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Exposure therapy is widely accepted as an evidence-based therapeutic intervention for a variety of mental health disorders. This article when taking a look at the psychological and mental health conditions that can be managed with exposure therapy.

Exposure-based therapies include a wide range of behavioral techniques that mostly involve exposing phobic patients to feared situations. From a behavioral point of view, specific phobias are sustained due to avoidance of the fearful stimuli so that the person does not have the chance to discover that they can endure the fear, that the anxiety of fear will subside by itself without escaping or avoiding, and that their feared consequences frequently do not occur or are less severe than they imagine. 

It is possible to avoid a situation either by not engaging in it at all or by embracing it but not completely feeling it (for instance, drinking alcohol before taking a flight for an individual with a phobia of flying).

Thus, exposure therapies are intended to urge the individual to enter frightening settings (either in real life or via imaginal practices) and attempt to remain in those conditions. In most types of exposure therapy (– for example, implosion therapy), the person is initially exposed to a highly anxiety-inducing stimulus, as opposed to being slowly subjected to increasingly anxiety-provoking stimuli.

Several types of exposure therapy are helpful in the treatment of various phobias, therefore the specific strategy chosen may vary according to the nature of the phobia, as well as the preferences of the therapist and client. Despite this, the scientific evidence provides stronger support for certain exposure therapies (— in other words, in vivo exposure) than for others (for example, systematic desensitization).

In vivo exposure is the actual confrontation with the feared stimuli, typically in a progressive manner (for example, in a phobia of spiders, an individual might first see the pictures of a spider and ultimately go on to have physical contact with a large tarantula; in a phobia of flying, an individual might first read about a plane crash and then go on to sitting in a real flight). The treatment often lasts several hours and can be provided in a single very long session (e.g., a 3-hour session for arachnophobia) or in numerous shorter ones (for instance, three to eight 1-1.5-hour-long sessions). 

A variety of specific phobias respond favorably to in vivo treatment, even though treatment compliance and discontinuation can be problematic. In addition, therapeutic benefits are typically maintained for up to a year following the conclusion of therapy, especially for animal phobias (though follow-up data for blood-injection-injury phobia is less impressive). This sort of exposure therapy is also known as Guided mastery or Participant modeling when the therapist proactively models each phase of the exposure and instructs the phobic person on how to engage with the feared stimulus.

Applied muscular tension is a kind of in vivo exposure used to treat a fear of blood-injection injuries. This treatment combines typical exposure approaches with muscle tension workouts to counteract blood pressure drops that might cause fainting.

Virtual reality exposure blends real-time computer visuals with various body tracking sensors so that the person can adapt to the environment (e.g., being on an airplane that is lifting off, confronting a giant tarantula, staring over a high balcony ledge). This therapy appears to be effective for phobias that may be hard to treat in vivo; specifically, phobias of flying (where repetitive plane journeys are prohibitive) and height phobias; nevertheless, additional research is necessary to confirm its efficacy for a wide variety of phobia subtypes.

Systematic desensitization is subjecting phobic persons to fear-inducing pictures and thoughts (i.e., imaginal exposure) or real phobic stimuli while coupling the exposure with relaxation (or another reaction that is inconsistent with fear) to reduce the typical fear response. Systematic desensitization typically takes more time than in vivo exposure and appears to be more successful in reducing subjective anxiety than avoidance. If a patient is open to trying in vivo or an alternative form of exposure therapy, it is not suggested as the primary line of treatment.

Note that the cognitive dimension of many exposure therapies includes cognitive restructuring to confront incorrect or irrational thinking associated with the phobic object or reaction (e.g., I am about to fall, The dog is planning to assault me, I cannot handle this fear, etc.). In addition, there is evidence that combining in vivo exposure to cognitive therapy or providing cognitive treatment alone can be beneficial for claustrophobia, and that it may also be beneficial for dental phobia. 

Evidence showing the effectiveness of cognitive therapy for flying phobia is contradictory, and it is unclear whether combining cognitive therapy with exposure therapy for other types of phobias enhances outcomes.

