Exposure therapy is a broad term used to describe a collection of techniques used to treat anxiety. Exposure therapy in early forms was referred to a systematic desensitization. Systematic desensitization had individuals confront an anxiety provoking situation while also engaging in a relaxation technique. The philosophy here was to use counter-conditioning by having the person in an anxiety provoking situation while providing their body with incongruent feedback of relaxation while confronting a normally fearful object or event. Over time researchers became curious as to what was causing the reduction in anxiety with systematic desensitization. Was it the relaxation? Just exposure to the feared object? Or relaxation and exposure together? They conducted what is called a component study to determine what part of the treatment was doing the heavy lifting so to speak. The results suggested that the relaxation portion of systematic desensitization was not doing much at all and may actually be counter productive but the exposure portion seemed to be doing most if not all of the good. These studies confirmed that the mechanism known as habituation was responsible for most if not all of the treatment gains. Habituation is quite simply the reduction of anxiety just with exposure to the feared object and the passage of time.
Most modern treatments for anxiety disorders used what is known as gradual or graduated exposure. What this means is that the therapist and patient produce a list of feared situations from easiest to hardest. They begin with easier feared situations and simply expose themselves to them until habituation is allowed to have its effect. Once this occurs and the person has mastered the exercise they move on to more challenging exercises. When doing exposure it is very important that the patient remain in the exposure exercise trial until habituation has occurred and there anxiety has decreased 50 to 75 percent before stopping the exercise. If the person stops doing the exercise early escape conditioning can occur and will cause the anxiety to get worse, meaning the exposure exercise did not help but actually made the person sicker! This is why it is important that if you are very anxious and are seeking exposure therapy that you seek assistance from a qualified person who has experience doing behavior therapy and more specifically exposure therapy.
As you can tell exposure therapy is work. You must do homework outside of therapy sessions or it is unlikely you will make significant gains. This is a form of therapy where active participation and significant effort is needed on the part of the patient in order for gains to occur. I have often characterized myself as a “glorified coach” when doing exposure therapy. I the therapist can merely guide, suggest, advise, and cheer-lead. The patient must go out on the field and make it happen. Thankfully, if done correctly, with patience, and time, exposure therapy is approximately 80 to 90 percent effective for many of the anxiety disorders. It is a very rewarding form of therapy because you can see your progress and feel the difference it is making. If you or a loved one experiences significant anxiety I encourage you to seek out a qualified therapist that can use exposure therapy.