EXPOSURE THERAPY
WHAT IS EXPOSURE THERAPY?
Exposure therapy is a specialized form of Cognitive Behavior Therapy that usually involves gradually facing your fears with the guidance of a trained therapist. It can be particularly helpful in addressing fears and a variety of anxiety-related issues. For example, Exposure and Response Prevention (ERP) has the most research support for treating Obsessive Compulsive Disorder (OCD).
Facing your Fears
While it can seem counter-intuitive to face your fears at times, you’ve probably already applied the wisdom of facing your fear in some ways.
For example, the adage, “get back on the horse,” encourages us to continue riding (rather than avoid). Think about the first time you drove a car. You might have been excited. You might have also been afraid of hitting someone. The more and more you practiced driving, the more your anxiety level likely decreased over time (as you improved your skills, such as using your blinker, braking, parking, etc.). Driving also gave you the opportunity to learn that getting behind the wheel of a car doesn’t necessarily lead to an accident every time. Your brain likely encoded memories of each time you drove a car and did not crash.
These memories and the ability to recall them help to combat anxiety in the previously feared situation—driving a car. Exposure therapy can work similarly when working with an experienced therapist to overcome other fears and anxieties.
History of the Effectiveness of Exposure Therapy
Exposure therapy has roots in Pavlov’s initial behaviorism work of the 1920s and Mowrer’s two stage theory (1939) describing how fears and avoidance patterns develop. Since then, decades of studies and experiments have demonstrated the effectiveness of exposure therapy in targeting anxiety. Early studies showed the benefits of exposure therapy for phobias.
Then, Meyer (1966) reported on the use of Exposure and Response Prevention to treat OCD (which was largely considered essentially untreatable until then). Perhaps impressed by the effectiveness of exposure therapy in reducing anxiety in OCD, researchers then used exposure therapy to treat trauma in a veteran (Keane and Kaloupek, 1982). Reilly and colleagues’ (2017) more recent research indicates exposures might also have a role to play in treating eating disorders. This early research on the effectiveness of exposure therapy lays a foundation for the copious amounts of research support for exposure therapy that we have today.
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How Exposure Therapy Works
Building a solid foundation for exposure therapy is important.
First, having a good relationship with your therapist can make a real difference in preparing you for facing your fears. Second, being ready to commit to doing the work of exposure therapy can also be helpful. (It’s okay if you’re not there yet. Your therapist can help you get ready.) Third, learning about the effectiveness of exposure therapy can further improve your hope. Hope (confidence that exposure therapy will help you achieve your goals) may help you to get more out of therapy.
Currently, Emotional Processing Theory and Implicit Learning Theory help to explain the underlying mechanisms of what makes exposure therapy so effective at targeting anxiety. According to Emotional Processing Theory, exposures give you the opportunity to identify and challenge unhelpful beliefs that maintain fear. Through challenging these beliefs, anxiety can decrease with repeated and prolonged exposures.
This process of decreasing anxiety with practice is called habituation. According to Inhibitory Learning Theory, exposures give you the opportunity to learn new, safety beliefs to compete with old, fear beliefs. The more you recall safety beliefs learned from exposure therapy, the more likely you are to block fear beliefs from stirring up anxiety in each situation. This is why it’s called inhibitory learning: the more that safety beliefs inhibit fear beliefs from running the show, the less anxiety you’re likely to experience.
Overview of our Exposure Therapy Process
Laying a strong foundation before starting exposure therapy is key. Your exposure therapist will teach you more about anxiety and exposure therapy, and help get you ready for exposure work. Importantly, they’ll also take the time to get to know you and understand the intricacies of your anxiety and how it impacts your life.
Oftentimes, this initial stage involves tracking your thoughts and emotions to inform future exposure work. Then, you and your therapist will develop a fear hierarchy together. A fear hierarchy is a customized plan for gradually facing the fears that bring you to therapy.
While your therapist will guide you in developing your exposure plan, you will have control over the exposures you choose to do. Once you have an established plan, your therapist will guide you in your first exposure together in session.
