EXPOSURE THERAPY: HOW IT WORKS, TYPES AND DISORDERS - PSYCHOLOGY - 2025

The exposure therapy is a type of cognitive behavioral therapy is to approach the feared situation in order to eliminate anxiety or fear. It is often used in phobias, panic disorder, obsessive compulsive disorder, anorexia, bulimia, among others. In short, in pathologies where there is anxiety or fear of something happening.

Some examples of feared situations in which exposure therapy is helpful are riding the bus or subway, speaking in public, receiving criticism, eating "forbidden" foods, drawing blood, and so on.

Exposure in dog phobia is one of the most common

Exposure can also focus on internal stimuli that provoke anxiety or other negative emotions. For example: fear of feeling anxious, fainting, worrying, or getting sick. Most of these fears are inordinate and do not usually correspond to the real danger that the situation would have if it occurred. In addition, they affect the daily life of the person.

Exposure therapy does not imply forgetting or disappearing the learning of fear. Rather, the person develops new learning that competes with the old memory of fear.

How does exposure therapy work?

When we are afraid of something, we tend to avoid related objects, activities, or situations. In the short term, avoidance serves to reduce feelings of fear and nervousness. However, in the long term it contributes to the fear being maintained and growing more and more.

That is why it is important to expose ourselves to what we fear in order to eliminate fear at its roots. Exposure therapy breaks the vicious cycle of avoidance and fear.

Thus, psychologists create a safe and controlled environment in which they expose patients to things they fear, ensuring that negative consequences do not appear.

For exposure therapy to be effective, the patient must remain in the feared situation until the anxiety subsides or until the negative consequences that his mind imagines do not occur.

It is essential that this therapy is carried out in a gradual and controlled manner. What is sought is for the person to face their fears in a systematic way and to control the impulse to avoid the situation.

At first it can be very difficult because anxiety levels can rise significantly, so it is usually done gradually. As the person faces their fears without the expected negative consequences, anxiety levels progressively drop until they disappear.

Why is exposure therapy effective?

It is not known for sure why exposure therapy works. Apparently, there are different explanations that do not have to be incompatible with each other.

- Extinction: as the feared stimuli are not followed by negative consequences, there is an extinction or disappearance of the learned anxiety responses.

- Habituation: or decrease in emotional and physiological activation after the feared stimulus appears several times. It can be said that the body becomes fatigued from staying at high levels of anxiety, and at some point it is reduced.

- Increased expectations of self-efficacy: confidence in one's ability to face the feared stimulus.

- Reduction of threatening interpretations, which occurs when realizing that the feared does not happen.

- Emotional processing: the person changes their cognitive schemes about what scares them. It establishes new memories and thoughts that are incongruous with the ideas that sustain the fear.

- Emotional acceptance: assume and tolerate emotional states and negative somatic sensations, without escaping from them or trying to control them.

For which disorders is it effective?

Exposure therapy has been scientifically proven useful for conditions such as:

- All kinds of phobias, such as social phobia or agoraphobia.

- Panic disorder.

- Obsessive compulsive disorder.

- Post-traumatic stress disorder.

- Generalized anxiety disorder.

- Eating disorders such as anorexia or bulimia. As there is an intense fear of eating certain foods and gaining weight, the patient can be exposed to these stimuli.

- Hypochondria.

- Addictive disorders to alcohol, drugs or pathological gambling.

- Anger management. That is, expose yourself to comments or situations that trigger anger to learn to control yourself before them.

Types of exposure therapies

In some cases, traumas or fears can all be dealt with at the same time. They can also be worked gradually accompanying the process of relaxation techniques.

Normally, it begins with situations that cause less anxiety and little by little, the level of difficulty increases.

In the event that a panic attack occurs, it is recommended that the patient sit as close as possible to where the panic occurred and wait for it to pass. It is important that you avoid paying attention to your bodily sensations and face the phobic situation again.

The person accompanying him should sit next to him, but avoid talking to the patient about the sensations he is experiencing, as this makes the situation worse.

Different exposure therapies can be distinguished. For example, depending on the way of exposing themselves, three types stand out: the exhibition live, in imagination or in virtual reality.

Live exhibition

In the live exhibition the person faces the feared situation in real life, in scenarios that normally produce fear. For example, if you are afraid of flying, you can take the person to an airport to watch the planes take off.

This exposure can be done with the help of the therapist in very controlled situations. It is necessary to remain in the triggering situation of fear until it disappears or subsides.

