How exposure therapy can help you confront your fears

If you’ve ever struggled with intense fear or know someone who has, you may have heard of exposure therapy. Many people avoid common fears like public speaking, flying, interactions with specific animals or insects, or anxiety-provoking experiences like dental appointments or being in crowds. 

While some fears are easy to avoid, others may interfere with everyday life and functioning. Phobias can hold us back from experiencing positive events, pursuing goals, or having healthy personal and professional relationships. Seeking relief through exposure therapy can majorly benefit those living with fear.

This article provides an overview of exposure therapy and the mental health concerns it addresses. It explains how exposure therapy works, exposure therapy types, techniques for relieving fear, and in-depth information on more advanced methods of addressing irrational fear.

What is exposure therapy?

Exposure therapy is a method of facing phobias in a controlled and emotionally safe environment. Through structured and repeated exposure to a feared object guided by a therapist, you can achieve cognitive restructuring. This is the process of interrupting the established pattern of stimulus and automatic response. Exposure creates new pathways in the brain that are more adaptive than your previous response.  

How does exposure therapy work?

Exposure therapy uses evidence-based techniques to help you gain relief from anxious feelings or fear. For instance, a therapist works to change the stimulus-response mapping causing a maladaptive response. They provide guided exposure to the stimulus to change the ingrained response. It’s a type of behavior therapy recognized by the American Psychological Association and other medical bodies as a method to reduce fear and decrease avoidance. 

Exposure therapy works through four mechanisms: 

• Habituation: Repeated exposure to a trigger acclimates you to its presence. Gradually, this lessens the degree to which you experience a response.
• Extinction: Exposure weakens the response to a trigger. Over time, the original reaction (an unconditioned response) no longer occurs, and a new behavior emerges (a conditioned response).
• Emotional processing: You learn a new way of processing the emotions around the stimulus. This shifts your response to triggering conditions.
• Self-efficacy: You develop new skills to overcome your reaction to triggers and actively participate in managing them.You come to believe in your own ability to regulate your fear response.

The ultimate goal of exposure therapy is to improve your functioning by reducing your level of anxiety. Over time, you can experience the triggering stimulus without the associated feelings of anxiety, fear, or panic.

Methods of exposure therapy

The course and manner of exposure in exposure therapy are individual to each person. Even those with similar fears (like an animal or a social setting) may need a different approach. Your therapist will work with you to develop a therapeutic yet sensitive approach.

Placing someone in a triggering situation is a job for a professional. Often, well-meaning family or friends may expose someone to a trigger in a way that does more harm than good.

A therapist might introduce a stimulus to a client in one or more ways:

Imaginal exposure: This type of exposure begins in the mind’s eye. The therapist will prompt you to engage with a phobia through guided imagery. Interacting with a triggering stimulus is sometimes too intense for a client. Imaginal exposure provides a safe way to engage with and extinguish emotional reactions.

Virtual exposure: This approach works in the same way as imagination-based exposure. Using a VR headset and therapeutic program, you experience a lifelike virtual trigger. This presents a convincing way to experience and extinguish triggers without live exposure. Virtual exposure can be a stepping stone to an in vivo approach.

In vivo exposure: This is physical exposure to a triggering object, animal, or situation. For example, if you have a dog phobia, you might spend time with a dog. This exposure might start as a slow introduction in the same room. As therapy progresses, you might get closer to the dog. You might even interact at some point, such as petting the dog or taking it for a walk. The therapist might pair this exposure with regulating techniques such as deep breathing.

Interoceptive exposure: Sometimes, physical sensations can trigger feelings of panic. Feeling-based exposure addresses body sensation phobias by safely re-creating them. In the therapy setting, the therapist will re-create the sensation. For example, if a racing heart triggers anxiety, you might increase your heart rate with exercise. The goal is to create self-awareness about your response to sensations.

