exposure therapy

The Ultimate Guide to Exposure Therapy


Exposure therapy is one of the most effective treatments for anxiety, PTSD, OCD and phobias. If you struggle with overwhelming fear or obsessive urges, this comprehensive guide will teach you everything you need to know about exposure therapy. You’ll learn what it is, how it works, types of techniques used, how to find a therapist and maximize your success with exposure treatment. Arm yourself with knowledge to overcome anxiety and reclaim your life.

What is Exposure Therapy?

Exposure therapy is a psychological treatment that helps reduce fear and anxiety triggered by specific objects, activities, situations or memories. It works by gradually and repeatedly exposing you to the source of your fear in a safe, controlled setting.

For example, exposure therapy for someone afraid of flying might begin by looking at photos of planes. Over time, they work up to watching videos of flights, driving to the airport, sitting in a stationary plane and finally taking a short flight. Through this progressive exposure process, anxiety lessens as the person habituates or gets used to the feared stimuli while learning they are not actually dangerous.

Exposure therapy began in the 1950s and numerous studies demonstrate its effectiveness, especially when combined with cognitive behavioral therapy (CBT) techniques. It provides long-lasting relief by targeting the root cause of anxiety.

How Does Exposure Therapy Work?

Exposure therapy is based on the principle of fear extinction. When you repeatedly confront a feared but safe situation, your perception of threat decreases while your ability to cope increases. Anxiety levels decline through habituation and new learning.

The amygdala, the brain’s emotional center, calms down as it processes that no real harm is occurring. Cortisol and other stress hormones are reduced. Neural pathways change as non-threatening associations weaken fear responses over time.

Through enough exposure, you stop anticipating disaster each time you encounter the stimulus. Mastery and self-efficacy replace dread. The emotional memory loses its power – fears are “unlearned.”

This makes exposure therapy more effective than just avoiding triggers, which offers only temporary relief by reinforcing fears. It retrains your brain toward lasting calm and confidence.

Conditions Treated with Exposure Therapy

exposure therapy can treat

Exposure therapy helps treat:

  • Specific phobias like fears of flying, animals, needles or heights
  • Social anxiety disorder
  • Panic disorder and agoraphobia
  • Generalized anxiety disorder (GAD)
  • Obsessive compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Illness anxiety disorder
  • Separation anxiety

It rewires the brain’s threat perception to reverse conditioned fear responses. Research confirms exposure therapy’s usefulness across these anxiety disorders.

Types of Exposure Therapy

exposure therapy types

Mental health providers have several exposure therapy techniques to choose from:

Imaginal exposure – Visualizing the fear stimulus through memories or imagination. Used for PTSD and fear of public speaking.

In vivo exposure – Real-life encounters with feared objects or situations. Going to the dentist for someone afraid of dental work is an example.

Interoceptive exposure – Triggers physical sensations like rapid heart rate or dizziness to reduce panic symptoms.

Virtual reality exposure (VRE) – Uses VR technology to mimic challenging scenarios like flying, skyscrapers or spiders.

Systematic desensitization – Builds a fear hierarchy then gradually works up the list while learning relaxation skills.

The therapist selects appropriate techniques based on your diagnosis, symptoms and preferences. Most use a combination approach tailored to you.

The Exposure Therapy Process Step-by-Step

Successful exposure therapy follows this basic process under a provider’s guidance:

Assess – Identify all specific triggers and define target symptoms. Rate severity.

Develop hierarchy – Rank triggers from least to most anxiety provoking to build a personalized fear hierarchy.

Learn coping skills – Teach techniques like deep breathing, positive self-talk and mindfulness to manage distress.

Begin exposures – Start with lower-risk items on your hierarchy, building up gradually as anxiety reduces.

Process – Discuss your experience and new learnings after each exposure session.

Repeat – Work through the hierarchy approaching the most feared stimuli through multiple sessions over weeks or months.

Review progress – Measure symptom improvements, adjust feared stimuli ranking as needed and reinforce gains.

