exposure-based treatments

TL/DR:

  • Exposure techniques are highly effective in helping people confront situations or stimuli that cause them fear or anxiety.

  • Exposure-based therapies are far and away our best available treatments for anxiety disorders [i.e., Social Anxiety Disorder, Specific Phobia, Generalized Anxiety Disorder, & Panic Attacks], OCD, and PTSD.

  • In general, when implemented well, exposure works fairly quickly to get people to a place where they feel completely neutral toward the stimulus or situation that was previously causing them distress.

Exposure: An overview

Exposure is a highly effective therapeutic technique that was helps people confront things that cause them fear or anxiety. Because it works so well, exposure is an important part of several evidence-based therapies, including CBT for anxiety disorders and Exposure and Response Prevention (ExRP) for OCD.

When people are confronted with something they’re afraid of, a natural response is to avoid or escape the thing that makes them anxious or afraid. When that thing is an actual danger, this makes a lot of sense; however, when its not, avoidance actually serves to maintain and, in many cases, worsen anxiety and fear over time. When you avoid or escape these situations, you prevent yourself learning whether or not your anxiety and avoidance were actually warranted. Moreover, you may assume that the only reason you’re “okay” is because you avoided or escaped the situation. As a result, you’ll continue to experience anxiety and need to engage in avoidance or escape behaviors in the future, locking you into a cycle that’s difficult to disrupt alone. Exposure works by systematically exposing a person to the thing that causes unwarranted fear or anxiety in a safe environment without allowing them to engage in avoidance or escape behaviors; this process allows them to overcome their anxiety and fear by learning that either (a) the thing they’re afraid of doesn’t happen or (b) it does happen but it’s not as bad as they expected it to be.

Exposure-based therapies have been shown to be effective and are the first-line treatments for a number of conditions, including:

  • Specific Phobia

  • Social Anxiety Disorder

  • Panic Disorder

  • Generalized Anxiety Disorder

  • Obsessive-Compulsive Disorder

  • Post-traumatic Stress Disorder

Types of Exposure

As a first step, a therapist trained in exposure-based treatments will work with you to generate a list of the situations that cause you distress and together you’ll work to decide which techniques are best suited to addressing your specific feared situations. Depending on the nature of what you’re struggling with, different forms of exposure may be more useful than others. Here’s a brief breakdown of the types of exposure techniques that exist and what they involve:

In Vivo Exposure: In vivo exposure involves direct exposure to the thing you’re afraid of in the real world. For instance, someone with a specific phobia of dogs would be instructed to interact with a dog or someone with Social Anxiety Disorder who is afraid of starting conversations may be instructed to engage in small talk with a stranger.

Imaginal Exposure: Imaginal exposure involves using techniques to imagine the feared stimulus or situation vividly in your mind. Imaginal exposure is often useful when confronting the situation using in vivo exposure is not possible. For instance, someone with Generalized Anxiety Disorder may worry excessively about being fired from their job; rather than having the person engage in behavior that causes them to get fired, they will instead be instructed on how to engage in imaginal exposure of the feared situation.

Interoceptive Exposure: Interoceptive exposure involves exposure to harmless bodily cues or sensations that are being misinterpreted as dangerous. For instance, someone with Panic Disorder may experience anxiety that they may be having a heart attack when they notice their heart beat; to address this, they may be instructed to engage in cardiovascular exercise (e.g., running or jumping jacks) that intentionally increases their heart rate to learn that it is a harmless bodily sensation.

Although exposure sounds fairly straightforward, implementing these techniques as efficiently and effectively as possible requires working with a therapist who has advanced training in these strategies. When done well, exposure works fairly quickly, with the ultimate goal of having these stimuli or situations eventually becoming completely neutral to you.