Sometimes a relative or friend who has previously been instructed to help you can also accompany you to expose yourself.

Exposure in imagination

It is about vividly imagining the feared object or situation, with all possible details. This is done with the help and supervision of the therapist. The professional will make sure that they are imagining exactly what is causing fear.

This type of exposure seems safer and more comfortable, but it can be difficult for some patients to imagine. Previous training may be required to do it well. There is also the danger that they will avoid certain thoughts, preventing full exposure.

Exhibition in virtual reality

Virtual reality exposure combines imaginative and live exposure components to expose the patient to seemingly real situations.

It is more attractive to patients as they make sure they are in safe environments that are not going to get out of hand. At the same time it recreates realistic environments in which it can be completely immersed, being able to create sensations very similar to live stimuli.

On the other hand, three types of exposure therapy can be distinguished according to who accompanies the patient during the process. These are self-exposure, therapist-assisted exposure, and group exposure.

Self exposure

Because phobic people tend to be very dependent, it is possible that, at times, it is recommended that they expose themselves to anxiety stimuli.

This method is more powerful and offers longer lasting results. However, in the initial stages it is better to be accompanied by the therapist.

For it to be carried out successfully, it is necessary to follow the professional's instructions. How to set realistic goals, identify potential problem behaviors, and regularly practice self-exposure with each of them. As well as the control of unforeseen events and knowing how to evaluate the reduction of anxiety levels in oneself.

Exposure assisted by the therapist

It is the most common mode of exposure, where the therapist accompanies the patient in almost the entire exposure process.

Group exhibition

It is recommended when you live alone, have few social skills or have conflicting relationships with your partner or family in which they do not collaborate with therapy.

The group has an added motivational effect, especially if it is a cohesive group. Another advantage is the social benefits obtained such as establishing relationships, working on social skills, occupying free time, etc.

However, it is not recommended for other cases such as social phobia, where the group can be threatening, causing therapy to be abandoned.

Other types of exposure therapy include:

Systematic desensitization

It is a widely used behavior modification technique. First, a hierarchy of anxiety-producing situations is established. Then the hierarchy stimuli are exposed when the patient is in a safe and very relaxed environment.

To do this, relaxation exercises are performed before the exposure sessions. The goal is for the feared stimuli to be associated with the incompatible response (relaxation) and to stop producing anxiety.

Successive approaches or shaping

It is an operant technique to establish behaviors. It is used for many cases, but one of them is exposure to feared stimuli or situations.

Through this technique, behaviors of approach to what produces anxiety are reinforced or rewarded until the complete behavior is achieved.

For example, in someone who is afraid to speak in public, at first you can try to ask a question in front of a small audience, then make a comment or give an opinion, later do it in larger groups… Until you can give a talk without feeling anxiety. All these behaviors will be rewarded in the most appropriate way according to the person.

Interoceptive exposure

Interoceptive exposure is about eliciting feared bodily sensations. For example, people with panic attacks are often afraid of the physiological symptoms of anxiety such as a racing heartbeat, heat, or sweating.

In this type of exposure, these symptoms would be created (by doing intense physical exercise, for example) until anxiety is reduced and avoiding escape behaviors.

The goal is to disconnect bodily sensations from panic reactions (Encinas Labrador, 2014).

Exposure and response prevention

It is a type of exposure used to treat obsessive compulsive disorder. It combines exposure to feared stimuli plus avoidance of the unwanted response.

It is necessary to remember that in obsessive compulsive disorder there are thoughts and obsessions that the patient tries to neutralize with behaviors or mental rituals.

For example, they may have obsessions related to pollution and to reduce the anxiety that these generate, they carry out cleaning behaviors continuously.

Through this technique, subjects are exposed to their fears (being in contact with something contaminated or dirty) while preventing the response (they must remain unwashed until anxiety subsides).

Flood

The flood is a more intense and abrupt exposure, but effective. It consists of exposing yourself directly to the stimulus or situation that generates the most fear and staying in it until the anxiety subsides.

It can last about an hour and is done accompanied by the therapist. It can be done live or in imagination.

Exposure therapy and safety behaviors

For exposure therapy to be effective, safety behaviors must be avoided. These are cognitive or behavioral strategies that patients use to try to decrease their anxiety during exposure.

For example, a safety behavior in the face of fear of flying would be to take tranquilizers or sleeping pills.

This causes the person not to fully expose themselves to their fear, interfering with the effectiveness of the therapy. The problem is that it temporarily produces a relief from fear, but in the medium and long term they maintain anxiety and avoidance.

References

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