Exposure Therapy

Exposure therapy is not as widely discussed in our culture as other forms of therapy. Furthermore, most therapists don’t specialize in exposure therapy. So, you might not have an in depth understanding of exposure therapy. However, exposure therapy can be very effective in helping people overcome numerous types of fears, panic attacks, PTSD, OCD, etc.

The Best Exposure Therapy

While the best exposure therapy is highly tailored to your unique context, thoughts, and avoidance patterns, there are five primary forms of exposures that experienced therapists often use to help adults overcome fears and anxiety. We’ll also go over examples of what each type of exposure might look like for a fictional adult with a fear of flying to help dispel some of the mysteriousness around exposure therapy. We’ll call him Michael. Michael started to develop a fear of flying after going on a particularly turbulent flight for work. He pushed through his fear of flying for important business meetings for the next couple of months with intense anxiety, using distraction, a drink, and only flying first class to try to manage his anxiety. Then, he stopped flying with the start of COVID-19 and hasn’t been on a plane since.

(It’s important to note that good exposure therapy is highly individualized to an individual person’s fears and situation with the guidance of a trained therapist. Therefore, these examples for fictional Michael’s flying phobia likely won’t apply to you.)

TYPES OF EXPOSURES

There are several types of exposure therapy. The five most commonly used forms of exposure therapy are: In Vivo Exposure, Imaginal Exposure, Interoceptive Exposure, Role Play Exposure, and Virtual Reality Exposure.

1. In Vivo Exposure

Understanding the root of the name in vivo exposure might help you remember what it is. “In Vivo” is Latin for “within the living.” In vivo exposure therapy involves directly doing an activity or putting yourself in a feared situation (that is not actually dangerous). When possible, this can be the most effective form of exposure therapy.

An example of an in vivo exposure for Michael is going on a flight with his therapist to help overcome his fear of flying.

2. Imaginal Exposure

Imaginal exposure is similar to watching a scary movie. While watching it, you might get absorbed in the movie. Your heart rate increases, you might shudder when a character gets closer to the monster. You forget that it’s a movie; it seems very real. However, you’re not in danger. Like making a movie, imaginal exposure involves your therapist guiding you in writing a script tailored to your fears to help you overcome them. Then, you imagine the story happening to help you face your fears. Imaginal exposure can be particularly helpful in guiding you to build up to in vivo exposure, as well as processing fears that are a challenge to face in real life (whether for logistical, safety, or moral reasons).

For example, Michael might start with an imaginal exposure of going on a flight to help him build up to going on an actual flight. He might imagine turbulence (rather than intentionally causing turbulence in a flight). He might imagine an emergency landing (rather than creating an actual emergency landing).

3. Interoceptive Exposure

Physical sensations of anxiety often accompany more intense levels of anxiety. If you notice your heart rate increase, lightheadedness, stomach discomfort, chest tightness, feeling like you can’t breathe, or sweaty palms then you might be experiencing anxiety. Sometimes, people start to fear these physical sensations of anxiety (particularly in the case of panic attacks and health anxiety). When you fear physiological sensations, interoceptive exposures can be particularly useful in overcoming your fear. They involve creating situations that give you the opportunity to face internal sensations in your body.

For example, if Michael fears becoming lightheaded on the plane and passing out, then choosing to spin around several times and experience the sensation of dizziness in the safe setting of his therapist’s office could help him to address this fear. Engaging in this interoceptive exposure gives him the chance to experientially learn that lightheadedness and dizziness don’t necessarily lead to passing out; they might not actually be dangerous.

4. Role Play Exposure

We often use role playing when learning new ways of communicating or interacting with people, such as teaching a child to be polite, preparing executives for a tough meeting, or practicing new communication skills with a partner. Role play exposures in therapy involve you and your therapist acting out a feared interaction or conversation to help target related fear beliefs. They tend to be particularly helpful in the context of social and performance anxiety. Rehearsing a feared conversation with your therapist can help you to have the courage to initiate a challenging conversation with the person you really want to talk to.

If part of Michael’s anxiety around flying is that he’ll feel trapped in his seat and not have enough room to relax because he’ll be seated next to someone who takes over the armrest on his row, then a role play exposure might be helpful. His therapist could guide him in having a conversation about letting his seatmate know he’d like to get up to use the restroom or kindly asking his seatmate to share the armrest.

5. Virtual Reality Exposure

You’re probably familiar with virtual reality: the artificial 3-D representation of a situation. Virtual reality is increasingly used for exposure therapy. A benefit of virtual reality is that it can overcome logistical barriers to engaging in exposures. A con is: if the graphics are not very sophisticated, it might not be very realistic. Additionally, it might be relatively more challenging to tailor virtual reality to your unique fears (like you and your therapist can do with imaginal exposures).

In Michael’s case, his therapist could guide him in using a virtual reality headset to mimic the experience of being on a flight. 

Exposure Therapy for Fears, Phobias, and OCD 

Research shows exposure therapy can be effective in overcoming phobias, panic disorder, social anxiety, PTSD, OCD, health anxiety, body dysmorphic disorder, eating fears, etc. A therapist who specializes in exposure therapy can guide you in tailoring exposures to your unique fears and handpicking the types of exposures that best meet your needs. They’ll give you tips on how to get the most out of your exposure sessions.

If you want to read more about exposure therapy for phobias or exposure and response prevention for OCD in Dallas-Ft Worth, TX, check out our exposure therapy page by clicking below.