What is Exposure Therapy?

Exposure therapy, also known as Exposure and Response Prevention (ERP) Therapy, is a type of cognitive behavioral therapy used to help patients confront and learn to tolerate their fears. Patients who have been coping with their fears or traumatic triggers through avoidance of the places, actions or situations that caused their trauma or fears to develop may be hindered from carrying out their daily activities due to their crippling fear and anxiety. Exposure therapy with a trained therapist can aid patients to face and overcome their fears.

What Can Exposure Therapy Be Used to Treat?

Exposure therapy can treat a variety of disorders including:

Post-traumatic Stress Disorder (PTSD)
Complex Post-traumatic Stress Disorder (C-PTSD)
Generalized Anxiety Disorder (GAD)
Social Anxiety Disorder (SAD)
Obsessive-Compulsive Disorder (OCD)
Phobias

How Does It Work?

Exposure therapy is performed by exposing the patient to the source of their fear or anxiety in a safe, controlled environment. The treatment works by helping the patient break their habit of avoidance or escape from the feared situation. The therapist can do this in several ways:

In vivo exposure: Letting the patient face their real-life trigger, the feared object, environment, or situation, directly, when it is safe and viable to do so (ex. Letting an arachnophobic person interact with a pet spider that is safe to touch)
Imaginal exposure: Asking the patient to vividly imagine their fears, or recall and describe a traumatic memory in order to process and reduce their fear. This can be employed in situations where it is not safe for the patient to re-expose themselves to the traumatic situation (ex. A war veteran recalling his memories of combat)
Virtual reality exposure: Experiencing the trigger through a simulation to become accustomed to it (ex. Performing a driving simulation to overcome the fear of driving)
Interoceptive exposure: deliberately inducing feared internal sensations within the patient (ex. Running to increase heart rate, which can help a person with panic disorder become accustomed to that sensation and disassociate it with danger)

Exposure therapy may also be paced in different ways, based on a hierarchy where the therapist and patient work together to identify and rank the various triggers or phobias the patient will confront. These are:

Graded exposure: Beginning with confronting the mildest or smallest fears before moving on to the more challenging, bigger triggers.
Flooding: Beginning with the biggest, most challenging triggers.
Systematic Desensitization: Combining exposure to triggering situations with a calming or relaxing trigger or stimulation, which can help to regulate the anxiety reponse triggered by the feared situation and associate it with a more relaxed state

What the Outcomes and Risks of Exposure Therapy?

Since the patient may be exposing themselves to a potential source of trauma, they may risk re-traumatizing themselves, which may result in a short-term worsening of their anxiety. However, for a majority of the patients, the long-term reduction in stress, anxiety and fear outweighs the initial negatives of exposure.

Positive outcomes of exposure therapy include:

Habituation: With repeated exposure, patients find that their fears and anxiety responses lessen over time as they become accustomed to the situations they previously avoided.
Fear extinction: Previous learned associations made between the triggering situations, objects, or activities and negative outcomes is lessened or eliminated.
Self-efficacy: The patient learns that they have the ability to facetheir feared situations and can manage their anxiety on their own.
Emotional processing: the patient can make new, positive and realistic associations with the feared situation, activity, or object, and become comfortable with experiencing fear.