Exposure therapy helps you face your fears in a planned, controlled, & gradual way.

Exposure therapy and Exposure and Response Prevention (ERP) are under the umbrella of Cognitive-Behavioral Therapy. They represent the behavioral part of CBT.

Exposure therapy has been found to be an effective treatment for anxiety disorders such as Panic Disorder, Social Anxiety Disorder, Generalized Anxiety Disorder, Health Anxiety Disorders, and specific phobias. ERP has been found to be an effective treatment specifically for OCD.

Exposure Therapy

The focus of Exposure Therapy is on confronting rather than avoiding triggers for anxiety. For example, for someone with social anxiety, exposure therapy may involve engaging in small talk, going to a social gathering, speaking up at a work meeting, or giving a presentation or speech. For someone with health anxiety, exposure might involve going to a doctor’s appointment, attending medical procedures or tests ordered by their doctor, visiting a hospital, or reading about an illness. The goal is to expose yourself to the feared trigger long enough for anxiety to peak, to plateau, and to come down over time. This is what is referred to as habituation. This allows a person to learn that anxiety will come down on its own, without needing to engage in avoidance. This can happen because it gives a person the opportunity to learn that anxiety reduces on its own over time; that they have the skills or can practice new skills to manage a challenging or uncomfortable situation; or that their feared scenario or outcome does not actually come true. All of these can contribute to lowering anxiety over time, with repeated exposure practices.

Exposure & Response Prevention

ERP is a specific type of exposure therapy that is used to treat Obsessive-Compulsive Disorder (OCD). There are two important components. The first, exposure, aims to confront the person with the trigger for anxiety by putting them in a situation that triggers their fear. For example, someone with a contamination obsession might deliberately touch a public doorknob. The second, Response Prevention, aims to prevent the compulsion of washing their hands subsequently, as a way to avoid contamination. This interrupts the OCD cycle by allowing people to learn that they can tolerate and cope with uncomfortable and distressing feelings without resorting to compulsions or avoidance. They can also learn that compulsions and rituals are not necessary to reduce or eliminate feelings of anxiety.

Exposures are most effective when they are planned and controlled. This means that the individual decides ahead of time, what trigger or situation they will confront. Exposures should also be gradual, meaning the person starts with smaller triggers and works their way up to more anxiety provoking triggers over time, as they build their skills and confidence.

Types of Exposures

1. In Vivo exposures involve directly confronting the feared trigger or situation. For example, for someone with social anxiety, they may ask someone they don’t know for directions or they may introduce themselves to someone at a social gathering.
2. Imaginal exposures involve vividly imagining, in a lot of detail, their worst fear or worst case scenario. For example, for someone with health anxiety, they might imagine being given a life-threatening diagnosis by their doctor.
3. Interoceptive exposures involve purposefully triggering uncomfortable and feared physical sensations through various physical exercises. For example, for someone with a fear of panic attacks, they might be guided to induce the feeling of dizziness or light-headedness by spinning in a chair.

Exposure work can feel scary, especially for people who have been engaging in avoidance for a long time. It is important to remember that you are always in control, and that setting exposure practices is a collaborative process between the client and therapist. You work at your own pace and set goals that challenge you while remaining manageable.

West Toronto CBT is a psychology practice that delivers evidence-based psychological treatments – Cognitive-Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and Acceptance & Commitment Therapy (ACT) – to address mood and anxiety-related difficulties, including depression, Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Social Anxiety, Health Anxiety, Panic Disorder and Agoraphobia, Insomnia, Grief/Loss and more.