What Is Exposure Therapy? How It Can Help Anxiety Disorders
Olivia Guy-Evans, MSc
Associate Editor for Simply Psychology
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Learn about our Editorial Process
Saul McLeod, PhD
Editor-in-Chief for Simply Psychology
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
On This Page:
Exposure therapy is a technique used in the treatment of anxiety disorders like phobias or posttraumatic stress disorder (PTSD). Its goal is to help individuals overcome specific fears or sources of anxiety. It works by exposing them to anxiety-provoking situations or stimuli in a gradual, controlled way to reduce fear. For example, someone afraid of spiders would be systematically exposed to spiders under a therapist’s guidance.
The idea is that avoidance maintains anxiety, so controlled exposures teach the person to manage fear and decrease avoidance.
By creating a safe environment, the person learns the triggers are not dangerous, so anxiety is decreased through new learning.
Types of exposure can include real-life interactions, imagination, virtual reality simulated exposures, or intentionally bringing on bodily sensations like dizziness. It is often used within cognitive behavioral therapy (CBT) as well.
What Conditions Can Exposure Therapy Help With?
Exposure therapy is typically used in the treatment of anxiety disorders , as these are conditions where there is a lot of fear to overcome. Some of these anxiety disorders include the following:
Generalized anxiety disorder (GAD)
Posttraumatic stress disorder (PTSD)
Obsessive-compulsive disorder (ocd).
Phobias – such as specific phobias and agoraphobia
Panic disorder
Social anxiety disorder, the vicious cycle of avoidance.
When feeling anxious or fearful, it makes sense that people try to do what they can to reduce these feelings, such as avoiding what makes them anxious.
This avoidance will usually instantly decrease the anxiety as the person has not put themselves in a distressing situation. However, while avoidance can provide short-term relief from anxiety, it can worsen the anxiety in the long term.
An example of this can be someone avoiding leaving the house because outside the house is where they feel fear. In the short term, avoiding leaving the house can avoid any distress the person may feel.
But in the long term, they can become more fearful about leaving the house and become even more unwilling to confront their anxiety. If this person doesn’t try to break this cycle of avoidance, they will never know whether they can cope in these situations.
In situations like these, it may be recommended to undertake a program of exposure therapy to break this pattern of avoidance.
Types of Exposure Therapy
According to the American Psychological Association, some of the potential variations of exposure therapies include the following:
In vivo exposure
In vivo exposure involves directly facing a feared object, situation, or activity in real life. Some examples of how this can be put into practice include:
Going to the supermarket if someone has a fear of supermarkets.
Seeing and going into a car for someone fearful of cars.
Attending a party for someone who gets anxious at parties.
This type of exposure is likely to be used if the fear that someone has is something that can be directly experienced at any time, so there is more opportunity to practice.
In many cases, in vivo exposure is not possible. For instance, for someone with PTSD , when exposed to the sights and sounds of combat, it is not possible or ethical to use in vivo exposure. In such cases, other types of exposure would be used.
Imaginal exposure
In imaginal exposure, the individual is asked to imagine and describe the feared stimulus vividly, usually using present-tense language and including details about external (sights, sounds, and tastes) and internal (thoughts and emotions) cues.
This can work best for someone with PTSD. Through this, they can re-imagine the sights, sounds, and emotions of being in a traumatic situation such as combat.
Imaginal exposure is useful for those who cannot expose themselves to the feared situation directly. It can also be useful as a stepping stone toward in vivo exposure. For instance, someone with a fear of spiders could vividly imagine a spider until they feel comfortable seeing a spider in person.
Virtual reality exposure
In recent years, technology means that the use of virtual reality devices can aid in exposure therapy . This can be especially useful in situations when it is difficult to experience the cause of the fear in reality.
For example, someone with a fear of flying could use a flight simulator to help expose them to flying, where it may be impractical to go onto a flight in person.
Interoceptive exposure
Interoceptive exposure involves deliberately triggering a physical sensation to show that it is harmless, although feared. This type of exposure is most useful for people who fear internal physical sensations.
For instance, someone who is afraid of feeling light-headed because they think it means they’re having a stroke may be instructed to stand up quickly to trigger this sensation to show it is harmless.
Likewise, someone with panic disorder may fear an increased heart rate as they think it may result in a panic attack, so they may be structured to run in place to purposely increase their heart rate to show that this sensation will not always result in a panic attack.
Trauma-focused treatments directly address the traumatic event(s) and related memories, thoughts, and emotions.
Examples include Prolonged Exposure (PE) therapy, Cognitive Processing Therapy (CPT), and Eye Movement Desensitization and Reprocessing ( EMDR ).
They involve exposure to the traumatic memory through techniques such as imaginal exposure (recounting the traumatic event) or in vivo exposure (confronting trauma-related situations or objects in real life).
The aim is to process and integrate traumatic memories, modify maladaptive beliefs related to the trauma, and reduce trauma-related symptoms.
Graded exposure
Graded exposure involves gradually exposing someone to their feared object, situation, or activity. This usually starts off with the therapist helping the client to construct an exposure fear hierarchy.
This is where the fears are given a score based on how fearful they are and ranked from lowest to highest.
The therapist and the client will then begin by tackling the mildly or moderately difficult exposures and then progress to the more challenging ones when the client is ready.
