Facing your Worst Fears: Exposure Therapy
Exposure therapy is an evidence-based psychological treatment for a variety of mental health issues, such as anxiety, phobias, Obsessive Compulsive Disorder, panic disorder and Post-Traumatic Stress Disorder. The client is supported in gradually confronting their fears in a safe, therapeutic environment. With repeated exposure to the same object or situation, the client learns that their fears are unwarranted or an overreaction. They also learn that they can tolerate the anxiety related to the experience, even though it may be uncomfortable.
When people fear an object or situation, their main urge is to avoid it. Although this helps with the anxiety or uncomfortable emotions temporarily, it only serves to maintain the fear long-term, as the individual does not learn anything new about the situation. This can turn into a vicious cycle of avoidance in the person’s life that leads to other associated problems. For example, someone with social anxiety may avoid going out with friends or participating at work, causing isolation, career stress, and possible depression. Another example is someone who develops a fear of driving after a car accident: In the short term, the person may avoid the unpleasant reminder of their accident by not getting back in a car, but long term, is reinforcing the fear of another accident happening by not allowing themselves the opportunity to enjoy driving again.
Exposure therapy is one part of Cognitive Behaviour Therapy that helps people re-train their brain to feel safe in certain situations where they have fallen victim to a cycle of avoidance. Therapists work with their clients to first challenge their thoughts with facts and helpful coping statements. They may also teach the client some relaxation techniques to help deal with anxiety. In graded exposure, they then create a hierarchy, or ‘ladder’ of feared situations, ranking from ‘least scary’ to ‘most scary’. In a controlled, supportive environment, clients are encourage to work their way up the ladder with both in-session exposures and for home practice between therapy sessions. The therapist will help the client notice the differences between the original prediction of what would happen and what really did happen when the client faced their fears. Repetition is key – the more exposure to the feared situation, the less anxiety-provoking it will become!
There are many types and levels of exposure tasks that are possible in exposure therapy:
Imaginal Exposures: This is when the person imagines, in great detail, the feared situation. For example, if someone has PTSD from a traumatic experience, they may work with their therapist to recall the event over and over while practicing relaxation to learn to feel calmer about the memories and associated triggers.
In-vivo Exposures: This is when the person confronts their fears head-on. For example, someone with a fear of heights is instructed to spend time at graduated heights, such as apartment buildings, bridges etc.
Sensational Exposures: The person confronts their fear of uncomfortable physiological sensations associated with their anxiety. For example, someone with panic disorder is asked to complete activities to bring on the sensation of panic, such as breathing through a straw to cause dizziness and shortness of breath. With repetition, the person learns the sensation itself can be tolerated and is not dangerous.
If you or a loved one is struggling with anxiety, a phobia, PTSD or OCD, exposure therapy can be very helpful. Clinicians at Brookhaven Psychotherapy are highly trained in exposure therapy and can work with you in achieving real results.
Find out more about Exposure and Response Prevention here
Find out more about OCD here