This gradual immersion process activates anxiety initially but fosters healing over time.

How Long Does Exposure Therapy Take?

The length of exposure therapy depends on the severity of your symptoms. Fear of a phobia like needles may resolve in 4-6 hourly sessions while OCD or PTSD may take 8-16 sessions over 2 or more months.

Factors affecting duration include:

  • Number of feared objects or situations to target
  • Your level of baseline anxiety
  • Frequency/length of therapy sessions
  • How quickly fear decreases with exposure
  • Willingness to persist through temporary distress

Stick with the process as long as anxiety continues declining between sessions. Repeated practice strengthens new neural pathways and skills until fears are conquered.

Medication During Exposure Therapy

Anti-anxiety medication is not usually necessary but may be helpful during the early most-intense exposure sessions.

Benefits include:

  • Taking the edge off while you build tolerance
  • Preventing excessive distress that impedes progress
  • Breaking anxiety cycles to engage fully in treatment

Drawbacks include:

  • Dampening the learning effects of exposure
  • Delaying developing your own coping skills
  • Addictiveness and side effects of benzos

Discuss the pros and cons with your provider. Use medication cautiously on an as-needed basis to complement therapy.

Does Exposure Therapy Really Work?

Anxiety thrives on avoidance. Exposure therapy provides lasting relief by gradually confronting feared situations so you build confidence and resilience. Reviews of dozens of high-quality studies confirm its effectiveness for:

Exposure therapy rewires the brain’s fear responses for lasting reduction in anxiety symptoms.

Does Exposure Therapy Have Side Effects?

Exposure therapy causes only minimal temporary distress in the process of facing fears. This is normal and manageable with your provider’s support.

Lasting emotional side effects or harm are very rare. However, some key considerations include:

  • Exposures may initially worsen anxiety, so proceed gradually.
  • Discuss any concerns about feeling emotionally unready or overwhelmed by exposures.
  • If distress escalates into panic attacks, slow down exposures and build more coping skills first.
  • Extreme flooding/immersion methods without pacing or coping skills can worsen anxiety.
  • Notify your provider if anxiety or depression increase outside of sessions.

With a trusted therapist overseeing the gradual exposure process, side effects are minimal and progress continues.

Tips for Getting the Most out of  Therapy

To conquer your fears most effectively through exposure therapy, keep these tips in mind:

  • Learn anxiety management and coping techniques like deep breathing, mindfulness and positive self-talk to apply during exposures
  • Let anxiety levels reduce between sessions rather than pushing into distress
  • Recall successful exposures to boost confidence for future challenges
  • Reward yourself after exposure exercises
  • Repeat key exposures over multiple sessions for benefits to fully stabilize
  • Share any difficulties so the therapist can adjust the approach
  • Practice outside of sessions through real-life exposure homework
  • Make time to engage fully without rushing – recovery takes patience
  • Maintain a commitment to the process even as discomfort arises
  • Continue using your skills after therapy ends to prevent relapse

Staying motivated and actively applying coping strategies amplifies exposure therapy’s benefits.

Overcoming Common Barriers and Challenges

It’s normal to hit some bumps in exposure therapy. Strategies to overcome common barriers include:

Difficulty tolerating distress – Use calming skills and work up very gradually to exposures. Added medication can temporarily take the edge off.

Losing motivation – Revisit your goals. Review progress and readiness to change. Pace exposures to maximize success experiences.

Avoiding homework – Start small with manageable steps. Troubleshoot obstacles. Have accountability to a support person. Consider incentives.

Fatigue – Balance exposures with self-care. Shorter, more frequent sessions can help.

Life disruptions – Reschedule missed sessions promptly. Adjust treatment plan flexibly as needed.

Discouragement from slow progress – Celebrate small successes. Progress speeds up over time as skills strengthen. Compare improvement to treatment start.

Don’t let setbacks derail your recovery. Communicate concerns immediately so you stay on track.

