Exposure Therapy For Anxiety: What It Is and What to Expect

When you're dealing with anxiety, it can be difficult to know what to do. Not only is anxiety something that's been created from years of experiences. It also fuels itself, causing it to create a type of cycle that requires intervention to be treated.

Anxiety often starts with a trigger, such as an event or situation that sets one off. It then escalates into an endless loop of thoughts and feelings. These can include fear, worry, and even self-doubt.

To try to interrupt that cycle and enhance your capacity to handle anxiety, cognitive behavioral psychologists rely on a variety of strategies. Exposure therapy for anxiety is one such technique, and studies have shown that it is one of the best ways to treat both short-term and long-term anxiety.

What is Exposure Therapy?

Exposure therapy is one type of psychological therapy that can help people get rid of their fears or anxiety disorders. It can help to ease any worry, distress, or dread that a person may experience as a result of a disorder or traumatic experience in the past.

In exposure therapy for anxiety disorders, a patient is exposed to a situation or stimuli that makes them feel anxious or afraid during exposure treatment. The worry and anxiety they endure over time can be lessened by safe, limited exposure.

Different exposure treatment strategies may be used by a therapist, depending on the patient's anxiety or problem. The therapist might create a plausible scenario for the patient to experience, for example. They could also encourage the patient to conceive situations or relive traumatic experiences during talk therapy.

How Does Exposure Therapy Work for Anxiety?

A person who has anxiety, terror, or panic is exposed to situations, events, or objects in exposure therapy. This applies to everyone with anxiety, including anxiety in adults and anxiety in children. Anxiety or panic might reduce over time with controlled exposure to a trigger by a reliable person in a secure environment.

Anxiety Disorders Exposure Therapy Can Help With

There are various types of anxiety disorders, such as generalized anxiety, sleep anxiety, social anxiety, and others. Exposure therapy can be effective at treating some of these types of anxiety, such as the following:

Generalized Anxiety

Both imaginal exposure and in-vivo exposure can be used as treatments for generalized anxiety disorder (GAD). However, in-vivo exposure is less frequently used. When compared to relaxation and nondirective therapy, research has shown that cognitive behavioral therapy (CBT) and imaginal exposure improve overall functioning in patients with GAD [*].

Social Anxiety

There is also exposure therapy for social anxiety. Individuals with social anxiety are frequently treated with in-vivo exposure. This can involve engaging in social interactions and not rejecting particular activities. The same study cited above revealed that cognitive therapy or exposure therapy may both be useful in easing social anxiety symptoms.

Separation Anxiety

One of the most prevalent anxiety disorders among children is separation anxiety disorder. The best method of treatment for it is exposure therapy. To do this, it is necessary to expose the child to frightening circumstances while simultaneously promoting flexible behavior and thought. For instance, children with social anxiety at school can be exposed to playing with their classmates gradually. The worry should then fade over time.

Common Types of Exposure Therapy Used in Anxiety

There are several types of exposure therapy. Work with your psychologist to determine which one is best for you. Some of the common variations of exposure therapy used in treating anxiety are the following:

In-vivo

A person will face a scenario or phobia that makes them feel anxious or fearful in real life during in-vivo exposure therapy. Someone may gradually work toward touching a live spider if they, for instance, have a spider phobia.

Imaginal

The right level of exposure will also be taken into account by the therapist when deciding how to do exposure therapy for anxiety. In imaginal exposure therapy, a patient is instructed to have a clear mental image of the situation or trigger that is generating them fear or anxiety. This can be a useful tactic for folks who are dealing with trauma because it would not be suitable to reproduce such events in-vivo.

If a person has already experienced trauma or PTSD, they may talk about their experience.

Imagining the source of fear or anxiety in a secure setting might help ease uncomfortable sensations in addition to talk therapy.

Virtual reality

As was previously mentioned, a therapist cannot realistically imitate all phobias in-person. If a patient, for example, has a fear of flying, a therapist might mimic flying for them using virtual reality equipment.

This exposes the client to a realistic and comparable experience, helping to diminish feelings of dread associated with, say, flying.

Interoceptive exposure

Interoceptive exposure therapy aims to cause physical responses that patients will later associate with anxiety or discomfort. For instance, a person with panic disorder may associate a spike in heart rate with a feeling of dread or danger.

The therapist might suggest running on the spot in a safe setting to recreate similar physical sensations without any sense of danger.

The therapist and the client may create a hierarchy out of the worries or concerns of the client. This requires ranking the scenarios according to the person's level of difficulty.

Then, the therapist could decide to start by addressing the patient's least or biggest fear. Inundation and gradual exposure are two terms that might be used to describe these two tactics.

Gradual exposure happens when individuals gradually expose themselves to more challenging circumstances, beginning with their least frightful concerns. This can help people develop the confidence they need to go over a more serious concern.

For instance, someone who fears snakes would begin by looking at pictures of snakes. The next step might be to put a snake behind glass in the space before holding it.

The act of exposing people to their most challenging concerns first is referred to as flooding. They may find it simpler to deal with their less-threatening issues after that.

Some people may just require one or two sessions to address an issue, while others may require longer-term counseling.

How Effective is Exposure Therapy for Anxiety?

The effectiveness of exposure-based therapy for anxiety disorders has been shown in several studies, and this conclusion has been compiled in numerous published meta-analyses. Several studies [*] looked at how patients with particular phobias responded to a single, 1–3 hour in vivo exposure session. 90% of these patients continued to exhibit a considerable decrease in fear, avoidance, and overall level of impairment at posttreatment follow-up (after an average of 4 years), and 65% no longer displayed a particular phobia.

Other research [*] randomized patients with OCD. In this study, patients received in-vivo exposure and response prevention, the medicine clomipramine, or a combination of both. From the participants who completed the study, 86% in the exposure group improved in terms of their obsessions and compulsions. This was 79% effective in the combined treatment group and 48% effective in the medicine only group.

How to Prepare for Exposure Therapy

Preparing yourself for exposure therapy can be a nerve wracking experience. After all, you’re going in for a treatment that will require you to confront the things that you fear.

Meditating for a few minutes before going to your session can help you remain calm throughout the process. It may also help to say some coping statements for anxiety to yourself before and after therapy.

Keeping a therapy journal is also useful because it will show your progress. Understanding how you’re improving and what else you need to work on can motivate you to keep going with therapy. If you’re feeling especially anxious, you can attach an anxious thoughts breakdown worksheet to your journal so that you can identify your anxious thoughts before, during, and after therapy.

Lastly, it’s best to have a support system in the form of family or friends that will help you throughout the experience.

The Bottom Line

PTSD, OCD, and panic disorder are just a few of the phobias and anxiety disorders that can benefit from exposure therapy. Collaborating with an exposure therapist can help you confront your anxieties or phobias.

Anyone interested in trying exposure therapy should find a psychologist or therapist with the necessary training and experience.

References:

1. Kaczkurkin A. Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. 2015.
2. Norton PJ, Price EC. A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. 2007.
3. Foa EB, Liebowitz MR, Kozak MJ, et al. Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. Am J Psychiatry. 2005.