Exposure therapy techniques

A therapist relies on one or more techniques to introduce a stimulus in a helpful way. Every phobia and client is different. The method and type of introduction are individual to the nature of the phobia. Based on the severity of the response and your personal tolerance, your therapist may use one of the following methods:

1. Graded exposure is a gradual, systematic confrontation with a feared stimulus. It aims to reduce anxiety through controlled, repeated exposure. Graded exposure follows a hierarchy. It starts with less intense triggers and increases to more intense ones.
2. Systematic desensitization: This method pairs the slow increase of triggers with mitigation efforts. Before exposure, the therapist works with you to use relaxation techniques. These may include structured breathing or other self-management methods. You then encounter triggers of varying intensity to work through self-regulation during exposure.
3. Flooding: Flooding is the opposite approach to graded exposure. It introduces maximum-intensity triggers (real or imaginary) without attempting to mitigate response.
4. Prolonged exposure: This method extinguishes stimulus response by letting you “ride out” the initial reaction. Through a longer exposure duration, your feelings peak and then weaken. This gives you time to address the reaction and calm yourself down.
5. Exposure and response prevention: Compulsions associated with obsessive-compulsive disorder (ODC) need a special approach. In this method, you encounter a trigger such as a thought, image, or situation. In daily life, this trigger prompts a ritual or response. During controlled exposure, the therapist supports you to resist the compulsion. The goal is to change your response to the trigger and extinguish undesired behaviors. Response prevention takes time to achieve lasting and noticeable effects on your compulsion response.

Exposure therapy benefits

Successful exposure therapy offers numerous benefits. Most importantly, it empowers individuals to regain control over their lives, reducing the debilitating effects of disorders like OCD. Managing and resisting responses and compulsions allows clients to lead a less restricted lifestyle. Exposure therapy also fosters resilience. Letting people face their fears in a controlled environment allows them to develop coping mechanisms for anxiety-inducing situations. 

Building confidence, happiness, and fulfillment

Overcoming fear responses through exposure therapy paves the way to enhanced self-confidence, happiness, and fulfillment. As individuals learn how to be brave in the face of irrational fears, they experience a profound sense of achievement that bolsters their self-esteem. They may no longer view themselves as prisoners of their anxieties. Instead, they’ll feel liberated and capable of taking charge and controlling their responses. This newfound confidence can seep into all aspects of life, transforming personal relationships, career progression, and overall well-being.

Controlling fearful responses helps people pursue happiness without obstacles. As people overcome fear, they fully embrace and enjoy life’s moments without apprehension or dread. Activities that were once avoided due to triggering fears become sources of joy and satisfaction. The world opens up in a new light, filled with opportunities for exploration.

The journey through exposure therapy is one of personal growth and self-discovery. Individuals learn about their own strength and resilience in the face of adversity, as well as their capacity for change. This realization can create a deep sense of fulfillment in reclaiming control over one’s life. 

What mental health issues can exposure therapy treat?

Exposure therapy is useful in addressing fear responses stemming from various mental health conditions, whether chronic or acute. Many mental conditions can create conditions where fear becomes unmanageable. 

Exposure may help alleviate symptoms from any of these sources:

Post-traumatic stress disorder (PTSD)

This is a disorder that may happen when a person has witnessed or experienced a traumatic event. These events may involve sexual assault, a serious accident, a natural disaster, a terrorist attack, or violence.

People who suffer from PTSD may have disturbing thoughts and feelings related to the trauma they experienced. These responses may come out of the blue or be triggered by a stimulus that reminds them of the trauma. Moreover, these may include bodily responses (anxious symptoms, freezing up, etc.), sadness, fear, flashbacks, nightmares, or night terrors.

For example, a person who has been sexually abused may experience flashbacks of the moment it happened. They might also have an unpleasant bodily response to physical touch.

Generalized anxiety disorder (GAD)

This disorder is characterized by persistent worry about everyday life events. Anxiety is a necessary response our body has as a survival mechanism. Still, it becomes a problem when this anxious response is not necessary because no danger or threat needs a “fight or flight” response from us.

For instance, a person with GAD could experience anxious symptoms over a loved one not responding to their texts, changes to plans, or fear of the future.

Obsessive-compulsive disorder (OCD)

People who suffer from OCD experience obsessive thoughts centered around a certain theme. They engage in compulsive behaviors to relieve the anxiety they feel due to these thoughts. 

Obsessive thoughts can vary, but here are some common themes:

• Germs and cleanliness
• Illness and disease
• Controlling your environment
• Religious obsessions
• Unwanted sexual obsessions

The compulsions that people can experience due to these obsessive thoughts are also diverse. Common compulsive behaviors include excessive cleaning, disinfecting, checking, repeating, counting, evening out numbers, and even making body movements such as exaggerated posture correction. 

OCD is sometimes portrayed as quirky or comical in pop culture. However, intrusive thoughts and phobias can be very distressing. Compulsive rituals can become elaborate or constant, such as hand-washing to the point of bleeding or sequences that have to be restarted if they aren’t executed perfectly. At such a point, they severely interfere with basic daily life. Distress and complications from OCD result in a higher likelihood of suicidal ideation. 

