Dr. Dan Villers on Exposure Therapy
As an enthusiastic proponent of exposure therapy, I get a lot of questions about why I favor it as a treatment for anxiety disorders. And I love answering these questions! So for this post, I decided to recreate the kind of conversation I’ve had with many parents, patients, and friends about why exposure therapy is my treatment of choice.
What is exposure therapy?
Exposure therapy is a treatment for anxiety disorders in which patients are exposed to the very thing that makes them anxious. The exposure is done in a gradual, controlled manner with the goal of helping patients overcome their fear.
Wouldn’t exposing patients to the things they fear make them more anxious?
In fact, exposure therapy does initially increase patients’ fears. It’s through this exposure that patients develop the skills and confidence needed to deal more effectively with whatever triggers their anxiety. Simply put, this treatment enables people to face their fears. Experienced practitioners of exposure therapy take great care in creating an environment in which patients can safely confront their anxiety triggers.
How exactly is the exposure done?
The exact methodology will vary by therapist and patient need. But I’ll share a typical example of how we use exposure therapy with patients at Anxiety Institute.
Before we begin a course of exposure therapy – or any treatment – we assess the patient. If, in fact, we determine the presence of an anxiety disorder, we suggest an exposure-based treatment.
The exposure process typically starts with encouraging the patient to talk about whatever it is that triggers their anxiety. Sometimes just talking about a fear will trigger anxiety symptoms. If that’s the case, we’ll work with the patient until they’re able to speak about it without experiencing symptoms.
The next stage of treatment involves encouraging the patient to vividly imagine the feared object, situation, or activity. We might ask them to relive it in their imagination and speak about what they’re experiencing.
Once someone is able to effectively manage their response to an imagined scenario, we utilize virtual reality to recreate the fear-inducing situation. Thanks to this rapidly-evolving technology, we can increase or decrease variables within the virtual environment to meet the specific therapeutic needs of each individual.
Finally, we move from the virtual world to the real world, having the patient engage directly in the fear-inducing activity.
With appropriate repetition and reinforcement at each step, this gradual, step-wise approach usually results in the patient learning to overcome their fear.
Sounds pretty involved. How long does treatment?
That all depends on the nature of the patient’s anxiety, the number of situations that trigger the severe response, and the frequency of treatment.
For example, a patient with a single triggering situation who gets treated in an intensive in-patient setting might only need three weeks of therapy while someone with multiple anxiety-causing activities being treated weekly might require the better part of a year.
While exposure therapy doesn’t promise a “quick fix,” it is finite in nature. When the patient is able to consistently face the source of their anxiety without symptoms, the therapy can be concluded.
Wouldn’t it be easier for someone just to avoid the situations that trigger their anxiety?
While staying away from triggers may enable someone to avoid experiencing anxiety, in most cases avoidance isn’t a healthy coping strategy. For example, someone with social phobia could choose to avoid situations that requires them to interact with others. But this coping mechanism is likely to place significant limits on both their professional and personal lives.
If that individual chooses to address their anxiety through exposure therapy, not only are they likely to overcome that specific fear, but they will also gain confidence in their ability to overcome other fears that may occur in the future.
Can’t anxiety disorders be treated with medicine?
Anxiety disorders are often treated with antidepressants. And while antidepressants are somewhat less effective than exposure therapy in addressing anxiety disorders, many people are able to overcome their phobias with the help of these medicines. For those unable or unwilling to undertake exposure therapy, medicine can be a viable option for addressing anxiety disorders.
There are a several reasons why I encourage patients to pursue exposure therapy rather than relying on medicine. For one thing, research has shown exposure therapy to be effective in a greater percentage of patients than antidepressants when it comes to treating anxiety disorders. What’s more, all medicines have side effects, which leads me to recommend against ongoing use of antidepressants when other options are available. And, like the avoidance strategy discussed above, pharmaceutical treatment doesn’t provide the opportunity for a patient to develop the confidence that comes from facing and overcoming the source of their anxiety.
What about talk therapy as a treatment for anxiety disorders?
Traditional talk therapy has limited effectiveness when it comes to anxiety disorders.
It can be useful in helping patients better understand that their fears are not rational and in providing a framework for thinking about their anxiety differently.
The problem is, when confronted with the trigger of a phobia – let’s use spiders as an example – all rational thinking tends to fly out the window. The terror induced by the spider prevents those with that phobia from thinking clearly enough to access their rational thoughts.
While this cognitive approach can be helpful in less severe cases, it lacks the essential behavioral component that exposure therapy provides. That’s why a cognitive behavioral approach like exposure therapy is typically more effective than talk therapy alone.
Do most therapists offer exposure therapy?
Unfortunately, most therapists lack the formal training and practical experience needed to provide exposure therapy. This can be explained by the relative newness of this approach. While exposure therapy was developed in the 1960’s, it wasn’t until the late 1990’s that it began entering the mainstream of psychological practice. As clinical results have demonstrated the effectiveness of exposure therapy, it has grown in popularity. I expect that in the years and decades ahead, more therapists will embrace it as a primary treatment for anxiety disorders.
How did you develop an interest in exposure therapy?
My interest grew out of personal experience. In my late teens, I suffered from social anxiety that was severe enough to keep me housebound for six months. I was fortunate enough to find a therapist who treated my anxiety with exposure therapy, enabling me over time to re-engage fully with the world.
I still experience anxiety around a number of situations, including public speaking. And I utilize the principles of exposure therapy to help me manage my fear.
My own ongoing struggles with anxiety help me relate deeply with my patients. I’m grateful to have experienced the benefits of exposure therapy and feel fortunate to be able to help others with this life-changing treatment.