Over a quarter of America’s population will suffer from an anxiety condition at some point in their lives. However, only a tiny fraction of individuals are managed with exposure therapy, even though it is well-established that exposure-based behavior therapies are effective interventions for many disorders. In the Harvard/Brown Anxiety Research Project, for instance, only 23 percent of treated patients indicated occasional imaginal exposure and only 19 percent showed occasionally in vivo exposure. The majority of mental health physicians do not have specific training in exposure-based therapy, which may be a contributing factor.

Exposure-based therapy is recommended as the first-line treatment for a range of anxiety disorders, according to the existing data. Here, we discuss a selection of the most prominent research demonstrating the effectiveness of exposure therapy. In addition, we address theoretical principles, practical relevance, and empirical evidence for this treatment, as well as present practical advice for therapists who seek to employ exposure therapy and empirical research to assist decision-making.

Flooding Vs Graded Exposure

The majority of exposure therapists employ a stepped strategy in which slightly frightened stimuli are addressed first, followed by stimuli that elicit more apprehension. This strategy involves building a hierarchy of exposure in which fearful stimuli are ordered according to the predicted fear response. By convention, higher-level exposures are not tried until the patient’s fear of the lower-level exposure fades. In contrast, some therapists have adopted flooding, in which the most challenging stimuli are handled right away (implosive therapy, an older variant, is not discussed here). In actual practice, these approaches look equally successful; nonetheless, the majority of patients and professionals prefer a graded approach due to a higher level of comfort.

In Vivo Vs Imaginal

In vivo exposure refers to the confronting of frightening stimuli in the real world. Occasionally, in vivo exposure is not possible (for example, It would be challenging and maybe dangerous for someone with war-related PTSD to encounter the sounds, sights, and scents of actual fighting.). Imaginal exposure can be a viable alternative in such situations. In imaginal exposure, the client is instructed to vividly picture and depict the feared stimuli (in this instance, a painful memory), typically in the present tense and with details about environmental (e.g., sights, sounds, scents) and internal (— for example, emotions, thoughts) signals.

In recent times, virtual reality exposure therapy (in which clients are involved in a virtual world that helps them to tackle their anxieties) has been investigated as an alternative to imaginal exposure, and preliminary studies indicate that it may be extremely helpful. Imaginal exposures may also be effective for confronting anxieties of worst-case situations (i.e., individuals with OCD who imagine contracting a fatal illness, or individuals with social phobia who envision being humiliated) to diminish the assertiveness of the concept.

Exposure therapy is recognized as behavioral therapy for PTSD. This is because exposure therapy targets acquired behaviors that individuals engage in (most commonly avoidance) in reaction to thoughts, situations, and memories that are seen as unpleasant or anxiety-provoking. For instance, a survivor of rape may avoid relationships and dates out of concern that she would be attacked again.

It is essential to acknowledge that this learned avoidance serves a function. A person who has had a traumatic event may seek to avoid threatening situations in an attempt to avert a recurrence of the traumatic event.

Moreover, avoidance can cause PTSD symptoms to persist for longer or even intensify.

A person who avoids particular thoughts, situations, or feelings misses out on the opportunity to discover that they may not be as frightening as they initially appear. Additionally, by suppressing, ignoring, or avoiding thoughts, memories, and feelings, a person stops processing these experiences to their fullest extent.

Exposure treatment is aimed to lower a person’s anxiety and fear with the ultimate objective of eliminating avoidance behavior and enhancing life quality. This is accomplished by deliberately confronting a person’s fears. A person might learn that worry and fear will subside on their own by confronting feared circumstances, emotions, and thoughts.

Consequently, how can one actively engage feared thoughts, situations, and feelings during exposure therapy? A therapist may utilize a variety of techniques. The details are listed below.

In Vivo Exposure

Under the supervision of a therapist, in vivo exposure is the direct exposure or confrontation with frightening objects, actions, or situations. A woman with PTSD who fears the place where she was abused, for instance, may be encouraged by her therapist to go there and openly confront her concerns (if it is not harmful indeed).

Similarly, an individual with a social anxiety disorder who is afraid of speaking in public may be encouraged to tackle these anxieties by giving a speech.

Imaginal Exposure

In imaginal exposure, the client is instructed to visualize frightening circumstances or imagery. It can assist an individual in confronting frightening ideas and memories directly. Imaginal exposure may also be employed when confronting a fearful event directly is impossible or unsafe.

