A Closer Look At Exposure Therapy For Anxiety

What is anxiety?

Since the dawn of man, we have fought dangerous situations that risked our health and livelihood. To combat these natural threats, our bodies develop an intricate stress response that fuels our mind and body to keep us out of danger’s way and get us out of dangerous situations should we find ourselves trapped in one. 

This stress management system is normal and healthy, and we still experience it today. If you’ve ever had someone merge and nearly hit you while you’re going down the highway, only for you to swerve out of the way at the last second with your heart racing, you’ve experienced a healthy stress response. 

Anxiety is that stress response stretched past its use. Anxiety will read danger into safe situations and will be unable to turn itself off after the danger has passed.  

A stress state will release three main brain chemicals:

• Epinephrine (formerly known as adrenaline): increases blood pressure and heart rate, speeds reaction time
• Norepinephrine (formerly known as noradrenaline): increases alertness, arousal, and attention
• Cortisol: Releases sugar from body reserves to energy that can be used to power muscles and brains. 

In a healthy brain, cortisol will also effectively shut down the stress response after the threat has passed. However, with anxiety, this doesn’t always happen. 

But the fight-or-flight response also interacts with parts of your brain, such as:

• The Limbic system, which controls motivation and mood
• The amygdala, which generates fear in response to danger
• The hippocampus, plays an important part in memory formation as well as in mood and motivation.

And hormones throughout your body, affecting your: 

• Heart rate
• Blood pressure
• Digestion
• Body temperature 
• Appetite
• Pain response 

In a normal, healthy brain, your stress response is a well-oiled machine that provides you the energy and motor ability to escape dangerous threats. It even comes with its own off-switch. However, as anyone with clinical anxiety knows, it doesn’t turn off on its own, and, more often than not, it’s responding to normal, everyday things that aren’t a threat. 

Anxiety is a debilitating condition that often needs treatment by a licensed therapist. Symptoms include: 

• Excessive worry and anxiety
• Difficulty controlling the anxious thoughts
• Difficulty sleeping
• Restlessness or feeling on edge
• Easily fatigued 
• Difficulty concentrating or brain fog
• Irritability 
• Muscle tension
• Nausea 

This is not an exhaustive list, and we encourage you to reach out to a licensed therapist if you think you are experiencing an anxiety disorder.

What is Exposure Therapy?

Exposure Therapy is a proven therapeutic method to decrease anxiety by gradually exposing you to the object of your fear and teaching coping mechanisms to decrease the physical symptoms of anxiety in your body. 

For example, if you have a fear of dogs, an anxiety therapist using Exposure Therapy might start by showing you a picture of a dog. They will then help you address any anxious thoughts and emotions that come up. After you feel calm when seeing the picture of the dog, your therapist will do the same while showing you a video of a dog. Finally, they might bring you into real-world situations in which you watch dogs, are near dogs, and, finally, pet a dog. 

This is only an example and every therapist will take a nuanced approach to Exposure Therapy and adjust it to serve your needs best. In general, Exposure Therapy works to reset your stress response and teach it to not respond to non-threatening things.

How Does Exposure Therapy Work?

There are two different metrics your anxiety therapist may play with to ensure exposure therapy is safe and effective for you. These are methods and pace.

Exposure Therapy Method

Sometimes, it’s helpful to face your fear in person. Other times that isn’t safe or possible, like a fear of flying. Therefore, an anxiety therapist will choose from four different methods of exposing you to your phobia.

1. In vivo exposure: Being directly exposed to a feared object, situation, or activity in real life. Examples include making a speech in public, petting a dog, or holding a spider. 
2. Imaginal exposure: Also known as mental visualization, this method is when your therapist guides you to imagine your feared object, situation, and activity until it feels real in your mind. This technique is most frequently used to treat PTSD or phobias that are impractical to experience in real life, like a fear of flying on airplanes. 
3. Virtual reality exposure: Technology enables anxiety therapists to simulate an in vivo exposure from the convenience of their office. Virtual reality technology can be used to treat phobias that are impractical to experience in real life but could benefit from in vivo exposure, such as swimming or fear of heights. 
4. Interoceptive exposure: When the fear is of a physical sensation, such as Panic Disorder, it can help to produce physical sensations similar to the feared state. For example, running in place to speed up your heart rate to simulate a racing heart. 

Exposure Therapy Pace

Next, your therapist will have to find the right pace at which to expose you to your phobia. This can be all at once, or gradually. It depends on the therapist and your unique needs and goals. Pacing options for exposure therapy include: 

• Graded exposure: This is the most gradual approach to exposure therapy, in which your anxiety therapist will help you face your fears in order of smallest to largest. So, for example, they will start with a picture of your feared object and work their way up to experiencing it in real life. 
• Flooding: The opposite of the Graded Exposure route, Flooding addresses your most feared task first. This technique is not used often but can be effective in treating some anxiety conditions such as OCD. For example, if someone has obsessions and compulsions surrounding doorways, a Flooding protocol would have them walk through a doorway without engaging in any of their compulsions. 
• Systematic desensitization: Often used in conjunction with Graded Exposure, this method helps clients associate feared objects with feelings of relaxation by teaching them to engage in relaxation techniques while facing a feared object. 

Your therapist should prepare you for whatever method and pacing they choose. If you have any questions or hesitations about their chosen method and pacing, speak up! Exposure therapy works best when both client and therapist are working together and communicating about their stress levels, symptoms, and thoughts. 

Why Does Exposure Therapy Work?

The American Psychological Association lists four ways exposure therapy can help treat anxiety. 

