Uses of Exposure Therapy

Exposure-based therapies include a wide range of behavioral techniques that mostly involve exposing phobic patients to feared situations. From a behavioral point of view, specific phobias are sustained due to avoidance of the fearful stimuli so that the person does not have the chance to discover that they can endure the fear, that the anxiety of fear will subside by itself without escaping or avoiding, and that their feared consequences frequently do not occur or are less severe than they imagine. 

It is possible to avoid a situation either by not engaging in it at all or by embracing it but not completely feeling it (for instance, drinking alcohol before taking a flight for an individual with a phobia of flying).

Thus, exposure therapies are intended to urge the individual to enter frightening settings (either in real life or via imaginal practices) and attempt to remain in those conditions. In most types of exposure therapy (– for example, implosion therapy), the person is initially exposed to a highly anxiety-inducing stimulus, as opposed to being slowly subjected to increasingly anxiety-provoking stimuli.

Several types of exposure therapy are helpful in the treatment of various phobias, therefore the specific strategy chosen may vary according to the nature of the phobia, as well as the preferences of the therapist and client. Despite this, the scientific evidence provides stronger support for certain exposure therapies (— in other words, in vivo exposure) than for others (for example, systematic desensitization).

In vivo exposure is the actual confrontation with the feared stimuli, typically in a progressive manner (for example, in a phobia of spiders, an individual might first see the pictures of a spider and ultimately go on to have physical contact with a large tarantula; in a phobia of flying, an individual might first read about a plane crash and then go on to sitting in a real flight). The treatment often lasts several hours and can be provided in a single very long session (e.g., a 3-hour session for arachnophobia) or in numerous shorter ones (for instance, three to eight 1-1.5-hour-long sessions). 

A variety of specific phobias respond favorably to in vivo treatment, even though treatment compliance and discontinuation can be problematic. In addition, therapeutic benefits are typically maintained for up to a year following the conclusion of therapy, especially for animal phobias (though follow-up data for blood-injection-injury phobia is less impressive). This sort of exposure therapy is also known as Guided mastery or Participant modeling when the therapist proactively models each phase of the exposure and instructs the phobic person on how to engage with the feared stimulus.

Applied muscular tension is a kind of in vivo exposure used to treat a fear of blood-injection injuries. This treatment combines typical exposure approaches with muscle tension workouts to counteract blood pressure drops that might cause fainting.

Virtual reality exposure blends real-time computer visuals with various body tracking sensors so that the person can adapt to the environment (e.g., being on an airplane that is lifting off, confronting a giant tarantula, staring over a high balcony ledge). This therapy appears to be effective for phobias that may be hard to treat in vivo; specifically, phobias of flying (where repetitive plane journeys are prohibitive) and height phobias; nevertheless, additional research is necessary to confirm its efficacy for a wide variety of phobia subtypes.

Systematic desensitization is subjecting phobic persons to fear-inducing pictures and thoughts (i.e., imaginal exposure) or real phobic stimuli while coupling the exposure with relaxation (or another reaction that is inconsistent with fear) to reduce the typical fear response. Systematic desensitization typically takes more time than in vivo exposure and appears to be more successful in reducing subjective anxiety than avoidance. If a patient is open to trying in vivo or an alternative form of exposure therapy, it is not suggested as the primary line of treatment.

Note that the cognitive dimension of many exposure therapies includes cognitive restructuring to confront incorrect or irrational thinking associated with the phobic object or reaction (e.g., I am about to fall, The dog is planning to assault me, I cannot handle this fear, etc.). In addition, there is evidence that combining in vivo exposure to cognitive therapy or providing cognitive treatment alone can be beneficial for claustrophobia, and that it may also be beneficial for dental phobia. 

Evidence showing the effectiveness of cognitive therapy for flying phobia is contradictory, and it is unclear whether combining cognitive therapy with exposure therapy for other types of phobias enhances outcomes.