Exposure therapy to overcome fears, phobia, and trauma

Exposure therapy focuses on altering your action to the things or situations that you fear. Progressively, repeated exposure to the source of your certain phobia and also the associated thoughts, feelings and experiences may help you find out to manage your anxiety.

This therapy reflects a variety of behavioral strategies that are all based on exposing the phobic individuals to the stimuli that frighten them.

So that the individual does not have the opportunity to learn that they can tolerate the fear, that the fear will come down on its own without avoiding or escaping, and that their feared outcomes often do not come true or are not as terrible as they imagine. 

Exposure therapy

Exposure therapy made to urge the individual to enter feared situations (either actually or through imaginal exercises) and to try to remain in those situations.

The exposure therapy has been clinically demonstrated to be a helpful therapy or treatment component for a variety of problems, including:

  1. Phobias
  2. Panic Disorder
  3. Social Anxiety Disorder
  4. Obsessive-Compulsive Disorder
  5. Posttraumatic Stress Disorder
  6. Generalized Anxiety Disorder

The selection of the situation is individually-tailor made that starts with situations that are only mildly anxiety-provoking and builds up to the most feared encounters.

In some forms of exposure therapy, the individual starts out being exposed to a very anxiety-provoking stimulus rather than building up to that point more progressively.

Types

Your psychotherapist can aid you figure out which approach is best for you. These consist of:

In vivo exposure

Directly facing a feared object, situation or activity in real life. For example, someone with a fear of snakes might be instructed to handle a snake, or someone with social anxiety might be instructed to give a speech in front of an audience.

It involves actually confronting the feared stimuli, usually in a graduated fashion. The treatment usually last a number of hours, and can be administered in one very long session (e.g., one 3-hour session for spider phobia) or across multiple sessions (e.g., three to eight 1-1.5-hour-long sessions).

Imaginal exposure

Vividly imagining the feared object, situation or activity. For example, someone with Posttraumatic Stress Disorder might be asked to recall and describe his or her traumatic experience in order to reduce feelings of fear.

Virtual reality exposure

In some cases, virtual reality technology can be used when in vivo exposure is not practical. For example, someone with a fear of flying might take a virtual flight in the psychologist’s office, using equipment that provides the sights, sounds and smells of an airplane.

It uses a computer program to generate the phobic situation, and integrates real-time computer graphics with various body tracking devices so that the individual can interact in the environment.

Interoceptive exposure

Deliberately bringing on physical sensations that are harmless yet feared. For example, someone with Panic Disorder might be instructed to run in place in order to make his or her heart speed up, and therefore learn that this sensation is not dangerous.

Applied muscle tension

Itis a special variant of in vivo exposure for the treatment of blood-injection-injury phobia. This treatment uses standard exposure techniques but also incorporates muscle tension exercises to respond to decreases in blood pressure that can lead to fainting.

Cognitive restructuring

Note that many exposure therapies also include a cognitive component that involves cognitive restructuring to challenge distorted or irrational thoughts related to the phobic object or response (e.g., I am going to fall, The dog is going to attack me, I can’t tolerate this fear, etc.).

Further, there is some evidence that either adding cognitive therapy to in vivo exposure or administering cognitive therapy alone can be helpful for claustrophobia and it may also be useful for dental phobia.

Stages

Exposure therapy can also be paced in different ways. This may include;

Graded exposure

The psychologist helps the client construct an exposure fear hierarchy, in which feared objects, activities or situations are ranked according to difficulty. They begin with mildly or moderately difficult exposures, then progress to harder ones.

Flooding

Using the exposure fear hierarchy to begin exposure with the most difficult tasks.

Systematic desensitization

In some cases, exposure can be combined with relaxation exercises to make them feel more manageable and to associate the feared objects, activities or situations with relaxation to decrease the normal fear response.

Benefits

Exposure therapy is thought to help in several ways, including:

Habituation: Over time, people find that their reactions to feared objects or situations decrease.

Extinction: Exposure can help weaken previously learned associations between feared objects, activities or situations and bad outcomes.

Self-efficacy: Exposure can help show the client that he/she is capable of confronting his/her fears and can manage the feelings of anxiety.

Emotional processing: During exposure, the client can learn to attach new, more realistic beliefs about feared objects, activities or situations, and can become more comfortable with the experience of fear.

Although there is a great deal of research to support the efficacy of exposure therapy, there are some notable limitations of the treatment. Though, due to limited availability of specialized trainings, many professional counselors and therapists do not implement it.

A survey of psychologists who treat PTSD revealed that many believe exposure therapy may exacerbate symptoms. Beliefs that exposure therapy might make things worse may prevent many professionals from using it.

References:

  1. American Psychology Association – Clinical practice guideline for the treatment of Post-traumatic disorder
  2. Cognitive Behavior Therapy. (n.d.). In International OCD Foundation. Retrieved January 19, 2015, from http://iocdf.org/about-ocd/treatment/cbt
  3. Corey, G. (2009). Theory and Practice of Counseling and Psychotherapy (8th ed., pp. 245-248). Belmont, CA: Thomson Brooks/Cole.

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