What Is Exposure Therapy?

 

 

Famous behaviorists like the Russian physiologist Ivan Pavlov and the American psychologist John Watson developed the early principles of the behaviorist school of psychology. People who have taken an introductory psychology course are familiar with these two individuals. Pavlov is famous for his work with classical conditioning in dogs, where he was able to condition dogs to salivate when they heard a bell. Watson is famous for inducing fear in a young child whenever the young child saw a furry animal (the famous Little Albert studies).

In the 1920s, studies were conducted to actually counter condition fears in children by offering them comfort food in the presence of a feared stimulus such as furry animals. Late in the 1950s, the technique of systematic desensitization was developed to reduce anxiety in individuals. It was achieved by pairing relaxation with exposing the individual to increasingly anxious conditions.

In the 1970s, the exposure technique of response prevention was developed to assist people who had a severe disorder known as obsessive-compulsive disorder (see below). All of these techniques are based on the earlier work of individuals like Pavlov and Watson, and they are different types of exposure therapies.

Exposure therapies remain a powerful set of techniques, when used properly, to reduce certain types of fearful and anxious behaviors.

 

 
Exposure therapy was primarily designed to address individuals with anxious or fearful behavior. Individuals who are anxious about some situation or fearful regarding certain situations or things will often spend a great deal of time and energy avoiding the feared object. Avoiding the source of one’s anxiety or fear might be helpful in reducing the experience of anxiety or fear; however, it often is not a viable solution. For instance, someone who is severely fearful of being in open places with no escape route (agoraphobia) is eventually going to have to leave the house for some reason. Someone who has an extreme fear regarding spiders will eventually come into reasonably close proximity with a spider.

Moreover, continued avoidance of feared objects only makes the anxiety or fear related to the object or situation worse. Exposure therapy was designed to quickly treat these types of situations.

 

 
Results from research studies have indicated that exposure therapy can be useful in the treatment of:

• Panic disorder, where an individual has repetitive panic attacks
• Social anxiety disorder, where individuals are extremely anxious or fearful of interacting with others
• Phobias, which are unrealistic extreme fears or anxiety associated with relatively common objects or events
• Obsessive-compulsive disorder, a severe psychological disorder where an individual is troubled by recurrent and anxiety-provoking thoughts (obsessions) and engages in recurrent, ritualized, behaviors to reduce the anxiety they experience (compulsions)
• Post-traumatic stress disorder, a disorder that results in extreme fearfulness, intrusive thoughts, flashbacks, and other psychological symptoms as a result of being involved in some serious traumatic event
• Generalized anxiety disorder, which is characterized by chronic feelings of anxiety that interfere with an individual’s daily activities

 

 

There are a number of different types of exposure therapies that can be applied to an individual’s anxious or fearful behavior. Some of the major types of exposure therapies include:

• In vivo exposure: This involves directly confronting the situation or object that the individual is fearful of. For instance, someone who is extremely anxious about public speaking would be instructed to get up and give a speech in front of a group of people.
• Using imagery: In this form of exposure therapy, individuals imagine the feared object or situation. For example, exposure treatment for post-traumatic stress disorder often involves individuals recalling events of the traumatic experience.
• Interoceptive exposure: This form of exposure involves eliciting physical sensations that are associated with anxiety or fear. For instance, individuals with panic disorder could be instructed to increase their heart rate (which is often a trigger for their panic attacks) by doing light exercise. This physical exhilaration under controlled conditions teaches these individuals that their feelings are not dangerous.
• Exposure and Response Prevention Therapy: This is a specialized type of exposure therapy for treating obsessive-compulsive disorder. The therapist induces conditions that trigger the obsessions (recurrent thoughts) in the individual and then does not allow the person to engage in the compulsions (the repetitive behavior that is associated with recurrent thought). For example, those who are extremely anxious about bacteria or dirt and compulsively washes their hands would have their hands slightly soiled in a therapy session, and the therapist would not allow them to wash their hands.
• Virtual reality exposure: This is a relatively new form of exposure where virtual reality technology can be used in the therapeutic situation to recreate feared situations, such as flying in an airplane, riding on a train, etc.

 

 

Individuals reading the above descriptions of the different exposure therapies may be thinking that exposure therapies are a form of punishment. Actually, these techniques are quite effective and very often work rather quickly. While exposure therapy is effective, it is not a cure for severe disorders, such as obsessive-compulsive disorder or post-traumatic stress disorder. People with these disorders often experience marked reductions in their anxiety levels as a result of exposure therapy; however, further treatment is generally needed to address more longstanding issues.

Exposure therapy can create a certain level of discomfort in individuals. Trained therapists who use exposure therapy have several options regarding how it is implemented in treatment. Exposure therapy can be given all at once or implemented at a slower pace. Some of the ways to deliver exposure therapy include:

• Flooding: The individual is exposed to the most difficult or fearful task immediately. This technique can be effective but needs to be used with discretion for obvious reasons.
• Systematic desensitization: This technique combines relaxation training and the use of a hierarchy of fear-producing objects to help the individual adjust. Individuals are instructed in muscle relaxation and diaphragmatic breathing techniques to teach them to learn to relax. They are then exposed to a hierarchy of situations/objects that begin with the least fearful situations/object, and they are exposed to them while practicing their relaxation techniques. As they master their anxiety, they move up to the next object in the hierarchy until they can tolerate the most feared situation/object.
• Graded exposure: This refers to using the hierarchy of fears described above without the relaxation component.
• Imagery or in vivo exposure can be used in any of the above situations.

 

 
The potential mechanism by which exposure therapy works is most likely via a combination of several factors. These include:

• Extinction: Extinction refers to a weakening of the previous learned associations with stimuli.
• Habituation: When we are exposed to stimuli that produce intense feelings, the longer we remain exposed to the stimuli, the less intense the feelings become. When a person sits in a very hot tub of water, as the body adjusts to the temperature, the water does not feel as hot. Exposure therapy may work in this manner.
• Replacing emotions: Being exposed to a feared object results in individuals learning more realistic attitudes toward the feared object.
• Increased efficacy: As people are exposed to situations or objects they fear for longer periods of time, they tend to learn that the reason for their fears was unjustified.  They develop stronger feelings of self-confidence regarding their ability to deal with the anxiety-provoking stimuli.

 

 
Exposure therapies are typically limited to treating issues with anxiety or fearful behavior.  They can be useful components in substance abuse treatment where anxiety is an issue, but they are not designed to treat substance abuse. While exposure therapy is backed by empirical evidence that supports its use for a number of different conditions, there is also a potential that if used by the wrong person negative effects and even serious harm could occur. For instance, using exposure therapy in cases of post-traumatic stress disorder should only be attempted by clinicians who are well trained in the use of this technique for this particular patient population.

Therapists using exposure therapy need to apply sound judgment, individualized programs, and the ability to listen to clients to make sure they can tolerate the treatment. In addition, even though exposure therapy has an impressive body of research to support its use in treating a number of psychological disorders that are associated with fearful or anxious behavior, many therapists are not properly trained in its use. Clients entering treatment who are being treated with exposure therapy should make sure that the therapist has been fully trained in its use.

Exposure therapy is not recommended for individuals who have severe psychological problems that result in them being psychotic, extremely emotionally unstable, or potentially suicidal or self-harming.  Some alternatives to exposure therapy include:

• Most forms of Cognitive Behavioral Therapy
• Brief forms of psychodynamic therapy
• Interpersonal therapy
• Some forms of behavioral therapy