This technique can use variations of in vivo, imaginal, virtual reality, and interoceptive exposure, depending on the fear.
For instance, someone with a fear of crowded places may start by imagining they are in a crowded place, then see pictures or videos of crowds before progressing to being in an actual crowded place.
In contrast to graded exposure, flooding uses the exposure fear hierarchy to begin exposure with the most difficult task.
The process usually involves first teaching the clients some self-relaxation techniques before exposing them abruptly and directly to the fear-evoking stimulus.
So, for the person who is anxious in crowded places, the therapist would expose them directly to a crowded place.
Classical conditioning has taught that people associate fear with the stimulus, but the same principles can be used to extinguish the fear via flooding.
Flooding is rapid exposure compared to other techniques and can yield quick results. However, it is an older type of technique, and most clients and therapists choose a graded approach because of their personal comfort level.
Systematic desensitization
With systematic desensitization , exposure can be combined with relaxation exercises to make them feel more manageable and to associate the feared objects, activities, or situations with relaxation.
This involves constructing a desensitization hierarchy with the therapist and working through these, visualizing each anxiety-provoking event while engaging in relaxation.
This differs from graded exposure as it happens at a slower pace, so it can be more time-consuming. Often the clients are taught deep muscle relaxation and breathing exercises to use when faced with each exposure.
They usually start with the least unpleasant stimuli and practice their relaxation techniques as they go. When the client feels comfortable enough, they move on to the next stage until they reach the most anxiety-provoking event.
This technique aims to remove the fear response associated with an event and substitute a relaxation response to the conditional stimulus, gradually using counter-conditioning.
Prolonged exposure
Prolonged Exposure (PE) therapy is a specific type of cognitive-behavioral therapy (CBT ) that is commonly used to treat post-traumatic stress disorder (PTSD).
It is an evidence-based treatment that aims to help individuals process traumatic experiences and reduce trauma-related symptoms, such as avoidance, intrusive thoughts, and hyperarousal.
PE therapy typically consists of several key components:
- Psychoeducation : The therapist provides information about PTSD, its symptoms, and the rationale behind PE therapy.
- Breathing retraining : The individual learns relaxation techniques, such as diaphragmatic breathing, to help manage anxiety and stress.
- In vivo exposure : The person gradually confronts trauma-related situations, objects, or activities that they have been avoiding due to fear or anxiety. This exposure occurs in real-life settings and is done in a hierarchical manner, starting with less challenging situations and progressing to more difficult ones.
- Imaginal exposur e: The individual revisits and recounts the traumatic memory in detail during therapy sessions. This is done repeatedly, with the goal of helping the person process the traumatic experience and reduce the emotional distress associated with the memory.
- Processing : After each imaginal exposure, the therapist and the individual discuss the thoughts, feelings, and reactions that arose during the exposure. This processing helps the person gain new insights and perspectives on the traumatic experience.
PE therapy is typically conducted in 8-15 weekly or biweekly sessions, each lasting about 90 minutes. Between sessions, individuals practice confronting feared situations and listening to recordings of their imaginal exposure sessions as homework.
The goal of PE therapy is to help individuals process traumatic memories, reduce avoidance behaviors, and improve overall functioning. By confronting feared stimuli in a safe and controlled environment, individuals can learn that the memories and situations are not dangerous and that they can cope with the distress associated with them.
Exposure and response prevention
Exposure response prevention (ERP) therapy is an effective technique specifically for people who experience obsessions and compulsions, such as those with OCD.
This technique works to weaken the link between obsession and compulsions. The therapist intentionally provokes a person’s obsessions and then asks the person not to engage in their behavioral rituals or compulsions.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR involves recalling traumatic memories while simultaneously focusing on an external stimulus, such as the therapist’s finger movements or tapping.
The goal is to help process the traumatic memory and reduce its emotional intensity.
Narrative Exposure Therapy (NET)
NET is an intervention that helps individuals create a coherent narrative of their life, including traumatic experiences.
The therapist guides the person through a chronological account of their life, focusing on both traumatic and positive events, to help contextualize and process the trauma.
How Exposure Therapy Works
It is believed that there are six primary ways that exposure therapy may help people:
1. Extinction
Extinction involves the weakening of the conditioned fear response when the feared stimulus is repeatedly presented without the anticipated negative outcome.
Repeated exposure to a feared stimulus without the anticipated negative outcome can weaken the conditioned response (fear or anxiety).
Over time, this can result in gradually reducing or eliminating the fear response associated with the stimulus.
2. Habituation
Habituation refers to the gradual decrease in emotional and physiological reactivity to a feared stimulus over repeated exposures.
When an individual is repeatedly exposed to a feared stimulus, their emotional and physiological reactivity to that stimulus may decrease over time.
This process is known as habituation, and it allows the person to develop an increased tolerance for the anxiety or discomfort associated with the feared stimulus.
Therefore, repeated exposure to a feared stimulus should help decrease the reaction to it over time.
3. Self–efficacy
Exposure therapy provides individuals with opportunities to confront their fears and manage their anxiety in a controlled setting.
As they successfully navigate these experiences, they can develop a greater sense of self-efficacy , which refers to their belief in their own ability to cope with and overcome challenging situations.
4. Emotional processing
Exposure therapy allows individuals to confront their feared stimuli in a safe environment, which can lead to the development of new, more realistic beliefs about the perceived threat.
