Brain Science and Updates From the Field

What is exposure therapy?

Thursday, December 22, 2016

While fear and anxiety can be useful tools that warn us when danger is imminent, they can also be debilitating forces.

And when they prevent us from carrying out necessary functions or have an adverse effect on our happiness, one’s natural instinct might be to avoid the experience at all costs.

Interestingly, a therapy based in doing the opposite has proven to be among the most effective treatments at confronting—and conquering—fears, anxieties and phobias.

For people who struggle with anxiety disorders and phobias, exposure therapy brings them face to face with their fears, helping them attain a sense of ease in the process.

The practice involves subjecting individuals to increasing amounts of the feared object or experience without any danger in order to help them overcome their anxiety. It is effective in the treatment of anxiety disorders such as Post-Traumatic Stress and Obsessive Compulsive disorders.

Donnelle Super has been using exposure therapy for about a decade as a therapist at Stairways Behavioral Health’s Erie Outpatient Clinic. While working with clients who have various phobias and fears, Super starts by identifying a fear, recognizing the irrational thought that causes it and confronting it.

“If you have a fear of spiders, we might start by showing you pictures of spiders as a way to challenge the irrational thoughts that are causing that fear,” she said.

Most exposure therapists use a graded approach in which they begin by targeting mildly feared stimuli and gradually move on to challenge greater ones. Super said she often tasks clients with assignments in which they confront their fears outside the office.

Using the example of a client who is fearful of going to the grocery store, Super described the steps they may take during exposure therapy.

“You might want to start by taking them to the parking lot just to see and visualize what the experience might be,” she said. “The next time you might go inside the store and buy one item and use the quick check-out line, and then the next time, you’ll buy a few more items.”

Super also stressed the importance of determining what triggers might elicit strong responses and to not put individuals in those positions where they would feel imminent danger.

“You would never want to take them past an anxiety point,” she said. “That’s why it is so important to establish a trigger hierarchy that you would know at what point the client feels some anxiety but they wouldn’t feel at risk of danger.”

However, there should always be some level of discomfort, she said.

“If there is no anxiety, you’re not going to perform much. At some point, there has to be fear, because if there isn’t, we aren’t working on anything.”

While the main mechanisms of exposure therapy have remained much the same since the treatment became widely recognized in the 1950s, the method has received renewed attention thanks to the introduction of virtual reality.

In particular, for those who have experienced trauma, virtual reality has proven to be an effective tool. Virtual Reality can transport users to a time and place where they can experience their fears in a seemingly authentic but controlled environment.

Super noted this is a trend to keep an eye on as VR comes in the mainstream.

But whether it’s performed conventionally or using state-of-the-art technology, the research and results are clear when it comes to exposure therapy: for a number of problems, the best way out is often through.

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