Exposure Therapy for Anxiety: What to Expect and Effectiveness – Healthline

In exposure therapy, a person is exposed to a situation, event, or object that triggers anxiety, fear, or panic for them. Over a period of time, controlled exposure to a trigger by a trusted person in a safe space can lessen the anxiety or panic.

There are different kinds of exposure therapies. They can include:

• In vivo exposure. This therapy involves directly facing the feared situation or activity in real life.
• Imaginal exposure. It involves vividly imagining the trigger situation in detail.
• Virtual reality exposure. This therapy can be used when in vivo exposure isn’t realistic, like if someone has a fear of flying.
• Interoceptive exposure. This therapy involves purposefully triggering a physical sensation that is feared, but harmless.

A 2015 research review showed that within those kinds of exposure therapies there are different techniques like:

• Prolonged exposure (PE). This includes a combination of in vivo and imaginal exposure. For example, someone might repeatedly revisit a traumatic event by visualizing it, and talking about it with a therapist simultaneously, and then discussing it to gain a new perspective about the event.
• Exposure and response prevention (EX/RP, or ERP). Typically used for people with obsessive compulsive disorder (OCD), this involves doing exposure homework, such as touching something considered “dirty,” and then refraining from performing the compulsive behavior that is triggered from the exposure.

Generalized anxiety

Treatment for generalized anxiety disorder (GAD) can include imaginal exposure and in vivo, but in vivo exposure is not as common. The 2015 research review above showed that cognitive behavioral therapy (CBT) and imaginal exposure improved general functioning in people with GAD compared to relaxation and nondirective therapy.

There is not a lot of research with exposure therapy and GAD, and more is needed to further explore its effectiveness.

Social anxiety

In vivo exposure is typically used for people with social anxiety. This can include things like going to a social situation and not avoiding certain activities. The same 2015 research review above showed that exposure with or without cognitive therapy may be effective in reducing symptoms of social anxiety.

Driving anxiety

Virtual reality exposure therapy has been used to help people with a driving phobia. A small 2018 study found that it was effective in reducing driving anxiety, but more research still needs to be done with this specific phobia. Other therapies may need to be used alongside exposure therapy.

Public speaking

Virtual reality exposure therapy has been found to be effective and therapeutic to treat anxiety about public speaking for both adults and teens. One small 2020 study found that there was a significant decrease in self-rated anxiety about public speaking after a 3-hour session. These results were maintained 3 months later.

Separation anxiety

Separation anxiety disorder is one of the most common anxiety disorders in children. Exposure therapy is considered the top treatment for it. This involves exposing the child to feared situations and, at the same time, encouraging adaptive behavior and thinking. Over time, the anxiety lessens.

Obsessive compulsive disorder (OCD)

Exposure and response prevention (ERP) uses imaginal and in vivo exposure and is often used to help treat OCD. In vivo exposures are done in the therapy session as well as assigned for homework, and the response prevention (not engaging in compulsive behaviors) is part of that. An individual lets the anxiety decrease on its own instead of performing the behaviors that would get rid of the anxiety. When in vivo exposure is too hard or impractical, imaginal exposure is used.

While a 2015 research review showed that ERP was effective, ERP is comparable to cognitive restructuring alone and ERP with cognitive restructuring. Exposure therapy for OCD is most effective when guided by a therapist and not done independently. It’s also more effective when using both in vivo and imaginal exposure, as opposed to solely in vivo.

Panic disorder

Interoceptive exposure therapy is often used to treat panic disorder. According to a 2018 research review of 72 studies, interoceptive exposure and face-to-face settings, meaning working with a trained professional, were associated with better rates of effectiveness, and people were more accepting of the treatment.

Exposure therapy is effective for the treatment of anxiety disorders. According to EBBP.org, about 60 to 90 percent of people have either no symptoms or mild symptoms of their original disorder after completing their exposure therapy. Combining the exposure therapy with cognitive behavioral therapy (CBT), relaxation techniques, and other treatments may enhance the effectiveness as well.

As with other mental health conditions, exposure therapy may be used in conjunction with other treatments. This can depend on the severity of your anxiety disorder and your symptoms. Your therapist may suggest using exposure therapy with things like cognitive therapy or relaxation techniques.

Medication may also be helpful for some people. Talk with your therapist or doctor about what treatments may be beneficial for you along with exposure therapy.

Exposure therapy is done by psychiatrists, psychologists, and therapists with the proper training. Especially with certain kinds of exposure therapy, like prolonged exposure, it is important to work with a therapist with training in how to safely and properly use exposure therapy so that you are not caused undue distress or psychological harm.

To find a therapist who is qualified to offer exposure therapy, you can find a cognitive behavioral therapist who is part of reputable organizations like the Association of Behavioral and Cognitive Therapists.

Ask them questions about their training and what techniques they use.

Exposure therapy is a safe and effective treatment for a variety of anxiety disorders. It can be used alone or in combination with other treatments. If you think it might help you, talk with your doctor about finding a therapist who is experienced in the technique.