This process enables them to better understand and manage their emotional responses to the feared stimuli.
During exposure therapy, the person can be helped to create new and realistic beliefs about their feared stimulus.
After learning these new beliefs, the idea is that they can become more comfortable with the experience of fear and manage their emotional response.
5. Memory reconsolidation
Memory reconsolidation refers to the process by which a previously consolidated memory becomes labile and susceptible to modification upon retrieval.
During exposure therapy, when a person retrieves a fear memory in a safe environment, the memory becomes unstable and can be updated with new, non-threatening information.
This process allows for the modification of the original fear memory, reducing the associated emotional response.
Research studies have demonstrated that the timing of exposure sessions can significantly influence the effectiveness of the therapy.
Massed exposure sessions, which are closely spaced together, have been shown to lead to better outcomes compared to sessions that are spaced further apart (Craske et al., 2008; Wachen et al., 2019).
This finding aligns with the concept of memory reconsolidation, which suggests a specific time window after memory retrieval during which the memory is susceptible to modification (Nader et al., 2000; Schiller et al., 2010).
6. Integration
Integration involves incorporating the updated, less threatening memory into the person’s overall autobiographical memory and belief system.
This process helps individuals develop a more coherent and adaptive understanding of their experiences, reducing the impact of the fear memory on their daily life.
How Effective Is Exposure Therapy?
A lot of research has supported the effectiveness of exposure therapy in the treatment of anxiety disorders.
Below are some of the key findings supporting the use of exposure therapy for anxiety disorders:
A 2013 study found clinically significant reductions in PTSD symptoms among male and female veterans of all war eras and those with combat-related and non-combat-related PTSD.
The results also indicated that prolonged exposure effectively reduced depressive symptoms in these individuals (Eftekhari et al., 2013).
Another study examined the effectiveness of virtual reality exposure therapy for active-duty soldiers and found there was a significant reduction in self-reported PTSD symptoms (Reger et al., 2011).
Virtual reality exposure therapy has been shown to be effective for those with public speaking anxiety, decreasing catastrophic belief expectancy and distress and increasing perceived performance quality (Linder et al., 2021).
Another study found that exposure therapy was effective in treating social anxiety, with no significant difference in effect sizes between virtual reality, in vivo, or imaginal exposure (Chesham et al., 2018).
A 2019 exposure therapy intervention was tested on people with social anxiety who also stuttered.
There were shown to be substantial reductions in social anxiety and considerable improvements in affective, behavioral, and cognitive experiences of stuttering, but no change was observed in stuttering frequency (Scheurich et al., 2019).
This suggests that even if some behaviors do not change, the anxiety associated with the behavior can be minimized with exposure therapy.
A review into phobias found that most phobias respond robustly to in vivo exposure therapy, with few studies obtaining a response rate of 80-90% (Choy et al., 2007).
Another review found evidence that virtual reality exposure therapy is an effective treatment for phobia, concluding this is also a useful tool to combat these fears (Botella et al., 2017).
Exposure therapy has been supported for the treatment of OCD . Exposure and response prevention is seen as one of the first-line treatments for this condition (Law & Boisseau, 2019).
A study randomized patients with OCD to either receive in vivo exposure and response prevention, a type of antidepressant (clomipramine), or a combination of both.
For those who completed the study, 86% in the exposure group improved on measures examining the frequency and severity of obsessions and compulsions, compared with 48% in the antidepressant group and 79% in the combined treatment group (Foa et al., 2005).
A 2018 study found that a three-session therapist-guided exposure treatment was effective at treating panic attacks in a group of eight participants.
Six of the participants saw a reduction in symptoms, and four showed remissions. Although this is a small sample size, it suggests that exposure therapy can be effective for those with panic disorder (Bergmark Hall & Lundh, 2019).
Limitations Of Exposure Therapy
While exposure therapy can be highly effective for many individuals, there are some downsides and situations where it may not produce the desired outcomes. Below are some potential limitations of exposure therapy:
Emotional distress: Exposure therapy involves intentionally exposing individuals to their feared situations or stimuli, which can elicit intense emotional distress. This distress can be challenging to manage and may temporarily increase anxiety levels before reducing them.
Initial worsening of symptoms: As individuals confront their fears through exposure therapy, it’s not uncommon for their symptoms to temporarily worsen before improving. This initial increase in anxiety can be discouraging and may require additional support and reassurance from the therapist.
High dropout rates: Exposure therapy can be challenging, and some individuals may struggle to complete the treatment due to the discomfort and anxiety it evokes. High dropout rates can impact the overall effectiveness of the therapy and hinder progress.
Trauma reactivation: For individuals with a history of trauma, exposure therapy has the potential to reactivate traumatic memories or emotions. Careful assessment and modifications to the treatment approach are necessary to ensure that the therapy does not cause retraumatization.
Underlying issues: Anxiety disorders and phobias can sometimes be symptoms of underlying psychological or emotional issues. It’s important to consider whether additional therapeutic interventions or treatments are needed to address these underlying issues alongside exposure therapy.
Despite these considerations, exposure therapy remains a highly effective treatment for anxiety disorders and phobias.
It’s essential to work with a qualified mental health professional who can assess individual needs, provide appropriate guidance, and tailor the therapy to maximize its benefits while minimizing potential downsides.
