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Exposure therapy for anxiety is a well-established and effective approach that can be approached and conducted in different ways and is thought to have a variety of positive benefits for a range of disorders.

When someone has anxiety, it may be difficult to know the best way to resolve it. Some people may take medication but the most effective treatment is psychotherapy but with the array of treatments out there it can be difficult to know where to start and which to choose. Here are eight things about exposure therapy that might help you decide if it is right for you. 

1. Exposure therapy is a common psychological treatment for anxiety  

Exposure therapy works by making people confront fears that they have long been avoiding or have only been able to manage by engaging in safety-seeking behaviors (actions the person conducts to make themselves feel less anxious or as a way to stop feared catastrophes happening).

Although the avoidance of situations or objects associated with fears (or safety-seeking behaviors such as rituals) helps reduce the feelings in the short-term, it only serves to reinforce the fear in the long term. This is because the relief that you feel by removing yourself from a situation or avoiding a stimulus reiterates that the stimulus is bad, as it triggers uncomfortable feelings.

The avoidance (or ritual) is therefore deemed “good” as it makes you feel better by reducing your anxiety. In anxiety with avoidance (and especially phobias), a program of exposure therapy is often recommended in order to enable the person to change avoidance behaviors and extinguish the fear. This therapeutic approach aims to provide a safe environment from which people can be exposed to that which they fear and avoid.

2. Exposure therapy principles are quite simple

The initial form of exposure developed was desensitization in imagination. The theory was developed by Joseph Wolpe, who concluded that if associations are learned, so can they be unlearned. He therefore developed a therapy where the patient and therapist would explore a range of situations that provoke anxiety. They would then learn relaxation techniques, and subsequently imagine the anxiety-provoking scenario (starting with the least anxiety-provoking) and reassociate it with relaxation.

It has since become clear that imaginal desensitization is not as effective as more contemporary applications, and it is not often used in this pure form now.

3. Exposure therapy has long been used in the treatment of a range of anxiety disorders

Anxiety disorders that may improve with exposure therapy include:

  • Generalized Anxiety Disorder
  • Phobias
  • Social Anxiety Disorder
  • Obsessive-Compulsive Disorder
  • Post-traumatic Stress Disorder
  • Panic Disorder

4. How does exposure therapy impact your anxiety disorder?

Exposure therapy is thought to have an impact upon anxiety disorders in the following ways:

  • Habituation: Over a period of time, exposure therapy enables people to change their reactions to feared objects or situations.
  • Extinction: Entrenched associations that connect feared objects, activities or situations and negative outcomes can be unlearned or unpaired for good.
  • Self-efficacy: Overcoming fears through exposure therapy can significantly improve self-esteem, confidence, and your sense of personal competence.
  • Emotional processing: People can become less aroused by the experience of fear and learn to associate more proportional beliefs with objects of fear.

5. There are different forms of exposure therapy

These include:

  • In-vivo exposure: This term is used for actual confrontation in real life with a feared stimulus. So for example, if you had a spider phobia you would hold a real spider as your ultimate goal in therapy, or if you were socially phobic, you might go to a party as your final challenge.
  • Imaginal exposure: This is the original form of exposure therapy, not often used in contemporary therapy, and this involves vividly imagining a feared stimulus. For example, someone who has experienced trauma will relive the traumatic event while employing relaxation techniques to change the association from fear to calm.
  • Virtual reality exposure: Virtual reality technology is now being utilized in many areas other than gaming: for example, it can be employed as therapy when real-life exposure is not practical. Fear of flying is a good example where it might not be practical to actually take a flight, but where the exposure is essential to treatment progression; virtual reality can replicate the experience in the therapy environment.
  • Augmented exposure therapy: Virtual reality-based exposure therapy utilizes a virtual environment to expose someone to stimuli that might otherwise not be possible. In comparison, augmented reality produces specific virtual elements and then merges them into the actual world view to create an augmented reality.
  • Interoceptive exposure: This involves deliberately introducing physical sensations that trigger feelings of fear and learning to tolerate them. For example, someone with a panic disorder would be asked to do something to increase their heart rate so as to bring about the sensation of palpitations but know that the sensation is not dangerous.

6. Exposure therapy can be approached and conducted in different ways.

These include:

  • Graded exposure: This is where a hierarchy of fears are drawn up and the person will start exposure with the least fearful first.
  • Flooding: Flooding is when the most fearful is approached first and the person experiences prolonged exposure to the feared stimulus. The idea is that the fear response (such as adrenaline and other nervous system reactions) will only go on for so long, so eventually after continual exposure the person calms down and realizes the fear is unfounded. This can be fast but the effect does not always last and so the anxiety can return.
  • Systematic desensitization: This is very similar to graded exposure however, the exposure is augmented by techniques which bring about reactions (both physiological and psychological) that are not compatible with anxiety or fear.

7. Exposure therapy can target internal or external triggers

External triggers might be holding a snake if herpetophobic (fearful of snakes), while internal triggers might be deliberately thinking about a worrisome thought if you have Generalized Anxiety Disorder.

8. Exposure therapy can be conducted with or without relaxation

Flooding or graded exposure, for example, do not employ relaxation techniques, whereas systematic desensitization would be exposure to the fear while simultaneously engaging in progressive relaxation. Relaxation, can in some cases, prove counterproductive and it is actually the exposure that is the active ingredient.

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