Finding a Therapy Provider

Several types of licensed mental health professionals like psychiatrists, psychologists and therapists provide exposure therapy. To find an appropriate practitioner:

  • Search online directories like PsychologyToday or GoodTherapy screening for CBT and exposure therapy expertise.
  • Check provider credentials like licensure and specialized training.
  • Read reviews from other clients.
  • Interview potential therapists to confirm they use exposure therapy routinely for your diagnosis and have supported many clients through the process.
  • Ask how they pace exposures, prevent overwhelm, and help if you get stuck.

An experienced anxiety disorders specialist well-versed in customized exposure protocols brings the highest likelihood of success.

What to Expect at Your First  Therapy Session

The first visit focuses on assessment and planning. The therapist will:

  1. Explore your history of anxiety symptoms
  2. Identify specific fear triggers to target
  3. Have you rate your distress level when encountering triggers
  4. Explain the exposure therapy process and rationale
  5. Introduce coping strategies like relaxation skills and thought challenging
  6. Develop a personalized fear hierarchy
  7. Collaboratively plan initial exposure exercises to do for homework
  8. Address any concerns and build motivation

You’ll gain an understanding of how to approach exposures and start acquiring helpful coping tools right away.

Cost and Insurance Coverage

Exposure therapy costs on average $100-$200 per session in the U.S. if paying privately without insurance.

Many insurance plans cover a portion, typically subject to deductibles and copays. Verify coverage in advance and if your therapist is in-network to receive maximum benefits.

If finances are tight, ask about payment plans, sliding scale options and practicing exposures using free mobile apps like NOCD between some in-person sessions. Investment in overcoming anxiety pays off long-term.

Group Exposure Therapy

While individual therapy better personalizes treatment, group exposure therapy offers:

  • Shared costs among members
  • Accountability and motivation from peers
  • A supportive social environment
  • Learning how others experience anxiety
  • Practicing exposures relevant to the whole group

Ask your therapist about reputable group exposure therapy programs near you. Individual and group sessions combined maximize benefits for some.

Online Exposure Therapy

Remote tele therapy options increased recently, making exposure therapy more convenient through:

  • In-home videoconferencing
  • Online programs with therapist guidance
  • Virtual reality exposure via apps
  • Smartphone tools for real-world exposure homework

Ask providers if they offer remote online therapy. Research suggests online exposure therapy is effective for many phobias and anxiety disorders. The key is an experienced therapist guiding exposures and troubleshooting through technology.

Exposure Therapy for Kids and Teens

Exposure therapy provides safe, effective treatment of childhood anxiety, OCD and other phobias as well.

Benefits for kids and teens include:

  • Less reliance on medication
  • Learning coping skills for life
  • Higher self-confidence
  • Less school impairment
  • Healthy social and emotional development

Children as young as 7 can engage in exposure therapy when presented creatively. Involving parents provides extra support. Adjusting pacing for faster progress optimizes success.

Further Resources

Supplementary resources to learn more about exposure therapy include:


  • The Anxiety and Phobia Workbook by Edmund Bourne – Bestseller on self-guided exposure exercises
  • The OCD Workbook by Bruce Hyman and Cherry Pedrick – Top workbook for OCD exposure skills


  • Getting Over OCD by Jonathan Abramowitz – Excellent guide on optimizing OCD exposure therapy
  • Exposure Therapy for Anxiety by David Carbonell – Detailed walkthrough of fear extinction


Use books, workbooks and websites to learn everything possible before starting exposure therapy for best results.


In conclusion, exposure therapy provides a highly effective solution for anxiety, OCD and specific phobias when facilitated by a trusted therapist. Repeatedly confronting your fears in a controlled setting activates your brain’s fear extinction capacities to permanently reduce associated distress. Approach the process as an investment – some temporary discomfort leads to confidence, resilience and lasting liberation from anxiety’s grip. Thousands of peer-reviewed studies confirm exposure therapy’s benefits. With determination and skills to manage short-term anxiety, exposure therapy can help you reclaim a calm, fulfilling life unburdened by irrational fears.







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