Non-Trauma-Focused Treatments
It has also become clear that non-exposure-based treatments can be effective in treating PTSD.
Non-trauma-focused treatments do not directly focus on the traumatic event(s) or require the patient to revisit the trauma in detail.
Examples include Present-Centered Therapy (PCT), Interpersonal Psychotherapy (IPT), and Acceptance and Commitment Therapy ( ACT ).
Non-trauma treatments emphasize developing coping skills, improving interpersonal functioning, and managing current life stressors.
They aim to reduce PTSD symptoms by addressing factors that maintain them, such as avoidance, interpersonal difficulties, or maladaptive coping strategies.
Frequently Asked Questions
When should exposure therapy be considered.
If you feel that you experience a lot of fear or anxiety about many or specific things beyond what you would consider a usual amount, you may benefit from exposure therapy.
If you find you have an extreme physical and/or emotional response to the feared stimuli and it is interfering with your life in a negative way, such as negatively affecting work, school, relationships, or other activities, this may be a sign that you need to seek help.
How can I seek exposure therapy?
It can be useful to begin by speaking to your doctor if you think you may need help with your anxieties. They may recommend you take CBT sessions, which can incorporate a lot of exposure therapy.
If you want to find a specialist in exposure therapy, you can search online, making sure to use reliable sources to find the right person.
Ensure you check the therapist’s credentials and ask whether they implement exposure therapy in their treatment.
You should ask what type of exposure therapy they use and the techniques they use.
It may also be useful to ask about their experience, what their area of expertise is, and what they would plan to do if exposure therapy does not work.
What are some key considerations when thinking about having exposure therapy?
Although research strongly supports exposure therapy, its implementation is not widespread among therapists. Limited availability of specialized training and concerns about symptom exacerbation in certain conditions may contribute to this.
It’s crucial to acknowledge that exposure therapy can be highly challenging. Directly confronting fears entails experiencing physical and emotional discomfort.
There may be moments when you feel overwhelmed by the exposure techniques. In such cases, it’s important to communicate with your therapist about any concerns or the possibility of trying a less intense approach.
However, to fully benefit from the therapy, it’s necessary to push yourself beyond your comfort zone and anticipate a reduction in anxiety over time as you work through it.
Beaudoin, M. N., Moersch, M., & Evare, B. S. (2016). The effectiveness of narrative therapy with children’s social and emotional skill development: an empirical study of 813 problem-solving stories. Journal of Systemic Therapies, 35 (3), 42-59.
Botella, C., Fernández-Álvarez, J., Guillén, V., García-Palacios, A., & Baños, R. (2017). Recent progress in virtual reality exposure therapy for phobias: a systematic review. Current psychiatry reports, 19(7), 1-13.
Brown, L. S. (2024). Refreshing, necessary exposure to the problem with exposure therapies for trauma: Commentary on Rubenstein et al. (2024). American Psychologist, 79 (3), 344–346.
Brunet, A., Orr, S. P., Tremblay, J., Robertson, K., Nader, K., & Pitman, R. K. (2008). Effect of post-retrieval propranolol on psychophysiologic responding during subsequent script-driven traumatic imagery in post-traumatic stress disorder. Journal of Psychiatric Research, 42 (6), 503-506.
Cashin, A., Browne, G., Bradbury, J., & Mulder, A. (2013). The effectiveness of narrative therapy with young people with autism. Journal of Child and Adolescent Psychiatric Nursing, 26 (1), 32-41.
Chesham, R. K., Malouff, J. M., & Schutte, N. S. (2018). Meta-analysis of the efficacy of virtual reality exposure therapy for social anxiety. Behaviour Change, 35 (3), 152-166.
Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007). Treatment of specific phobia in adults. Clinical psychology review, 27 (3), 266-286.
Craske, M. G., Kircanski, K., Zelikowsky, M., Mystkowski, J., Chowdhury, N., & Baker, A. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46 (1), 5-27.
Debiec, J., & Ledoux, J. E. (2004). Disruption of reconsolidation but not consolidation of auditory fear conditioning by noradrenergic blockade in the amygdala. Neuroscience, 129 (2), 267-272.
Eftekhari, A., Ruzek, J. I., Crowley, J. J., Rosen, C. S., Greenbaum, M. A., & Karlin, B. E. (2013). Effectiveness of national implementation of prolonged exposure therapy in Veterans Affairs care. JAMA psychiatry, 70 (9), 949-955.
Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., Huppert, J. D., Kjernisted, K., Rowan, V., Schmidt, A. B., Simpson, B. & Tu, X. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of psychiatry, 162(1), 151-161.
Ghavibazou, E., Hosseinian, S., & Abdollahi, A. (2020). Effectiveness of narrative therapy on communication patterns for women experiencing low marital satisfaction. Australian and New Zealand Journal of Family Therapy, 41 (2), 195-207.
Hall, C. B., & Lundh, L. G. (2019). Brief Therapist-Guided Exposure Treatment of Panic Attacks: A Pilot Study. Behavior Modification, 43 (4), 564-586.
Kindt, M., Soeter, M., & Vervliet, B. (2009). Beyond extinction: Erasing human fear responses and preventing the return of fear. Nature Neuroscience, 12 (3), 256-258.
Law, C., & Boisseau, C. L. (2019). Exposure and response prevention in the treatment of obsessive-compulsive disorder: Current perspectives. Psychology research and behavior management.
