure therapy works to address both of these challenges so that you can realize that your anxiety will naturally fade over time when facing an uncomfortable or scary situation and that you can handle that anxiety,” says DeAngelis.
These are some of the conditions and anxiety disorders exposure therapy can help treat:
•Phobias
•Panic disorder
•Generalized anxiety disorder (GAD)
Courtney DeAngelis, PsyD
Exposure therapy can significantly reduce an individual's anxiety symptoms, increase a person's ability or willingness to approach uncomfortable situations, and strengthen learning that individuals can handle hard things. — Courtney DeAngelis, PsyD Habituation: As you gradually and repeatedly expose yourself to the source of your fear, your reaction to it may decrease over time. Extinction: Exposure therapy can offer a safe environment for you to learn that the situation you fear does not pose a threat to you. It can help weaken your association between the situation and the negative outcome you expect. Emotional processing: This form of therapy can help you explore and understand the source of your fear. It can also help you replace your instinctive response with more realistic thoughts and beliefs about the feared situation and make you more comfortable with fear and anxiety. Self-efficacy: Over time, exposure therapy can help you realize that you can confront the situation you fear and manage the anxiety it causes. What You Can Do to Cope With Anxiety
“Exposure therapy is an evidence-based treatment, which quite simply means that the research has shown us that it works,” says DeAngelis.
According to a 2015 study, empirical evidence has shown that exposure therapy can help treat anxiety disorders, including phobias, panic disorder, social anxiety disorder, GAD, PTSD, and OCD.
Facing your fears can be difficult, so exposure therapy can be uncomfortable and challenging.
When you undertake exposure therapy, “it's important to understand that the clinician's goal is not to torture you, and to feel willing to tolerate uncomfortable situations or stimuli that you have been avoiding,” says DeAngelis.
Exposure therapy can also have occasional drawbacks:
•Symptoms may return: Some patients may see their symptoms return over time. This is especially likely if the treatment ended prematurely.
•Simulated conditions don’t always reflect reality: The conditions in exposure therapy do not always reflect reality. So, someone with PTSD, for instance, may be able to handle simulated conditions in a therapist’s office but may not be able to cope with the situation if it presents itself in reality.
Despite these limitations, exposure therapy is worth considering as a treatment option, as research supports its effectiveness.
If you would like to seek exposure therapy, start by looking for a qualified therapist, psychologist, or psychiatrist trained in this form of therapy.
You can ask your primary care physician for a recommendation or find one through local or state mental health associations.
Once you have found a qualified professional, make an appointment with them and ensure they accept your insurance. Your first appointment will probably involve filling out the necessary paperwork, which can include details regarding your symptoms, medical history, and insurance plan.
Work with your mental healthcare provider on mapping out your goals for therapy and make an effort to build a strong, collaborative rapport with them. Known as a therapeutic rapport, it is vital to exposure therapy because you need to feel safe and supported as you confront your worst fears.
If you have a fear or condition that is getting in the way of you living your life, you can seek exposure therapy to help treat it. While the prospect of facing your fears can be daunting, your therapist can guide you through the process and equip you with tools to help you cope with the anxiety you experience.
“There is great reward for those who are willing to ride the wave of anxiety and start to feel better again in their daily life,” says DeAngelis.
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1.Hezel DM, Simpson HB. Exposure and response prevention for obsessive-compulsive disorder: a review and new directions. Indian J Psychiatry. 2019;61(Suppl 1):S85-S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18
2.Kaczkurkin AN, Foa EB. Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues Clin Neurosci. 2015;17(3):337-346. doi:10.31887/DCNS.2015.17.3/akaczkurkin
Jun 9, 2023 · 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 ).
Aug 4, 2023 · The three categories of in vivo exposures: Exposure to situations, activities, objects that are avoided because they are perceived as dangerous. Exposure to situations or cues that are avoided because they are reminders of the trauma. Behavioral activation.
Jul 31, 2017 · Prolonged exposure is a specific type of cognitive behavioral therapy that teaches individuals to gradually approach trauma-related memories, feelings and situations. Most people want to avoid anything that reminds them of the trauma they experienced, but doing so reinforces their fear.
In vivo exposure: Directly facing a feared object, situation or activity in real life. For example, someone with a fear of snakes might be instructed to handle a snake, or someone with social anxiety might be instructed to give a speech in front of an audience.
Jun 21, 2021 · Exposure therapy is a technique used by therapists to help people overcome fears and anxieties by breaking the pattern of fear and avoidance. It works by exposing you to a stimulus that causes...
