Exposure Therapy Basics: What It Is & Why It Works
Jill Stoddard
Written by Lauren Helm, M.A.
“Face your fears.” The wisdom of this adage is built into exposure therapy, an intervention that has been extensively researched and shown to be very effective in treating various anxiety disorders. What is exposure therapy? We break it down here.
Anxiety disorders are usually characterized by excessive and debilitating fear or anxiety. The anxiety may become so powerful that it can feel as though it has taken on a life of its own, domineering a person’s relationships, work, and quality of life. Though fear and anxiety are normal emotional responses to a threat (they motivate us to avoid potentially harmful situations), those with anxiety disorders often experience debilitating anxiety even when a truly dangerous threat is not present. Despite the absence of something that may cause physical harm, the brain’s fear centers are fully activated, and for someone with anxiety, it strongly feels as though something bad will happen. It is proposed that anxiety disorders in part develop as a result of both classical and operant conditioning, two important psychological concepts that inform and guide exposure therapy.
Basically, fear and anxiety are actually reinforced and strengthened when we avoid whatever causes it (whether it be a person, place, thing, thought, memory, emotion, or physical sensation that acts as a trigger). When we avoid or escape something that makes us feel afraid, it’s like our brain sends us a message that says, “Thank goodness I got away from that scary thing! It must have been truly dangerous. I am safe now that I am not longer in contact with the threat. If I get close to it again, I better make sure to get far away again!” A cycle is created. The next time we encounter the feared stimulus (i.e. whatever it is that triggered our anxiety), the more likely we are to experience a heightened fearful or anxious response, and to have stronger urges to avoid or escape.
In exposure therapy, the therapist leads her client through a set of experiences intended to elicit the very fear that the person has been avoided. Though this may seem counter-intuitive, it is an extremely effective behavioral approach that helps the client free themselves from the cycle of anxiety and avoidance. Essentially, avoidance is “blocked;” the client begins learning how to face his or her fears, and in doing so, experiences habituation. Habituation is like desensitization. When someone is exposed to something repeatedly, it begins to lose potency. Anxiety and fear naturally drop off, and with repeated exposures, become less intense and long-lasting. Additionally, when avoidance is prevented, the fear/anxiety response is no longer reinforced and strengthened. This leads to an extinguishing of the fear response. In other words, a fearful or anxious response is “extinguished” and fades away over time.
Most people have trepidation about starting exposure therapy. It is admittedly uncomfortable, at least in the short-term. However, the long-term benefits far outweigh the discomfort that may occur along with exposure therapy. Usually, it turns out that we hold beliefs about emotions (especially fear and anxiety) that interfere with our willingness to effectively face our fears.
Common myths about emotion typically include beliefs that:
- Fear or anxiety will continue to escalate (without a ceiling effect or peaking) indefinitely until the person gets away from whatever is causing them anxiety
- Fear or anxiety will become so intense that it will cause physical harm or death
- Fear or anxiety will become so intense that it will cause psychological damage, insanity, a loss of control, etc.
These beliefs often reflect a fear of emotions stemming from a commonly-held belief that emotions are dangerous. In and of themselves, emotions are not dangerous – they are physiological sensations (along with thought & urges). The sensations are designed to motivate us to act. The feelings that come along with emotions may be experienced as overwhelming (especially when we don’t understand them or it feels as though they can do us harm), but they will not hurt you (and it is not physically possible for them to intensify beyond a certain point). Frequently, exposure therapy results in the added benefit of being able to tolerate intense emotions, and learn that it is safe to fully feel your emotions. It’s what you do with your emotions that count – how we ACT can have a beneficial or detrimental effect on our lives and well-being. Therapists help you to learn how to effectively respond to your emotions, so that they don’t restrict your way of life. Your CSAM therapist is well-trained in exposure therapy principles and will explain in more detail why it is not the case that intense, acute emotional experiences cause harm. In fact, one of the principles of exposure therapy is to ensure that individuals are absolutely not caused harm – otherwise that would defeat the point! Exposure therapy is all about learning that despite the anxiety, there is no danger, but rather, safety. Once this is sufficiently experientially learned and processed (not just known intellectually), dramatic change begins to occur.
Don’t worry – your therapist will collaborate with you to figure out the best pace of treatment. Depending on your needs, you may opt to participate in flooding (which essentially means that you face some of your most intense fears right away), or the more commonly used approach, gradual exposure (you work your way up an exposurehierarchy, starting with mild-moderate fears). Both approaches have been found to be equally effective, but differ in the length of time that they may take to complete, and in the likelihood of premature drop-out. Remember, exposure requires repeated practice facing your fears until a re-learning occurs. Sticking with exposure therapy until anxiety has naturally begun to dissipate (or tolerance of anxiety has increased) is essential for success.
Are you interested in using exposure therapy to tackle your fears? Our CSAM therapists are trained in exposure therapy and can help you effectively respond to anxiety using evidence-based methods. If you'd like to speak with a professional at the Center for Stress and Anxiety Management for help with anxiety, please click here.
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References
Barlow, D. H., Craske, M. G., Cerny, J. A., & Klosko, J. S. (1989). Behavioral treatment of panic disorder. Behavior Therapy, 20(2), 261-282.
Barlow, D. H., Rapee, R. M., & Brown, T. A. (1992). Behavioral treatment of generalized anxiety disorder. Behavior Therapy, 23(4), 551-570.
Feeny, N. C., Hembree, E. A., & Zoellner, L. A. (2004). Myths regarding exposure therapy for PTSD. Cognitive and Behavioral Practice, 10(1), 85-90.
Foa, E., Hembree, E., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences therapist guide. Oxford University Press.
Hofmann, S. G. (2008). Cognitive processes during fear acquisition and extinction in animals and humans: Implications for exposure therapy of anxiety disorders. Clinical psychology review, 28(2), 199-210.