Lindner, P., Dagöö, J., Hamilton, W., Miloff, A., Andersson, G., Schill, A., & Carlbring, P. (2021). Virtual Reality exposure therapy for public speaking anxiety in routine care: a single-subject effectiveness trial. Cognitive Behaviour Therapy, 50 (1), 67-87.
McLeod, S. A. (2015). Systematic desensitization as a counter conditioning process. Simply Psychology. www.simplypsychology.org/Systematic-Desensitisation.html
Nader, K., Schafe, G. E., & Le Doux, J. E. (2000). Fear memories require protein synthesis in the amygdala for reconsolidation after retrieval. Nature, 406 (6797), 722-726.
Najavits, L. M. (2024). Beyond exposure: A healthy broadening of posttraumatic stress disorder treatment options: Commentary on Rubenstein et al. (2024). American Psychologist, 79 (3), 347–349.
Reger, G. M., Holloway, K. M., Candy, C., Rothbaum, B. O., Difede, J., Rizzo, A. A., & Gahm, G. A. (2011). Effectiveness of virtual reality exposure therapy for active duty soldiers in a military mental health clinic. Journal of traumatic stress, 24 (1), 93-96.
Rubenstein, A., Duek, O., Doran, J., & Harpaz-Rotem, I. (2024). To expose or not to expose: A comprehensive perspective on treatment for posttraumatic stress disorder. American Psychologist, 79(3), 331–343.
Rubenstein, A., Doran, J., Duek, O., & Harpaz-Rotem, I. (2024). Some closure on exposure—Realigning the perspective on trauma treatment and finding a pathway forward: Reply to Brown (2024) and Najavits (2024). American Psychologist, 79 (3), 350–351.
Scheurich, J. A., Beidel, D. C., & Vanryckeghem, M. (2019). Exposure therapy for social anxiety disorder in people who stutter: An exploratory multiple baseline design. Journal of fluency disorders, 59, 21-32.
Schiller, D., Monfils, M. H., Raio, C. M., Johnson, D. C., Ledoux, J. E., & Phelps, E. A. (2010). Preventing the return of fear in humans using reconsolidation update mechanisms. Nature, 463 (7277), 49-53.
Soeter, M., & Kindt, M. (2015). An abrupt transformation of phobic behavior after a post-retrieval amnesic agent. Biological Psychiatry, 78 (12), 880-886.
Wachen, J. S., Dondanville, K. A., Evans, W. R., Morris, K., & Cole, A. (2019). Massed versus spaced exposure therapy for posttraumatic stress disorder. The Journal of Clinical Psychiatry, 80 (4), 18m12309.
Prolonged Exposure (PE)
Prolonged exposure teaches individuals to gradually approach their trauma-related memories, feelings and situations. They presumably learn that trauma-related memories and cues are not dangerous and do not need to be avoided.
Introduction to PE
Exposure is an intervention strategy commonly used in cognitive behavioral therapy to help individuals confront fears. Prolonged exposure is a specific type of cognitive behavioral therapy that teaches individuals to gradually approach trauma-related memories, feelings and situations.
Most people want to avoid anything that reminds them of the trauma they experienced, but doing so reinforces their fear. By facing what has been avoided, a person can decrease symptoms of PTSD by actively learning that the trauma-related memories and cues are not dangerous and do not need to be avoided.
This treatment is strongly recommended for the treatment of PTSD.
Using PE to Treat PTSD
Prolonged exposure is typically provided over a period of about three months with weekly individual sessions, resulting in eight to 15 sessions overall. The original intervention protocol was described as nine to 12 sessions, each 90 minutes in length (Foa & Rothbaum, 1998). Sixty to 120-minute sessions are usually needed in order for the individual to engage in exposure and sufficiently process the experience.
Therapists begin with an overview of treatment and understanding the patient’s past experiences. Therapists continue with psychoeducation and then will generally teach a breathing technique to manage anxiety.
Generally, after the assessment and initial session, exposure begins. As this is very anxiety-provoking for most patients, the therapist works hard to ensure that the therapy relationship is perceived to be a safe space for encountering very scary stimuli. Both imaginal and in vivo exposure are utilized with the pace dictated by the patient.
- Imaginal exposure occurs in session with the patient describing the event in detail in the present tense with guidance from the therapist. Together, patient and therapist discuss and process the emotion raised by the imaginal exposure in session. The patient is recorded while describing the event so that she or he can listen to the recording between sessions, further process the emotions and practice the breathing techniques.
- In vivo exposure , that is confronting feared stimuli outside of therapy, is assigned as homework. The therapist and patient together identify a range of possible stimuli and situations connected to the traumatic fear, such as specific places or people. They agree on which stimuli to confront as part of in vivo exposure and devise a plan to do so between sessions. The patient is encouraged to challenge him or herself but to do so in a graduated fashion so as to experience some success in confronting feared stimuli and coping with the associated emotion.
Terry, a 42-year-old earthquake survivor
Terry consistently avoided thoughts and images related to witnessing the injuries and deaths of others during the earthquake. He began spending an increasing amount of time at work and filling his days with hobbies and activities. However, he found that whenever he had free time, he would have unwanted intrusive thoughts about the earthquake. In addition, he was having increasingly distressing nightmares.
Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences, therapist guide
Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2019). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences, therapist guide (2 nd ed.). Oxford University Press.
