Exposure therapy is a type of psychological intervention that involves exposing a person to the source of their fear or anxiety — but with the danger removed.
Basically, it’s that show “Fear Factor” but as a medical treatment. If you didn’t watch the show (it ran from 2001 to 2012), the premise is Joe Rogan commentating while six people play a game of fear chicken. Contestants are exposed to their phobias, and the last one to throw in the towel walks away with those sweet dollar-bucks.
Scared of spiders? Joe Rogan has spiders crawl over your head. Heights? Joe Rogan makes you jump off some really tall sh*t. Clowns? A tiny car pulls up outside your house, and dozens of Joe Rogans pile out.
Exposure therapy is the same thing, except the goal is mental well-being and conquering anxiety rather than winning Joe Rogan’s money and affection.
This mode of therapy has a huge success rate and has helped a whole bunch of people confront anxiety disorders, PTSD, OCD, and sexual trauma. And with the advent of virtual reality, exposure therapy is getting pretty cutting-edge.
We took a closer look.
There are different kinds of exposure therapy. While the specifics vary, the underlying principle is always the same: People are exposed to their triggers in incrementally larger amounts. The idea is that by exposing themselves to their fear trigger in a safe space, they’ll build up psychological resilience over time.
It’s a good idea, too, because 60 to 90 percent of people who go through exposure therapy report that their symptoms are either nearly or completely resolved. Those are some bananas numbers, TBH.
The details of treatment will depend on the type of exposure therapy you’re doing and the specific (or generalized) anxiety you’re trying to overcome. Someone with arachnophobia might have to face up to a bunch of spiders during exposure therapy. A face full of tarantula wouldn’t do much good for an Iraq veteran with PTSD.
The practitioner tailors the therapy to the individual’s needs. There are several types, which we discuss below.
Exposure therapy is effective for people with a wide range of psychological conditions, from life-disrupting phobias to acute clinical PTSD after experiencing trauma.
Exposure therapy for PTSD
A 2013 study on Iraq war veterans found that prolonged exposure therapy did them a world of good. The percentage of participants who screened positively for PTSD reduced from 87.6 percent to 46.2 percent after treatment. Talk about effectiveness.
Military PTSD isn’t the only trauma that exposure therapy has proven effective to treat. A 2003 study of rape and childhood sexual abuse survivors found that exposure therapy caused PTSD symptoms to resolve to a significant extent.
Treating PTSD with exposure therapy usually starts with the individual describing details of the traumatic experience in a safe, controlled environment. For folks undergoing treatment, this means confronting incredibly distressing emotions at first.
But a 2002 research review concluded that exposure therapy is generally safe and effective when carried out by a trained therapist. (And not, y’know, Joe heckin’ Rogan.)
Exposure therapy for anxiety
Exposure therapy is an effective treatment for anxiety disorders. When treating your anxiety with controlled exposure, your therapist will work with you to identify situations, objects, or people that trigger all the unpleasantness you associate with the condition.
You can guess what happens next. Your therapist will introduce you to a safe and controlled environment™ in which you’ll be exposed to all the stuff you wanted to avoid.
The level of exposure will start small (say, getting someone with a fear of flying to talk about airplanes) and increase session by session (having them sit in a flight simulator or an aircraft).
There are many reasons a person might develop anxiety. Regardless of the specifics, a mental health practitioner may prescribe exposure therapy as part of a wider cognitive-behavioral therapy (CBT) treatment plan.
Exposure therapy for social anxiety
Social anxiety is one of the most common types of anxiety in the United States, affecting an estimated 15 million adults.
Exposure therapy works just as well for social anxiety as it does for GAD. The treatment techniques follow the same core principles, but the exposure centers on social interaction. Research, including a 2013 study, suggests virtual reality exposure therapy can be particularly useful for treating social anxiety.
Exposure therapy for specific phobias
Exposure therapy is really f*cking good at helping folk get over phobias.
Regardless of the phobia, all treatment sticks to the same principle: Expose you to your phobia until it’s no longer a phobia.
VR exposure therapy is quickly becoming a go-to treatment method for phobias. In vivo exposure therapy also continues to be very common, and the debate among scientists is simply on which one works best.
Exposure therapy and OCD
OCD affects around 1 percent of people in the United States. It’s a mental health condition characterized by obsessive and/or compulsive behaviors.
The common Hollywood stereotype is that OCD turns people into hygiene-obsessed shut-ins. But, while cleanliness is a common OCD fixation, compulsive behaviors can take any form.
OCD compulsions could be anything from turning the lights on and off a set number of times before leaving a room to an inability to leave the house without reciting the Pledge of Allegiance first.
OCD can develop for any number of reasons, so compulsions are unique to each person. Exposure therapy can help folks with OCD manage the obsessive thoughts behind their compulsions without engaging in compulsive behaviors.
Exposure therapy comes in many varieties. While they all follow the basic premise of incrementally increasing exposure to negative/triggering stimuli, there are different ways to put this premise into practice.
Some types of exposure therapy are better for certain conditions than others (although many treatment plans include elements of multiple types, such as using in vivo and VR exposure as part of the same CBT plan).
Here’s a rundown of the main exposure therapy variations.
Prolonged exposure therapy
Prolonged exposure (PE) therapy is especially helpful for peeps with trauma/PTSD and longstanding clinical anxiety disorders. PE is any kind of exposure therapy plan that the practitioner deliberately spaces out over a longer period with repeated treatment sessions.
