Exposure therapy is a technique that puts you face-to-face with your biggest fears and forces you to develop coping mechanisms. As such, it’s become a prominent tool for those who struggle with an anxiety disorder. But how effective is exposure therapy, and what types can you choose?

What are the Types of Exposure Therapy?

While exposure therapy may seem dangerous, these sessions always occur in a safe environment. The purpose isn’t to put the patient in danger. Rather, it’s to help them develop the proper coping skills to overcome anxiety.

To do this, exposure therapy utilizes a variety of different technologies and the following four techniques: ¹

1.) In Vivo Exposure

Simply put, in vivo exposure forces you to confront fears directly in reality. For example, if you have agoraphobia, this means you’ll need to go out in public and face a crowd. ²

Since the reality of everyone’s fears differs, so will the exposure. However, the primary purpose of in vivo is to ensure you face reality for what it is.

Naturally, this comes with some drawbacks. Most notably, you’ll have to face these fears without a safety net. As such, in vivo usually occurs in states, where you’re gradually exposed to your fears.

Remember that it’s not in a therapist’s interest to overwhelm you. Rather, their primary concern is to give you the proper space to address your fears.

2.) Imaginal Exposure

If you struggle with a type of trauma, imaginal exposure may be the best route for you. Simply put, imaginal exposure forces you to reimagine previous experiences in detail and confront them. ³

This is extremely useful for trauma as your brain has a natural tendency to bury it with time. The purpose of this burial is to protect you from its negative effects. However, over time, such burial can lead to mental health conditions, such as anxiety and depression. ⁴

When you reimagine trauma, you can reread it from a new perspective. This aims to identify where your fears come from and take charge of how trauma has affected your life.

3.) Interoceptive Exposure

If you struggle with panic attacks (or another severe form of anxiety), you likely experience physical symptoms. Interoceptive exposure allows you to experience physical symptoms and simultaneously work through them. ⁵

Naturally, this can be an intimidating process. However, with the right effort, this can also be very therapeutic. By identifying physical symptoms, you allow yourself the opportunity to develop coping techniques.

For example, if a panic attack causes you to struggle with shortness of breath, interoceptive exposure can help you develop certain breathing exercises.

4.) Virtual Reality Exposure

In recent years, the innovation of virtual reality (VR) has made it possible to stimulate anxiety triggers without the risk of actual exposure.

VR exposure therapy has been most useful for those who struggle with military PTSD. The technology can recreate a battlefield or ambush and force veterans to come face-to-face with a traumatic experience. As the technology progresses, VR allows for more photorealistic depictions. ⁶

What Disorders Can Exposure Therapy Help With?

Exposure therapy can be an effective treatment option for various types of anxiety disorders, including:

• Agoraphobia ⁷
• Obsessive-compulsive disorder (OCD) ⁸
• Post-traumatic stress disorder (PTSD) ⁹
• Social anxiety disorder (SAD) ¹⁰

However, that’s not to say it can’t help with other mental health conditions. For example, you may struggle with depression due to previous traumas. As such, exposure therapy can help you identify these traumas to overcome depression. ¹¹

Things to Consider

Admittedly, exposure therapy is not always the best approach to confront anxiety. In some cases, exposure therapy can be detrimental to a person’s ability to cope with anxiety or panic-related issues.

It’s no secret that exposure therapy can be overwhelming. While it’s designed to strengthen your reaction to anxiety, it can also do the opposite. Exposure therapy may overwhelm you to the point of complete panic.

In such cases, therapists will recommend one of two options:

1. Gradually exposing you to your fears to not overwhelm your well-being
2. Attempting another therapeutic approach (i.e. cognitive behavioral therapy)

Everyone is different when it comes to how they adapt to anxiety treatment. As such, you’ll need to experiment before you find the right path.

References

¹ Hamlett GE, Foa EB, Brown LA. Exposure Therapy and Its Mechanisms. Curr Top Behav Neurosci. 2023;64:273-288. doi: 10.1007/7854_2023_428. PMID: 37532963.

² Levy AN, Nittas V, Wray TB. Patient Perceptions of In Vivo Versus Virtual Reality Exposures for the Treatment of Anxiety Disorders: Cross-Sectional Survey Study. JMIR Form Res. 2023 Oct 16;7:e47443. doi: 10.2196/47443. PMID: 37843884; PMCID: PMC10616729.

³ Gandelman EM, Miller SA, Back SE. Imaginal exposure processing during Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) therapy: Examination of linguistic markers of cohesiveness. J Trauma Stress. 2022 Apr;35(2):682-693. doi: 10.1002/jts.22786. Epub 2022 Jan 3. PMID: 34979039; PMCID: PMC9035056.

⁴ Overmier JB, Murison R, Taklo T, Espelid R. Effects of traumatic stress on defensive burying: an alternative test of the learned helplessness animal model of depression and enhanced retrieval of unpleasant memories. Biol Psychiatry. 1994 Nov 15;36(10):703-4. doi: 10.1016/0006-3223(94)91180-0. PMID: 7880940.

⁵ Boettcher H, Barlow DH. The unique and conditional effects of interoceptive exposure in the treatment of anxiety: A functional analysis. Behav Res Ther. 2019 Jun;117:65-78. doi: 10.1016/j.brat.2018.12.002. Epub 2018 Dec 6. PMID: 30579624.

⁶ Hawajri O, Lindberg J, Suominen S. Virtual Reality Exposure Therapy as a Treatment Method Against Anxiety Disorders and Depression-A Structured Literature Review. Issues Ment Health Nurs. 2023 Apr;44(4):245-269. doi: 10.1080/01612840.2023.2190051. Epub 2023 Apr 19. PMID: 37075308.

⁷ Malbos E, Rapee RM, Kavakli M. A controlled study of agoraphobia and the independent effect of virtual reality exposure therapy. Aust N Z J Psychiatry. 2013 Feb;47(2):160-8. doi: 10.1177/0004867412453626. Epub 2012 Jul 11. PMID: 22790176.

⁸ Hezel DM, Simpson HB. Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian J Psychiatry. 2019 Jan;61(Suppl 1):S85-S92. doi: 10.4103/psychiatry.IndianJPsychiatry_516_18. PMID: 30745681; PMCID: PMC6343408.

⁹ Rothbaum BO, Schwartz AC. Exposure therapy for posttraumatic stress disorder. Am J Psychother. 2002;56(1):59-75. doi: 10.1176/appi.psychotherapy.2002.56.1.59. PMID: 11977784.

¹⁰ Scheurich JA, Beidel DC, Vanryckeghem M. Exposure therapy for social anxiety disorder in people who stutter: An exploratory multiple baseline design. J Fluency Disord. 2019 Mar;59:21-32. doi: 10.1016/j.jfludis.2018.12.001. Epub 2018 Dec 13. PMID: 30578977.

¹¹ Geng C, Zhang M, Zhang L, Yin H, Wang S. Effects of Narrative Exposure Therapy for Treating Depressive and Anxious Disorders: A Systematic Review and Meta-Analysis. Psychiatry Investig. 2024 Apr;21(4):329-339. doi: 10.30773/pi.2023.0281. Epub 2024 Apr 23. PMID: 38695040; PMCID: PMC11065527.