For Patients and Families
What is Prolonged Exposure Therapy?
Prolonged exposure is a specific type of cognitive behavioral therapy that teaches individuals to gradually approach trauma-related memories, feelings, and situations. Individuals work with their therapist in a safe, graduated fashion to face stimuli and situations that evoke fear and remind them of the trauma to increase their comfort and reduce their fear.
Prolonged Exposure Therapy
The VA website provides an overview of the treatment and how it works, including details about what happens during therapy.
References and Resources
Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD . Guilford Press.
Rothbaum, B. O., Foa, E. B., & Hembree, E. A. (2007). Reclaiming your life from a traumatic experience: A prolonged exposure treatment program. Oxford University Press.
Hembree, E. A., Rauch, S. A. M., & Foa, E. B. (2003). Beyond the manual: The insider's guide to prolonged exposure therapy for PTSD . Cognitive and Behavioral Practice, 10 (1), 22–30.
About Prolonged Exposure Therapy Information from the Center for the Treatment and Study of Anxiety, directed by Edna B. Foa, PhD
Strongly Recommended
Prolonged Exposure is strongly recommended by the APA Clinical Practice Guideline for the Treatment of PTSD (PDF, 1MB).
Other Treatments
- Cognitive Behavioral Therapy
- Cognitive Processing Therapy
- Cognitive Therapy
- Brief Eclectic Psychotherapy
- Eye Movement Desensitization and Reprocessing Therapy
- Narrative Exposure Therapy
- Medications
All Therapy Is Exposure Therapy
Instead of spiders, we expose ourselves to our emotions, reducing avoidance..
Posted September 13, 2024 | Reviewed by Tyler Woods
- What Is Therapy?
- Take our Do I Need Therapy?
- Find a therapist near me
- Therapy is toughest at the beginning because it's hard to expose ourselves to feelings we've avoided.
- Just like exposure therapy for a spider phobia, talk therapy teaches us that feelings aren't dangerous.
- Therapy changes your relationship with your own feelings to reduce fear and avoidance.
Let’s say you plop on my couch.
“So, what brings you in?” I ask.
You start with a sigh, and at first speak in short, vague statements.
“I’ve been feeling down,” you say. Or “I’m having problems in my relationship.”
“Tell me more,” I say.
As I start to get curious, you begin to recognize that you are accepted in this space. You start to feel a little more comfortable. Your sentences become longer; the words start flowing. Your story unfolds.
You open up about how tough things have been. It’s hard to talk about, and you’re still feeling nervous about “going there.” Part of you wants to change the subject or leave my office altogether. But you stay here, with me, and you feel all of the emotions that come with talking about this struggle, right here in this room. As tears leak out of your eyes, I let you know that you don’t have to hold them back. So you let them come, despite your fear that if you cry, you’ll never stop.
At the end of the session, you feel relief. You felt your feelings—you went there, and nothing terrible happened. Instead, you were met with empathy and care.
You still feel dread about coming to your second session, though. You think about how you’ll have to talk about everything again, and it just sounds draining and exhausting. You think about calling to cancel but don’t. Here you are on my couch again, and I ask, “Tell me more.”
There’s a reason therapy is tough at the beginning. All therapy is exposure therapy.
In traditional exposure therapy, clients face their fears so that they can desensitize to their anxiety triggers. In the first session, a client with a spider phobia might feel intense fear just by looking at a picture of a spider. The client is exposed to the picture until they become desensitized to it, and then they graduate to a real spider in a cage and repeat the process. The client, throughout time, learns that it can share space with the spider and not be harmed; the client’s fear system learns that the spider is not dangerous, and the phobia is extinguished.
As humans, we are not only afraid of snakes and spiders—we’re scared of our emotions. Just like anything that brings up fear, we avoid our emotions. It might seem like it will reduce pain to keep disowned feelings far away, but in reality, it only makes them grow stronger. What we resist persists. Therapy is exposure to tough emotions, exposure to problems that need to be worked out, exposure to the things that we avoid because they are painful and hard. In the therapy room, we look our feelings right in the face. Instead of avoiding them, we feel our feelings to learn how capable we are of feeling them, of getting through them. We learn that we don’t have to avoid the topics we’re scared of or our painful feelings about them. And in the process, we learn that they aren't so scary after all, and they don't need to be avoided. Tough feelings are just a part of life, for everyone.
Therapy gets easier over time. While at the beginning, every session might feel like opening a floodgate of things left unsaid and feelings unfelt, as you move through the therapy process you start to form a new relationship with your feelings. You learn just how strong you are, and how you can handle tough emotions and do hard things. You learn that your emotions are not dangerous, and you can share space with them without being harmed.
To find a therapist near you, visit the Psychology Today Therapy Directory .