Conditions like PTSD and anxiety aren’t curable overnight. Folks living with them have to work long and hard to recover and achieve a mental/emotional equilibrium. Because of this, long-term treatment options like PE are much more effective for deep-rooted trauma like PTSD in military veterans, according to research from 2009.
A PE treatment plan could include in vivo, VR, and interoceptive exposure or any combination of exposure therapy and CBT techniques.
In vivo exposure therapy
In vivo exposure is your common or garden-variety exposure therapy: Get a little bit closer to what you’re scared of enough times, and you won’t be scared of it anymore. (That’s a massive oversimplification, but you get the gist.)
In vivo is the classic exposure therapy that takes you on a journey from looking at the spider to handling the spider.
VR exposure therapy
VR technology has been revolutionizing the world of exposure therapy. It has allowed exposure therapy to treat conditions and phobias for which it’s pretty difficult to create an in vivo plan.
A great example of this is the fear of flying (aka aviophobia). It’s difficult to gradually expose somebody to being miles above the Earth in a winged metal tube.
Peeps with aviophobia need to build themselves up before even setting foot on an airplane. Simulated VR flights might be the only reason many people are able to get on a flight without panicking.
And people with phobias aren’t the only ones who can benefit from VR exposure. Studies from the early 2000s suggest VR therapy is also a highly effective treatment for PTSD, OCD, and clinical anxiety disorders. Researchers pretty consistently agree that putting on a pair of goggles and simulating bad stuff makes that bad stuff easier to cope with IRL.
Imaginal exposure therapy
This is like a guided meditation, but instead of sandy beaches, your therapist will have you visualize a journey through your own personal hellscape. If you have claustrophobia (a fear of confined spaces), imaginal exposure therapy may involve imagining that you’re trapped in an elevator.
In a 2020 study, an online course of imaginal exposure therapy helped to significantly reduce eating disorder symptoms.
Exposure and response prevention
Exposure and response prevention (ERP) is “the most important type of CBT for OCD,” according to the International OCD Foundation. It has applications across the board, but we want to demonstrate just how important ERP is in the world of showing people scary sh*t until it isn’t scary anymore.
The “exposure” bit of ERP covers pretty much everything else in this article. The “response prevention” bit is why ERP needs its own section.
Exposure consists of growing accustomed to the trigger of your OCD, panic attacks, or dissociative episodes. Response prevention is the next step in the process. It involves training your mind to consciously choose not to engage in compulsive behavior or have a panic attack.
In the RP part of ERP, you take all the mental resilience you’re building and learn the skills to karate chop your anxieties in their stupid faces. Building mental resilience and mapping your thought processes to realign them is what CBT is all about. ERP is spot-on in that regard.
Interoceptive exposure therapy
Interoceptive exposure therapy is the most physiologically focused exposure therapy method. It’s a comprehensive approach, focusing as much on physical sensations as on mental/cognitive responses. It’s mostly prescribed as a treatment for panic disorder, but it can be also effective as a treatment for anxiety, OCD, and PTSD.
“Interoceptive” means that it re-creates the physical responses folks may associate with their distress or anxiety. The best example of this is running on the spot to re-create the breathlessness and rapid pulse of a panic attack.
Interoceptive exposure therapy often includes heavy workshopping between you and your psychologist to establish a hierarchy of your fears, anxieties, or triggers. Your practitioner may decide to look at either your smallest or your biggest fears first. These methods are called graded exposure and flooding, respectively.
Which one they’ll choose depends on whether they feel the best approach is to peel off the bandage slowly or rip it off quick-snap.
- Habituation. After a while, folks find that the intensity of their emotional responses decreases during panic/anxiety moments.
- Extinction. It’s nothing to do with dinosaurs (unless you’ve got a fear of dinosaurs). In CBT-land, this refers to the way exposure erodes the links in your mind between the sh*t you’re afraid of and negative outcomes.
- Self-efficacy. Exposure gives people a healthy dose of self-confidence by showing them they’re capable of confronting their fears and managing their emotional responses. Get ’em, tiger!
- Emotional processing. Exposure therapy helps folks create new, realistic emotional responses to troublesome stimuli. In the simplest terms, people who come out the other end of exposure therapy learn how to deal with fear better.
“Fear Factor” popularized exposure therapy, introducing the concept to much of the public. Joe Rogan most definitely did not invent it, though. He didn’t even come up with the show — he just repeated what was happening into the camera.
Exposure therapy started way back in the 1950s and was first practiced by trailblazers in South Africa. But it was Maudsley Hospital in England that first used it as part of their training program. This was revolutionary at a time when shoving spikes up people’s noses to jab their brains until they stopped being noisy was still considered a good idea.
Many people credit James G. Taylor of the University of Cape Town with inventing exposure therapy. He was way underrated in his day, so a lot of his work went unpublished. But thanks to the power of history and hindsight, it’s generally accepted that Jamie boy was the first dude to use exposure treatment for anxiety.
You go, Jamie!
Exposure therapy is a CBT technique mental health practitioners use to treat anxiety- and fear-related disorders. It’s also hella good for treating phobias.
There are many types of exposure therapy, and they all involve exposure to stimuli that trigger problematic emotional responses. It can be as simple as thinking about triggers or as in-depth as real-life immersion in a stressful situation.