What is Exposure Therapy?

A highly effective psychological intervention for many disorders, particularly anxiety disorders, is called exposure therapy. Exposure therapy requires fully encountering a fear-provoking activity or situation (e.g., public speaking) that has been long avoided.

Flooding and graded exposure

One form of exposure therapy is called flooding. Flooding is not a very popular approach because it requires facing the most feared situation and staying in it until the anxiety dissipates. For instance, if you have a phobia (i.e. extreme fear) of snakes, the therapist might ask you to go into a room in which there is a large snake and stay there until your high level of fear subsides.

More contemporary approaches, however, are more likely to use graded exposure therapy. In this form of exposure therapy, the patient is first asked to create a fear hierarchy, starting with mildly anxiety-provoking situations (e.g., looking at a picture of a snake), all the way to the most highly anxiety-provoking encounter (e.g., holding a live snake). The patient begins the exposure therapy with less frightening stimuli and only moves up his fear hierarchy when he has mastered lower levels.

The individual needs to be fully psychologically present during these exercises. The goal is to make sure he or she feels moderate levels of fear—enough to be emotionally engaged but not so much to feel overwhelmed.
Through practice, clients realize that what they used to fear was never as dangerous as they had imagined. Their fear and anxiety, they also learn, can be managed successfully.

Virtual reality exposure therapy and imaginal exposure

Sometimes it is difficult to design exposure exercises. Consider a person with flying phobia. How can she do weekly exposure exercises for fear of flying without having to drive to the airport or board a plane each week?

In such cases, one useful approach is virtual reality exposure therapy. Just as is done in flight simulators used for pilot training, it is possible to create an environment very similar to being on an airplane by using virtual reality apparatus and setting—chairs with airline seatbelts, flight announcements over a speaker, engine noises, flight scenery on display screens, etc.

A less expensive option is imaginal exposure. Imaginal exposure is also useful for facing fears that might be difficult or impossible to reproduce. For instance, imaginal exposure may be useful if you have a fear of developing a serious disease or fear that you will be responsible for some future disaster (e.g., accidentally setting the house on fire).

To create an imaginal exposure exercise, a patient, with the help of the therapist creates an elaborate scenario. The scenario includes many vivid details—the physical setting, the person’s sensations, and emotions, other people’s reactions, etc. Then, a script is written and recorded. The patient listens to the audiotape during the exercise and tries to vividly imagine the scene unfold.

Just as in graded exposure in real life, individuals can work their way up to imagining their worst fears coming true. Imaginal exposure helps the patients realize they are able to cope with strong fears, and, furthermore, fearful images or thoughts do not make disasters come true.
Exposure therapy is effective. The Society of Clinical Psychology suggests there is strong research support for the use of exposure therapy in the treatment of the obsessive-compulsive disorder, post-traumatic stress disorder, social anxiety disorder, and specific phobias.