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Resources Association for Play Therapy : www.a4pt.org The Association for Play Therapy provides a lot of useful information on Play Therapy, how play therapy is used, its effectiveness, and some techniques that might be used. Ask Dr. Sears: www.askdrsears.com The Sears have written several wonderful books on topics such as discipline, nutrition, breastfeeding and immunizations. Their website is a great place to get answers to questions about kids' health, pregnancy, childbirth, and other issues children face. Vanderbilt Center for Social Emotional Learning: csefel.vanderbilt.edu/ The Vanderbilt Center provides videos, articles and other information useful for assisting parents and teachers in facilitating healthy social and emotional development in young children. National Association for the Education of Young Children : www.naeyc.org NAEYC is a resource that provides a wide range of useful information related to early childhood. Parenting Counts: www.parentingcounts.org Parenting Counts is the research-based family of products developed by Talaris Institute to support parents and caregivers in raising socially and emotionally healthy children. Technical Assistance Center on Social Emotional Intervention: www.challengingbehavior.org TACSEI provides practical strategies for parents who are addressing daily behaviors of children. UCLA Mindful Awareness Research Center: www.marc.ucla.edu Free guided meditations provide an introduction to mindfulness meditations and awareness.Dosimetric Monitoring of Nonuniform Exposure
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29 Accesses Explore all metrics In case of remote and contact radiation therapy of oncological diseases using photon radiation, organs and tissues around the pathological lesion (irradiation target) are exposed to nonuniform ionizing radiation. The dose–effect ratio of nonuniform ionizing radiation in the exposed organ can vary by dozens of times. Therefore, it is difficult to estimate the dose of nonuniform radiation, which increases at the expense of application of different methods of exposure. In radiobiological practice, it is well known that the degree of body damage depends on the dose of radiation and exposed volume (number of exposed cells). The problem of estimation of the dose of radiation in case of nonuniform exposure can be solved by using the modal dose (dosimetric test characterizing irradiation of the maximum number of cells). This method provides a separate estimation of the degree for each method of beam therapy. This is a preview of subscription content, log in via an institution to check access. Access this articleSubscribe and save.
Price includes VAT (Russian Federation) Instant access to the full article PDF. Rent this article via DeepDyve Institutional subscriptions Similar content being viewed by others Controlling the Distribution of Doses in Photon Beam Radiotherapy Calculation of the Radiation Dose Absorbed by Human Biological Tissue When Using Imaging Equipment in Radiotherapy On the radiation quality characterization in radiation therapy: from linear energy transfer to experimental microdosimetryR. V. Stavitskii (ed.) Clinical Dosimetry [in Russian], MNPI, Moscow (2000), pp. 91–106. R. V. Stavitskii (ed.) Medical Radiology: Technical Aspects, Clinical Materials, and Radiation Security [in Russian], MNPI, Moscow (2003), pp. 151–161. R. V. Stavitskii (ed.) Medical Radiology: Technical Aspects, Clinical Materials, and Radiation Security [in Russian], MNPI, Moscow (2003), pp. 152–161. Nonuniform Exposure of Malignant Tumors to Remote Co-60 Gamma-Ray Therapy: Methodological recommendations [in Russian], Moscow (1975). Sources and Effects of Ionizing Radiation: UN SCEAR Report, Vol. 2, New York (1978), pp. 262–263, 250–310. N. N. Novitskaya, G. P. Snigireva, and R. V. Stavitskii, Radiobiol., 709–711 (1982). R. V. Stavitskii, Med. Rentgenol., No. 2, 50–54 (1975). S. P. Yarmonenko and A. A. Vainson, Radiobiology of Humans and Animals [in Russian], Vysshaya Shkola, Moscow (2004). Google Scholar M. Cohen and S. J. Martis, Atlas of Radiation Dose Distribution, FAEA, Viena (1966), pp. 31–32. F. Ellis and R. Oliver, Brit. J. Radiol., 34 , 258–261 (1961). Article Google Scholar F. W. Spiers and W. I. Meredith, Clin. Radiol., 13 , 163–166 (1962). ICRP-103. International Commission on Radiological Protection, Ann. ICRP, 37 , 2–3 (2007). Download references Author informationAuthors and affiliations. Russian Research Center for Roentgenoradiology, Moscow, Russia A. L. Lebedev & O. N. Plautin You can also search for this author in PubMed Google Scholar Corresponding authorCorrespondence to A. L. Lebedev . Additional informationTranslated from Meditsinskaya Tekhnika, Vol. 44, No. 5, 2010, pp. 19–22. Rights and permissionsReprints and permissions About this articleLebedev, A.L., Plautin, O.N. Dosimetric Monitoring of Nonuniform Exposure. Biomed Eng 44 , 176–179 (2011). https://doi.org/10.1007/s10527-011-9181-5 Download citation Received : 16 July 2009 Published : 12 February 2011 Issue Date : January 2011 DOI : https://doi.org/10.1007/s10527-011-9181-5 Share this articleAnyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative
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Exposure therapy is an evidence-based protocol for helping clients face their fears in a gradual, methodical way. Early in treatment, clients will create an exposure hierarchy, which is a list of scenarios they view as anxiety-provoking. ... Use this resource to support clients in their completion of exposure therapy homework. Review clients ...
ed Prolonged Exposure Therapy (PE). It is designed to help you recover from po. t-traumatic stress disorder (PTSD). To understand how this treatment works to help you reduce your PTSD symptoms, it is important to learn a little about h. PTSD develops in the first place. It is normal to feel.
g Exposure Worksheet Exposure means facin. fears to overcome them. Being afraid, anxious or worried when it is not dang. rous can get in the way. When you face fears on purpose, you learn 1) your worst fears are not likely to happen, 2) they aren't as bad as you expected, or 3) you can handle it. Avoiding fears makes them grow, but f.