• Habituation: People become accustomed to their feared objects or situations, and no longer experience an anxious response. 
• Extinction: When your anxiety surrounding an object or situation is learned because of previous bad outcomes, extinction deletes or weakens that learned association. 
• Self-efficacy: It is empowering to face your fears head-on and come out okay! By building self-efficacy and self-esteem, Exposure Therapy decreases the chances of anxiety taking root in the future. 
• Emotional processing: Sometimes we have unconscious emotions or beliefs about our feared object or situation. Exposure Therapy helps us process these and replace them with more realistic beliefs and more positive emotions. 

These are only some of the benefits exposure therapy can have on anxiety disorders. To learn more, reach out to a licensed therapist.

What Can Exposure Therapy Treat?

Exposure Therapy is used to treat anxiety disorders. However, a lot of different mental health issues fall under the umbrella of an anxiety disorder. Some respond better to exposure therapy than others. The disorders exposure therapy is known to help treat include: 

• Specific Phobias
• Social Anxiety 
• Post-Traumatic Stress Disorder
• Obsessive-Compulsive Disorder 
• Generalized Anxiety 

For some, such as specific phobias and social anxiety, exposure therapy may be enough. However, other disorders use exposure therapy in tandem with other therapies, such as:

• Cognitive Behavioral Therapy (CBT): CBT is a widely recognized and effective therapy for treating anxiety. It focuses on identifying and changing negative thought patterns and behaviors that contribute to anxiety. Through CBT, you can develop practical coping mechanisms, challenge irrational beliefs, and learn new ways to respond to anxious thoughts. By breaking the cycle of negative thinking and gradually facing your fears, CBT empowers you to regain control over your anxiety and live a more fulfilling life.
• Dialectical Behavioral Therapy (DBT): Originally developed to treat borderline personality disorder, DBT has also proven to be effective in managing anxiety. DBT combines elements of CBT with mindfulness techniques and emphasizes building skills to regulate emotions and improve interpersonal relationships. With DBT, you'll learn valuable strategies to manage anxiety in the moment, strengthen emotional resilience, and nurture self-compassion.
• Interpersonal Therapy: Anxiety can often be influenced by relationship difficulties or major life changes. Interpersonal therapy (IPT) focuses on improving your relationships and communication skills to alleviate anxiety symptoms. By exploring how your interactions and connections with others impact your anxiety, IPT helps you develop healthier patterns of relating and resolving conflicts. By addressing interpersonal challenges, IPT can lead to a reduction in anxiety symptoms and improve overall well-being.
• Mindfulness-Based Therapy: Mindfulness therapy approaches, such as mindfulness-based stress reduction (MBSR), cultivate a non-judgmental awareness of the present moment. These therapies help you develop skills to focus on the present, observe your thoughts and emotions without judgment, and cultivate inner calm. By practicing mindfulness, you can learn to navigate anxiety more skillfully, reduce stress, and develop a greater sense of resilience and self-awareness.

Is Exposure Therapy for Me?

Exposure therapy isn’t for everyone. Some people find they aren’t ready for the intensity of facing their fears head-on, and may benefit from a different approach. Talk to your therapist if you think Exposure Therapy is a good option for you. 

Signs exposure therapy will help you address anxiety include:

• Your anxiety is specific and tangible.
• Your avoidance of your anxious trigger negatively impacts your life. 
• You are unable to go where you want to go and do what you want to do because of your anxiety. 
• You are willing to face your anxiety triggers head-on.
• You have or are willing to learn strong relaxation and calming techniques.

Exposure Therapy can be a great option for a lot of different people. Don't forget that you can take it slow. There’s no pressure to dive into the deep end of your anxiety trigger; maybe you want to start with some mental visualization. Remember that you're not alone when you’re doing Exposure Therapy. Your anxiety therapist is there guiding you and will stop the therapy if it becomes too much. 

Therapists who practice Exposure therapy are licensed with years of education and experience. They will be there to make sure you are safe and don’t push yourself too hard. 

Is Exposure Therapy Effective? 

Yes! Exposure therapy is 90% effective in treating specific phobias. It is harder to measure the effectiveness of it in more complex anxiety disorders such as PTSD or OCD, but the experts agree that it is an effective treatment modality.

Can I Do Exposure Therapy On Myself?

We recommend you talk with a licensed therapist about Exposure Therapy for anxiety before you try to implement any of the skills talked about here by yourself. Exposure Therapy can be a very intense experience, and dangerous to your physical and mental health when not monitored properly. 

However, with mild cases of anxiety, OCD, phobias, and social anxiety, some level of self-exposure therapy can be effective. For example: 

• Social anxiety: You are afraid of talking to strangers, so you make an effort to ask your local barista one question while you order your coffee. 
• OCD: You have the compulsion to walk through a doorway until it feels right, so on your way to work you try to walk through the door only once. 
• Phobias: You are afraid of dogs, so you walk near the dog park once a week. 

If you are going to try any sort of exposure therapy by yourself, try to include a trusted friend or family member. Tell them your plan and come up with an escape plan in case the anxiety gets too much. 

If you experience panic attacks, nausea, fainting, or throwing up as a result of your anxiety, we strongly recommend you do not try exposure therapy on your own and seek professional help. 

Some therapists prescribe mild amounts of self-exposure therapy as homework for their clients to practice the skills learned in therapy. For mild cases of anxiety, it can be extremely helpful. Always consult a doctor or a mental health therapist before trying any of the techniques listed in this article. 

To meet with a licensed therapist, give Lifebulb a call, or browse our list of therapists near you.

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