For instance, it would be unsafe for a combat vet with PTSD to face a combat situation directly again. Consequently, he may be instructed to visualize a terrifying military event he encountered.

Interoceptive Exposure

Originally, interoceptive exposure was intended to treat panic disorder. However, evidence suggests that interoceptive exposure may also be effective in the treatment of PTSD.

 It is intended to help individuals directly confront feared physical symptoms linked with anxiety, like a rapid heartbeat and shortness of breath. The therapist may aid with this by having the patient hyperventilate briefly, exercise, hold his breath (in a safe and controlled manner), or breathe through a straw.

Prolonged Exposure

Extended exposure therapy is a mix of the three techniques listed above. It has been discovered that prolonged exposure is quite effective for PTSD patients. It entails a mean of eight to fifteen sessions lasting around 90 minutes each.

Exposure treatment can assist individuals with a social anxiety disorder (SAD) overcome their phobias of specific social and performance situations. While exposure training is typically undertaken under the supervision of a therapist as a component of a cognitive-behavioral therapy program, it can also be integrated into your everyday life.

If you suffer from social anxiety, you likely approach these situations with anxiety and fear or completely avoid them. This method can maintain your anxiety over time.

The following is a list with specific advice for conducting exposure therapy for a variety of phobias.

Exposure For Eating Fears

Individuals with a social anxiety disorder (SAD) who fear consuming food in public usually fear that they will be embarrassed while eating.

Exposure therapy for this phobia includes gradually engaging in increasingly challenging situations including eating in public.

Exposure For The Fear Of Social Situations

Individuals with SAD fear a variety of social settings, ranging from interacting with a cashier to participating in a huge formal party.

Exposure therapy for social anxiety might comprise a hierarchy that includes these and other anxiety-provoking circumstances.

This is among the easiest exposures to undertake, as it is quite simple to find and participate in the circumstances that you fear.

Exposure For Phone Phobia

Are you afraid of using a mobile phone?

Do you have frayed nerves when speaking on the phone in public? Do you occasionally avoid answering the phone or letting the voicemail reply?

If you responded yes to any of the above questions, you should seek exposure therapy for your phone phobia. Using a series of telephone scenarios, this common phobia can be readily overcome.

Exposure For The Fear Of Conflict With Others

Fear of conflict with those around you prompts many people with a social anxiety disorder to keep their viewpoints to themselves and let others take advantage of them.

Instead of avoiding conflict, exposure therapy can help you progressively confront future conflict and learn how to manage disagreements with others.

Important components of this exposure include learning and practicing assertive skills.

Exposure For The Fear Of Being The Center Of Attention

A common symptom of SAD is a crippling fear of being the focus of attention. You may blush or tremble when thrown into the spotlight, or you may want to swiftly change the subject if the discussion turns to you.

As with other challenging situations, you can conquer your anxiety of being the focus of attention by gently confronting your fears.

Exposure For Paruresis

Public toilet phobia is among the most difficult anxieties connected with social anxiety disorder.

This fear can impair your capacity to function and lead to social withdrawal and a desire to never leave the house.

You can use the concepts of exposure therapy to progressively become more comfortable visiting public restrooms if you suffer from this phobia.

Fear Of Being The Center Of Attention

Public speaking anxiety is frequent. SAD may be diagnosed, however, when anxiety about public speaking has a major influence on one’s professional and personal life.

One technique to conquer a phobia of speaking in public is to progressively confront exceedingly challenging speaking situations.

You may begin by delivering a toast at a gathering and then progress to enrolling in a Toastmasters course.

  1. Exposure therapy for anxiety disorders, Psychiatric Times. MJH Life Sciences. Available at: https://www.psychiatrictimes.com/view/exposure-therapy-anxiety-disorders.
  2. Exposure therapies for specific phobias: Society of Clinical Psychology | Division 12 of the APA. Available at: https://div12.org/treatment/exposure-therapies-for-specific-phobias.
  3. Exposure therapy for treating post-traumatic stress disorder symptoms. Verywell Mind. Available at: https://www.verywellmind.com/exposure-therapy-for-ptsd-2797654.
  4. How exposure therapy can treat PTSD. Verywell Mind. Available at: https://www.verywellmind.com/practice-social-anxiety-disorder-exposure-therapy-3024845.

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