Practicing Exposure Therapy: Exposure Worksheet . Learning to face the things that cause you to be fearful and anxious takes practice. After you create an Exposure Hierarchy, use this worksheet to practice facing your fears in small steps. List the behavior you are practicing_____
What is the likelihood that this could happen? 3. Evaluate the evidence fro and against the likelihood of his happening. 4. What is safety plan if "worst thing" happens? 5. Identify skills (breathing, self statements, relaxation) you will use during exposure exercise. Ratings before and after in-vivo exposure: Date.
A Therapy Assignment Workbook Between Sessions Resources ... used as therapeu]c homework. Overcoming Your OCD is one of a series of workbooks designed ... Do-It-Yourself Exposure and Response Preven]on Guide 139 Tools, Tricks, and Interven]ons for Your Contamina]on OCD 144
Exposure therapy is a treatment that helps people confront their fears and anxieties in a safe, controlled environment. Although avoiding feared situations may provide temporary relief, it can worsen anxiety over time. Exposure therapy teaches people how to develop coping skills and build resilience so they can overcome their fears.
worksheet. People with anxiety often invest tremendous energy trying to avoid their fears. While understandable, this avoidance limits their quality of life and ability to achieve their goals. That's where exposure therapy comes in. Exposure therapy is an evidence-based protocol for helping clients face their fears in a gradual, methodical way.
Saul McLeod, PhD. On This Page: Exposure therapy is a technique used in the treatment of anxiety disorders like phobias or posttraumatic stress disorder (PTSD). Its goal is to help individuals overcome specific fears or sources of anxiety. It works by exposing them to anxiety-provoking situations or stimuli in a gradual, controlled way to ...
This video demonstrates the rationale for imaginal exposure, instruction and set-up for the first imaginal exposure, and implementation of imaginal exposure. The client is well engaged even though this is the first exposure and the therapist responses and prompts are accordingly minimal, though she maintains occasional supportive statements and calm, solicitous voice tone to maintain ...
Exposure or fear hierarchies are a CBT tool for the treatment of avoidance-oriented anxiety in a wide range of disorders such as obsessive-compulsive disorder, panic disorder, social anxiety disorder, and specific phobias. Use the Exposure Hierarchy worksheet during exposure therapy to introduce your clients to feared stimuli in a gradual ...
This guide offers an easy-to-follow roadmap for creating an exposure hierarchy, which is often the centerpiece of exposure therapy. Also known as a "fear hierarchy" or "fear ladder," an exposure hierarchy is a list of scenarios that the client rates from least-distressing to most-distressing. Under the guidance of a therapist, the ...
Exposure is an intervention strategy commonly used in cognitive behavioral therapy to help individuals confront fears. Prolonged exposure is a specific type of cognitive behavioral therapy that teaches individuals to gradually approach trauma-related memories, feelings and situations. Most people want to avoid anything that reminds them of the ...
WET compared to CPT. Hypothesis 1: WET will be non-inferior. Hypothesis 2: WET will have a significantly CPT. Used original CPT version that has patients home after sessions 3 & 4), and Dr. Patricia Resick, CPT to the CPT arm. Randomly assigned 126 adults with PTSD and either WET (63) or CPT (63)
Written Exposure Therapy (WET) is a brief, 5-session psychotherapy—or talk therapy—for PTSD. WET can help you find new ways to think about a traumatic experience and what it means to you. Writing about what you were thinking and feeling during the event and then talking with your provider about the writing session can help you get relief ...
Therapy is exposure to tough emotions, exposure to problems that need to be worked out, exposure to the things that we avoid because they are painful and hard. In the therapy room, we look our ...
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of exposure therapy are thus generally preferred in contemporary clinical contexts (e.g., Gilroy et al., 2000 ; Gotestam and Hokstad, 2002 ). Access to the phobic stimulus is not always feasible in the clinic, and thus exposure without live stimuli has also been implemented. Such exposure might be completed using symbolic stimuli (i.e.,
The FSUE "Moscow Endocrine Plant" is under the jurisdiction of the Ministry of Industry and Trade of Russia and is one of the main producers of strategically important and vital and essential drugs. The Enterprise has a 75-year old history of success in the development and production of medicinal prodcuts. Analgesics with a central mode of ...
This OCD worksheet packet includes a blank exposure hierarchy template, and an exposure therapy homework form. The homework form provides a professional way for you to record your client's weekly exposure homework, and it gives your clients a nice place to keep track of their progress. To learn more about implementing these tools, check out our ...
Other Information. − Exposure therapy should be done under the guidance of an experienced professional. − Sometimes exposure therapy is combined with medication, such as an antidepressant. − 86% of OCD sufferers who completed exposure therapy improved, according to one study. − The benefits of exposure therapy for phobias can last for ...
Radio Moscow: circa 1968. February 11, 2014. Many thanks to David Firth, who is kindly sharing shortwave radio recordings he made on his reel-to-reel recording equipment in the late 1960's. Firth is uncovering and digitizing these recordings as time allows. We are grateful for this recording of Radio Moscow, which Firth recorded in 1968.
In case of remote and contact radiation therapy of oncological diseases using photon radiation, organs and tissues around the pathological lesion (irradiation target) are exposed to nonuniform ionizing radiation. The dose-effect ratio of nonuniform ionizing radiation in the exposed organ can vary by dozens of times. Therefore, it is difficult to estimate the dose of nonuniform radiation ...