Customized Exposure Therapy
The application of exposure therapy tailored to a specific individual with very specific thoughts and in specific situations can be quite complex. This is why having a trained therapist to guide you tends to be more effective than trying to go it alone. Your exposure plan is highly individualized to you and what you’re experiencing. Therefore, it’s impossible to know exactly what it will look like before working with your therapist.
However, there are some commonalities among specific fears. Research demonstrates the effectiveness of exposure therapy in treating a variety of anxiety-related disorders listed below.
We Provide Exposure Therapy Backed by Research:
☼ ERP Therapy for OCD
☼ Exposure Therapy for Health Anxiety & Illness Anxiety Disorder
☼ Exposures for Panic Disorder and Panic Attacks
☼ Exposures for Agoraphobia
☼ Exposures for Social Anxiety Disorder
☼ Prolonged Exposure for PTSD
☼ Exposures for Eating Disorders
☼ Exposure Therapy for Various Phobias and Fears
Experienced Exposure Therapist
We’re experienced in providing exposure therapy. Dr. Andrea Kirby has been providing exposure therapy to help people overcome various forms of anxiety for over a decade. She is a professional member of the International Obsessive Compulsive Disorder Foundation (IOCDF).
She has been certified in Trauma-Focused Cognitive Behavioral Therapy. She has also guest lectured on the use of Exposure and Response Prevention for OCD for doctoral clinical psychology students. Additionally, she regularly consults with other professionals on the use of exposure therapy.
Want to Learn More?
If you’re interested in learning more about exposure therapy, please check out our blog posts at the bottom of the page. You may also learn more about how to start working with an exposure specialist in Southlake, TX by visiting our Frequently Asked Questions Page, or click below to connect with us.
References
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Abramowitz, J. S. (2013). The practice of exposure therapy: Relevance of cognitive- behavioral theory and extinction theory. Behavior Therapy, 44(1), 548–558. https:// doi.org/10.1016/j.beth.2013.03.003
Courtois, C. A., Sonis, J., Brown, L. S., Cook, J., Fairbank, J. A., Friedman, M., Gone, J. P., Jones, R., La Greca, A., Mellman, T., Roberts, J., & Schulz, P. (2017). Clinical practice guidelines for the treatment of posttraumatic stress disorder (PTSD) in adults. American Psychological Association. http://www.apa.org/ptsd-guideline/
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maxi- mizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35. https://doi.org/10.1037/0033-2909. 99.1.20
Jones, M. C. (1924). A laboratory study of fear: The case of Peter. Pedagogical Seminary, 31(4), 308–315. https://doi.org/10.1080/08856559.1924.9944851
Keane, T. M., & Kaloupek, D. G. (1982). Imaginal flooding in the treatment of a posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 50(1), 138– 140. https://doi.org/10.1037/0022-006X.50.1.138
Krasner, L. (1971). Behavior therapy. Annual Review of Psychology, 22, 483–532. https:// doi.org/10.1146/annurev.ps.22.020171.002411
Levinson, C. A., Zerwas, S., Calebs, B., Forbush, K., Kordy, H., Watson, H., ... Runfola, C. D. (2017). The core symptoms of bulimia nervosa, anxi- ety, and depression: A network analysis. Journal of Abnormal Psychol- ogy, 126, 340–354.
Meyer, V. (1966). Modification of expectations in cases with obsessional rituals. Behaviour Research and Therapy, 4(1–2), 273–280. https://doi.org/10.1016/0005-7967 (66)90083-0
Mowrer, O. H. (1960). Learning theory and behavior. Wiley. https://doi.org/10.1037/ 10802-000
Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics of North America, 33(3), 557–577. https://doi.org/10.1016/j.psc.2010.04.002
Pavlov, I. P. (1927). Conditioned reflexes: An investigation of the physiological activity of the cerebral cortex. Dover.
Reilly, E. E., Anderson, L. M., Gorrell, S., Schaumberg, K., Anderson, D. A. (2017). Expanding exposure-based interventions for eating disorders. International Journal of Eating Disorders. 50(10), 1137-1141. doi: 10.1002/eat.22761.
Watson, J. B., & Rayner, R. (1920). Conditioned emotional reactions. Journal of Experimental Psychology, 3(1), 1–14. https://doi.org/10.1037/h0069608
