What is exposure therapy?

Everyone has a reason to be afraid sometimes. You might avoid certain people, places, or things that make you feel anxious. This is not necessarily a cause for concern. However, some people have fears that are so strong that they impact their ability to live their daily lives. This is often the result of a traumatic experience, phobia, or other mental health concerns. Fortunately, help is available, and one of the most effective treatments for addressing extreme fears and anxieties is something called exposure therapy.

As the name suggests, exposure therapy involves a slow, gradual “exposure” to triggers under the supervision of a mental health professional. Unlike some other therapies, exposure therapy focuses on reducing symptoms instead of focusing on why they exist. This evidence-based approach has helped many people reduce their fear response and gain control of their anxiety.

What happens in exposure therapy

If you’ve never tried exposure therapy, it’s normal to feel nervous or unsure about what to expect. Exposure therapy is usually done slowly and at a pace that feels manageable for you. Your therapist should guide you through the process and help you feel supported along the way.

During exposure therapy, you can usually expect:

• A conversation about your fears or triggers: Your therapist will help you identify situations, thoughts, memories, or feelings that cause anxiety or avoidance.

• An exposure hierarchy: Together, you’ll create a list of fears from least upsetting to most upsetting. This helps you start small and build confidence over time.

• Gradual exposure: You’ll slowly face feared situations or triggers in a safe and controlled way instead of avoiding them.

• Coping skills practice: Your therapist may teach breathing exercises, grounding skills, or other tools to help you manage anxiety during sessions.

• A client-directed pace: You should never feel forced to move faster than you’re ready for. It’s important to speak up if something feels too overwhelming.

• Ongoing support and reflection: Your therapist will help you process your reactions, notice progress, and adjust the plan as needed.

Over time, exposure therapy can help reduce fear, build confidence, and break patterns of avoidance that may be affecting your daily life.

Different types of exposure therapy

Like other therapeutic approaches, exposure therapy comes in many forms, and your therapist will base their approach on your unique treatment needs. Some different types of exposure therapy include:

• Systematic desensitization: With this approach, your therapist will combine exposure exercises with relaxation exercises to help you feel more relaxed, safe, and ready to engage with a trigger.

• Flooding: This approach is related to the pace of exposure therapy. It involves using the exposure hierarchy (a series of progressively more challenging triggers) to decide when you’re ready to advance to a more difficult exposure task.

• Virtual reality exposure: Sometimes, exposure to an actual trigger isn’t possible for practical reasons. For example, if you are afraid of flying, you can’t recreate that experience in your therapist’s office. So your therapist may use special technology to simulate a virtual flight. This will allow you to engage with some of the sights, sounds, and smells of an airplane.

• Prolonged exposure: Mental health professionals often use this form of exposure therapy to treat PTSD. It involves gradually approaching traumatic memories. Confronting fears in a systematic way over time can help reduce your fear response.

How effective is exposure therapy?

There is a lot of clinical evidence showing that exposure therapy can help treat many conditions. Researchers have found that:

• Exposure therapy is effective for treating symptoms of post-traumatic stress disorder (PTSD), especially among veterans.

• Exposure therapy can help young people overcome symptoms of social anxiety disorder.

• When they commit to treatment, exposure therapy can help more than 90% of people living with phobias.

• Thanks to its well-documented effectiveness, exposure therapy is the treatment of choice for many different forms of clinical anxiety.

Dig deeper:

• How psychiatry can help with phobias

What conditions can exposure therapy help treat?

Research shows that exposure therapy can be effective in treating a wide range of mental health conditions, including:

• Post-traumatic stress disorder (PTSD)

• Social anxiety disorder

• Generalized anxiety disorder (GAD)

• Obsessive-compulsive disorder (OCD)

• Certain eating disorders

• Acute stress disorder

• Agoraphobia and other phobias

• Complex post-traumatic stress disorder (PTSD)

• Panic disorder

Further exploring exposure therapy

Exposure therapy may be a good fit if anxiety or fear is causing you to avoid certain situations, thoughts, memories, or activities. It can help people slowly face fears in a safe and supportive way instead of continuing to avoid them.

If you’re interested in getting started, look for a therapist trained in exposure therapy, cognitive behavioral therapy (CBT), or exposure and response prevention (ERP). A therapist can help you decide whether this approach fits your needs and create a plan that feels manageable.

Clinician’s take

One of the most rewarding parts of exposure therapy is watching clients realize they’re stronger than their anxiety. What once felt impossible can start to feel manageable. Over time, many people regain activities, places, and experiences that fear had taken away from them.

Brandy Chalmers, LPC

Clinical reviewer