Exposure therapy is one of the most effective means of treatment we have. There is endless amounts of research supporting its efficacy, especially in the treatment of anxiety.
Exposure therapy, in a nutshell, is helping clients face their fears. Anxiety feeds off of uncertainty and the unknown and this often leads to avoidance. When we avoid, our anxiety and fears grow. Exposure therapy helps you confront vs. avoid. From an evolutionary perspective, our minds evolved to do an excellent job in getting us to think ahead about potential dangers so that we could continue to survive and avoid true threats to our lives (i.e., famine, attacks). Fortunately we don’t live in such a perilous environment day-to-day here in the DC Metro area. Unfortunately our minds still get us worked out about things that don’t necessarily pose true threats to our lives. Consequently, we end up just experiencing a high level of distress, often for no good reason at all. Anxiety and distress become problematic when we buy into what our minds are convincing us of and interpret our thoughts as fact. Exposure therapy helps your brain learn what is truly dangerous and what might just be a false alarm.
Below are examples of how exposure therapy is incorporated in treatment for various conditions:
Exposure therapy with OCD: Fear of germs and contamination? Washing your hands excessively to avoid this fear? We’ll have you touch a bunch of door knobs, use public restrooms, and not wash your hands for the rest of the day.
Indeed, our clients get very anxious, but that anxiety quickly goes down after repeatedly doing this because guess what? The client didn’t die from not washing their hands. So the brain had a chance to learn, ” Hmmm..the message I’ve been sending doesn’t seem to be true. Maybe I’m sending off a false alarm and we don’t need to both this person with this fear anymore.”
Another example of exposures with obsessions is having a client write down the thoughts they keep having and trying to avoid. In this way, the avoidance stops, the mind habituates to the thought and anxiety is reduced.
Exposure Therapy Specific Phobias: Fear of heights? We’ll take you to tall buildings, show you pictures of heights, have you practice going to locations with heights until your anxiety comes down and you habituate to the experience. Fear of elevators, insects, needles? There are exposures for all of those too! We’ll help you face your fears and reduce your anxiety.
Exposure Therapy with Generalized Anxiety: With generalized anxiety disorder, there can be a great deal of distress thinking about worst case scenarios. So to prevent having to think about worst case scenario, people will spend a lot of time worrying because it feels productive in some way. Occasionally with certain clients, we’ll have them make contact with worst case scenario in their mind. Eventually the mind habituates to this and it loses its power. Do you remember that old saying, “What you resist, persists”? Well, when we avoid certain images, or thoughts, they tend to become more powerful. When we confront them in the right way, they lose power.
Exposure Therapy with Panic Disorder: For some clients, panic results as a reaction to physical symptoms. So we can actually expose you to the physical symptoms that you’re most fearful of and help your mind learn that these symptoms are nothing to fear.
Exposure Therapy in PTSD: Though it sounds counter intuitive, a part of the effective aspects of trauma treatments is to process the trauma in safe, supportive environment and to help clients get back to living life and not avoiding certain things they might have been avoiding because of the trauma.
Exposure Therapy in Social Anxiety: Some people with social anxiety get uncomfortable with public speaking, talking on the phone, being the center of attention, conflict, making small talk. Exposure therapy might involve making several calls to places while in the therapy room with one of our providers or giving a speeches regularly to a group of people. Repeated exposure vs. avoidance helps the anxiety go down in these different scenarios.
Exposure Therapy with Weight Management: Afraid to go to the gym? Intimidated by the thought of cooking? Avoiding all the discomfort that might come with the process of managing your weight? We’ll help you to take steps in the direction of getting active, cooking, and monitoring your health behaviors so that you break through the mind barrier and realize it’s not as bad as your mind makes it out to be.
Exposure Therapy with Eating Disorders: Fear of eating certain foods that you haven’t allowed yourself to eat? We’ll eat those foods with you in sessions to help you break through the mind barrier and realize it’s not as bad as your mind makes it out to be. Meal exposures are an important part of treatment and we are increasingly incorporating this into our treatment .
Too scary to imagine doing any of this? We do graded exposures. If you have a fear and you’re too scared to face it, we’ll help you find a very small, manageable first step and build up from there. For instance, you might have a fear of elevators, and so the first thing we’ll do is just get you to look at pictures of elevators! That’s it. Once that becomes easy for you to tolerate, maybe we’ll get on the elevator and then get right off before it closes. Then maybe we just go up one floor. Then maybe we work on two floors and eventually you’re riding up and down the elevator for 20 minutes straight with no issues. With eating concerns, we create a food fear hierarchy. We start slowly incorporating more difficult foods and portions over time.
Don’t have a specific disorder like we’ve provided examples of above? Exposure therapy can probably still help. Anywhere in your life where there is avoidance, practice not avoiding. As I tell many of my clients, “lean into the discomfort.” That’s exposure therapy! Are you highly avoidant of having conversations with loved ones? The more you avoid it, the more anxiety-inducing or more difficult it will become. Exposure therapy can help you become really effective at communicating.