Phobias

This includes any extreme and persistent fear of an item or a situation that causes the person to avoid it at all costs. Some common phobias are agoraphobia (fear of open and public spaces), claustrophobia (fear of closed spaces), and a fear of specific things, such as a certain animal or object.

Social anxiety disorder

This disorder consists of an extreme fear of social situations involving meeting people or interacting with others. It can include thoughts of being constantly watched and judged by others.

A person who suffers from social anxiety disorder might avoid social situations such as parties or work gatherings in order to avoid this anxiety. They also suffer from a loss of social connection.

Panic disorder

This anxiety disorder is characterized by regular panic attacks that sometimes have no specific trigger. This can often interfere with everyday tasks and activities.

Trauma

This can include a wide variety of trauma, which is a response our bodies and minds have to a stressful or distressing situation. Trauma can leave a person feeling helpless, wounded, and lacking the ability to cope with certain feelings and emotions.

Examples of trauma include having experienced sexual assault, a terrorist attack, a natural disaster, domestic violence, or an abusive upbringing.

Is exposure therapy effective?

Exposure therapy is scientifically proven to help people overcome fears, with over 90% of clients reporting no remaining symptoms post-treatment or sub-clinical symptom levels (responses that do not rise to the level of intervention). When applied correctly by a trained professional, exposure therapy can be a powerful and effective technique that gives people back freedom and control over once-debilitating fears. This is especially compelling for pervasive phobia-related disorders like PTSD.

Two primary variables come into play when assessing the likelihood of success in exposure therapy:

• Type of exposure techniques. Depending on what a person fears, the exposure technique they engage in can have a bearing on their success. For example, exposure and response prevention (a form of cognitive behavioral therapy) is especially effective for addressing OCD behaviors.
• The client’s engagement. A client must be an active participant in their care. This means performing the exercises as outlined and trusting their provider and the process. While the provider’s efforts and expertise are important, the client’s participation in the therapy and techniques is equally important. Partnership and adherence to the exposure plan is a recipe for a successful exposure technique. Self-efficacy in those undergoing exposure therapy even predicts treatment-related decreases in symptoms. 

Preparing for exposure therapy

As with any type of therapy, strong beginnings make for better outcomes. Taking steps to prepare for exposure therapy before your first session provides tools and perspectives that will help you as you progress through the plan. 

Consider taking these steps to prepare for an upcoming exposure therapy plan:

Learn about the process

Understanding exposure therapy before starting treatment demystifies the experience. Taking this measure allows you to grasp its objectives and prepare for success. This knowledge also empowers you to participate in recovery, create a sense of control, and build commitment. 

Familiarity with exposure therapy can mitigate anxiety about treatment. Informed clients are better equipped to discuss their experiences, set boundaries, practice effective techniques, and gauge their emotions while getting treatment.

Consider your fear hierarchy

A fear hierarchy is a therapeutic tool used to gradually desensitize an individual to objects or situations that incite fear or anxiety. It’s essentially a step-by-step list created collaboratively by the client and therapist. It’s extremely useful for establishing a care plan. 

The fear hierarchy begins with scenarios that cause mild discomfort and progresses toward those that trigger intense fear. The idea is to confront these fears in ascending order. Each step builds upon the confidence gained from the previous one.

In exposure therapy, this systematic approach allows for gradual exposure. This avoids overwhelming experiences that could discourage or traumatize the client. It helps the client start small with little victories. The difficulty then increases at a manageable pace. This method fosters resilience and allows clients to manage their experience and measure their progress.

Setting SMART goals

In exposure therapy, setting SMART goals offers a structured and clear pathway to help clients navigate treatment. SMART goals are often used in business settings but provide the same benefits in a therapeutic setting.

These are the five components of every SMART goal: 

• Specific: The goal must be detailed in scope. For example, a smart goal might be to successfully complete a portion of exposure, like viewing a video of a spider.
• Measurable: The goal should have a duration or progress metric. This could be to watch a video of a spider for five minutes without pausing the exposure or looking away.
• Achievable: Goals should not be so lofty as to be difficult. Once a smaller goal is achieved, new and more ambitious goals can advance a person’s progress. 
• Relevant: The goal must relate to the desired outcome. If someone is trying to overcome a fear of spiders, therapy should focus on that one fear before addressing others.
• Time-bound: The goal must be achieved within a specified time, such as within a session or over a set interval.

Together, SMART components empower clients with realistic milestones and concrete progress markers as they overcome fears and phobias.

