What is Exposure Therapy and How Does it Reduce Anxiety?
Fears and anxieties can greatly impact a person's life. Someone with an intense fear of flying might avoid taking a job where they may need to travel for work, or might avoid going on vacations or home for the holidays if they require flying. Someone who experiences Social Anxiety Disorder may endure social interactions and situations some of the time, but their anxieties may keep them from being able to form the close social connections and bonds that they desire.
Fortunately, there is a type of anxiety treatment that has been shown to be highly effective at treating these types of anxieties, so that a person can go back to living their life without distress and without the need to avoid things or situations due to their anxiety.
Exposure therapy is a well-researched therapy that is a form of Cognitive Behavioral Therapy (or CBT). Exposure therapy has been shown to effectively treat a wide variety of anxiety disorders, including Phobias, Panic Disorder, Social Anxiety Disorder, and Posttraumatic Stress Disorder (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012). Studies have shown that as much as 80 to 90% of clients who receive exposure therapy for anxieties such as phobias show improvement in their symptoms (Thng, Lim-Ashworth, Poh, & Lim, 2020), often within just a few sessions.
Unfortunately, only about 10% of those who seek treatment for anxiety receive this first-line treatment (Hipol & Deacon, 2013), often due to a lack of therapists who are trained to provide it. Our therapists at Skyline Psychotherapy & Assessment Services are trained to provide clients with this important treatment.
So, what exactly is exposure therapy and how does it work?
Let’s take an example of a fictional client, Jane. Jane has an intense phobia of dogs which is impacting her life because she lives in a city where dogs are often walked on the sidewalks and live in her apartment building. She doesn’t know why she fears dogs so much, because she has never had a bad experience with a dog.
Exposure therapy is premised on the idea that regardless of the WHY for a specific fear, it can be treated through repeated confrontation with the feared object, situation, or sensation while the client is in a safe environment.
Exposure therapy can be done in a variety of ways, but many times a therapist will work with the client to create a list of feared situations that are then ranked according to how much distress the situation would cause (for example, from 1-10), to form a “fear hierarchy”. In Jane’s case, maybe she rates just seeing a picture of a dog as a “1” on her fear hierarchy, and petting a big dog as a “10” on her hierarchy, with something like walking next to a dog at a “5” out of 10.
Jane and her therapist would then start to “expose” her to her fears gradually in various situations. This is the exposure part of the therapy. This breaks the negative feedback loop of fear and avoidance, and teaches Jane that she actually CAN tolerate distress around dogs. So in this example, the therapist would at first work with Jane to look at a picture of a dog in the session. Once her discomfort with this has subsided and her level of anxiety has dropped (through a process called ‘habituation’), Jane moves on to the next most difficult exposure in her list. Over time, the idea is that Jane will eventually be able to even get to her “10” exposure of petting a dog. Again, all of this takes place in an environment of safety and with close supervision by the therapist.
Through these gradual exposures, researchers theorize that many processes are happening. One is that Jane is gaining self-efficacy as she comes to know that she is capable of being around dogs. Another is emotional processing and learning, as Jane learns more realistic beliefs about dogs (i.e, that she will most likely not be harmed by standing next to a dog). She learns these more realistic beliefs by experiencing them. She is also unlearning negative associations with dogs as she does the exposures and breaking the mental link between dogs and the feeling of fear. Jane is able to do all of this new learning because she is stopping the pattern of avoidance by engaging in the therapy. She is approaching something that she once avoided. In the end, Jane may never be a huge dog lover or want to own one herself, but the goal of most exposure therapy is simply to make life easier and reduce distress for the person—if after a few sessions of this therapy she can now walk down a city sidewalk without being overcome by fear, then that seems like a successful outcome!
For more, visit our page Beyond Worry: Anxiety, Stress, and Trauma or check out our other related posts.
If you are interested in consulting with a licensed psychologist about how exposure therapy might help to alleviate your anxiety, fill out a contact form to speak to a member of our Skyline Team.
We offer free 15-minute phone consultations for all new clients.
Hipol, L. J., & Deacon, B. J. (2013). Dissemination of evidence-based practices for anxiety disorders in Wyoming: A survey of practicing psychotherapists. Behavior Modification, 37(2), 170–188. https://doi.org/10.1177/0145445512458794
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
Thng, C. E. W., Lim-Ashworth, N. S. J., Poh, B. Z. Q., & Lim, C. G. (2020). Recent developments in the intervention of specific phobia among adults: a rapid review. F1000Research, 9, F1000 Faculty Rev-195. https://doi.org/10.12688/f1000research.20082.1