Exposure Therapy for Anxiety: A Practical Guide

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. For a deeper dive into how this method works, read The Benefits of Exposure Therapy.

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 — more on this in The Phases of Anxiety Recovery.

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 — see Psychological Testing for how this evaluation works.

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.

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. For teens and young adults who need more structured care, families often turn to the Intensive Outpatient Program (IOP).

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.  Parents who want to support this process at home often benefit from Parent Coaching.

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 several reasons why we encourage patients to pursue exposure therapy rather than relying on medicine. Research has shown exposure therapy to be effective in a greater percentage of patients than antidepressants when it comes to treating anxiety disorders. Medicines also have side effects, and unlike exposure therapy, medication does not help patients build confidence in their ability to face fears. To learn about how medicine and therapy can work together, see Pharmacotherapy of Severe Anxiety Disorders and OCD.

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 — see Understanding Therapy Names: CBT, DBT, ACT, and More.

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.