Building a support system

Every journey is easier with the right support. Establish a network of trusted individuals who can provide emotional reinforcement, encouragement, and assistance during the therapeutic process. The support system could include family members, friends, a therapist, or support groups. 

Supporters are there to offer understanding when fears resurface. They can also offer praise for victories achieved along the way. They help maintain motivation, ensuring you’re not alone during challenging moments and facilitating recovery. Supportive friends and family make the hard times easier and make success feel even better.

Can you perform exposure therapy on yourself?

While some individuals may attempt exposure therapy independently, doing so may not be as effective. Exposure therapy is often focused on confronting intense fears. Trying to overcome intense fears or phobias without the guidance of a trained professional could make things worse. 

A therapist versed in exposure techniques can better ensure the process is gradual and controlled. This prevents overwhelming distress that may cause setbacks. Such a professional can also provide immediate support in case of severe reactions. 

Moreover, therapists are skilled at helping people develop effective coping strategies. Although self-advocacy and independence in mental health care are admirable, professionals are best positioned to guide the process.

How to tell whether exposure therapy is working

It’s important to recognize success as you move through exposure therapy treatment. This builds confidence and reinforces the hard work of overcoming fear. 

Be sure to keep an eye out for these signs of success during and after treatment: 

• Experiencing a reduction in fear or anxiety levels related to the specific phobia
• Recognizing your ability to stay in situations previously avoided due to fear
• Noticing shorter reaction times to triggers over repeated exposure sessions
• Building confidence and self-efficacy as you successfully navigate anxiety-causing situations
• Feeling fewer physical symptoms, such as rapid heartbeat, sweating, or shortness of breath, during a fear trigger
• Noticing a change in thought patterns, transitioning from catastrophic predictions toward more balanced thinking
• Seeing quality-of-life improvements, such as participating in activities you previously avoided due to fear
• Getting comments from friends, family members, and providers about observable improvements in your fear response and management

Advanced strategies for lasting change

Therapists apply various modalities and techniques to help clients achieve relief from their fear. These psychological philosophies and alternative approaches may be useful parts of your care plan as outlined by a licensed mental health professional. 

Cognitive Behavioral Therapy (CBT)

CBT is a form of psychotherapy that alters thought patterns to affect behavior change. It helps the client identify and challenge irrational fears, replacing them with rational perspectives. 

In exposure therapy as a subset of CBT, individuals gradually increase exposure to their fear triggers in a controlled environment. This repeated exposure helps reframe the fear response over time, reducing anxiety symptoms and enabling better management of fear.

Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy (ACT) is a mindfulness-focused form of psychotherapy that encourages focusing on the present moment and approaching thoughts and feelings without judgment. It aims to help clients work through difficult emotions rather than dwelling on negative experiences.

ACT-informed exposure therapy promotes gradual exposure in a controlled setting combined with accepting and managing fear responses. These therapies may promote adaptive coping strategies and lasting change.

Therapy and coaching

Some clients find professional coaching to be a useful supplement to exposure therapy. It provides a personalized, goal-oriented approach that complements therapeutic strategies. Coaches work closely with clients, helping them identify their strengths and leverage them in confronting their fears. 

This proactive method fosters self-efficacy and resilience. In turn, you’re empowered to manage anxiety triggers effectively outside the therapy environment. 

Combining exposure therapy and professional coaching may enhance personal development, creating lasting change through adaptive coping mechanisms and confidence-building. Individuals who combine these approaches gain access to additional tools to help them relieve fear and improve their everyday lives. 

When to seek professional help

An individual should seek professional help when extreme fear or phobias start to significantly impair daily functioning, quality of life, and relationships. Disorders could manifest as excessive worry, avoidance behavior, intense distress about a specific object or situation, or frequent panic attacks.

If you experience fear and impairment for six months or more that interferes with work, school, or social activities, it’s time to consult a professional. Specialists can provide tailored therapies like exposure therapy and coaching strategies to help you manage and overcome anxiety triggers. 

But remember, it’s never too late to seek help and regain control over your life.

Consider coaching as part of your exposure therapy plan

There are many ways a licensed therapist may conduct exposure therapy. The process may be challenging. But it offers hope of rapid and significant relief from fear and improvements in quality of life and well-being. 

Coaching may further enhance your exposure therapy experience, providing tools and strategies to complement the work you perform with a therapist. 

BetterUp Coaches can help you see how fear or anxiety is affecting your life and recognize when to seek professional treatment. Learn how BetterUp Care™ can support you.