Exposure therapy: How it works, types, and benefits

Written by

therapist.com team

Last updated: 05/31/2024

A man sits holding his leg and looking thoughtfully at his therapist as he speaks to him

What is exposure therapy?

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.

Is exposure therapy a type of CBT?

Exposure therapy is considered a type of cognitive behavioral therapy (CBT).¹ CBT is a broad category of psychotherapy that focuses on changing unhelpful patterns of thinking and behavior to alleviate psychological distress. Exposure therapy specifically targets the behavioral aspect of this approach.

How does exposure therapy work?

A therapist will use certain exposure therapy techniques to gradually expose a client to aspects of a triggering situation. The exact procedure your therapist will follow depends on what kind of fear or anxiety you’re trying to overcome, what type of exposure therapy you’re undergoing, and other factors.

In general, an exposure therapy session may include:²

Creating a fear hierarchy. Your therapist will work with you to rank activities, objects, or events that you fear, ranked from least to most difficult.
Choosing exposure tasks. The therapist selects fear-inducing tasks that are challenging but possible for you to do.
Engaging with fears. You perform the tasks in a controlled environment, staying in the situation longer than comfortable.
Tracking anxiety changes. You are asked to tune into how your anxiety and beliefs about fear change during the process.
Learning from the experience. After each task, you and your therapist talk about what happened and what was learned about the fear.

What can exposure therapy treat?

Exposure therapy has been used to address mental health conditions such as:

Exposure therapy examples

In clinical practice, exposure therapy can take various forms depending on the specific mental health condition it’s addressing. Here are some examples:

A person with general anxiety disorder (GAD) might be exposed to their worry triggers. They would then be taught to tolerate uncertainty and the associated anxiety without engaging in excessive planning or avoidance behaviors.
For panic disorder with agoraphobia, exposure might start with imagining leaving the house. Then they might be asked to imagine themselves sitting on the porch or taking a short walk outside. Eventually, they might progress to going to crowded public places.
For someone with a fear of spiders (arachnophobia), a therapist might start by showing them pictures of spiders. Next, they might progress to watching videos. Lastly, they might try being in a room with a live spider.
A veteran with PTSD might be asked to write about their traumatic experiences in detail. Alternatively, they might be exposed to triggers that remind them of their trauma in a safe environment.
A person with OCD might be asked to touch something they consider contaminated and then refrain from their usual washing or cleaning rituals.

Types of exposure therapy

Some of the most common types of exposure therapy include the following:

Exposure and response prevention therapy (ERP) involves exposure to a feared object or idea (exposure), followed by the prevention of the usual compulsive response (response prevention). It’s commonly used to help treat OCD.³

Imaginal exposure therapy involves the client vividly imagining their fear. With their therapist’s guidance they’ll describe the object, place, or situation they’re afraid of in detail. They’ll be asked to note the emotions they feel during this process so they can begin dealing with those feelings and working to reduce their fear and anxiety.

Interoceptive exposure therapy involves exposing a client to feared physical sensations with the hope of reducing their sensitivity to them. For example, someone who fears they’re having a serious medical emergency when they become lightheaded may be asked to stand up quickly to trigger the sensation.

In vivo exposure therapy involves practicing self-regulation by facing anxiety-provoking situations outside of sessions. The therapist and client collaborate to identify challenging scenarios and develop coping strategies. As homework, the client is assigned exposure tasks. For instance, someone with social anxiety may be asked to engage in brief social interactions while using the techniques learned in therapy.

Narrative exposure therapy (NET) is typically used for trauma disorders like PTSD. It involves the client constructing a narrative of their traumatic experiences, creating a kind of emotional exposure to the events.⁴ The therapist then helps the client to process and integrate these memories into their life story.

Prolonged exposure therapy is a brief form of exposure therapy which takes place across nine to 12 sessions. It’s specifically used for treating PTSD and incorporates both real-world (in vivo) and visualized (imaginal) exposure to distressing situations.

Virtual reality exposure therapy may be used if the object or situation a client fears isn’t practical to confront in real life. For example, a person with a fear of flying might use a flight simulator instead of going on a real plane.

Written exposure therapy (WET) is similar to NET but involves the client writing about their traumatic experiences in detail. They will be asked to write about their thoughts, feelings, and sensations during traumatic events. This process is repeated several times, with the therapist providing guidance and support.

Cold exposure therapy involves exposing the body to cold temperatures, such as through cold showers or ice baths. Despite the name, cold exposure therapy is not a traditional form of exposure therapy, or even a psychotherapy. However, some research suggests that cold-water immersions may help reduce symptoms of depression and anxiety.⁵ It’s thought that the cold activates the body’s natural stress response and promotes the release of endorphins. However, more research is needed.

Pacing techniques

Exposure therapy may use the following pacing techniques:

Graded exposure begins by focusing on the least frightening thought or scenario, then progressively moves toward the most frightening.
Systematic desensitization gradually exposes clients to feared situations while using relaxation techniques, slowly teaching the client to respond with less and less anxiety or fear over time.
Flooding involves exposing the client to the object or situation they find most challenging without any efforts to prevent distress.

Benefits of exposure therapy

The benefits of exposure therapy can include:

Milder reactions: Gradual, repeated exposures can help decrease the intensity of a person’s reactions, making their responses more manageable.
Symptom elimination: In some cases, exposure can eliminate symptoms of fear or anxiety.
Better emotional regulation: People can learn to interrupt and regulate their emotional responses to upsetting situations.
An increased sense of agency: Learning to survive and thrive in situations that once caused fear can increase self-confidence and self-esteem.

How effective is exposure therapy?

Overall, exposure therapy is a well-supported and effective treatment for various conditions, particularly those related to anxiety and phobias.

Exposure therapy for anxiety disorders is considered to be one of the most effective psychological interventions, though it’s underused in clinical practice across the US.⁶
Exposure therapy for agoraphobia has proven more effective than self-guided CBT.⁷ It can help reduce both the fear of open or crowded spaces and panic attacks.
Exposure therapy for PTSD effectively helps reduce symptoms and can be beneficial for children and adolescents.^8,9
Exposure therapy for OCD has a high success rate; exposure and response therapy is considered by some to be the top psychotherapy of choice for the disorder.¹⁰

Can exposure therapy make anxiety worse?

Exposure therapy relies on placing clients in uncomfortable situations and building resistance to distress. This exposure could cause anxiety or fear to worsen as you undergo treatment. While it’s a common treatment for anxiety disorders, its effectiveness can vary among different people. And some people may experience a relapse of anxiety symptoms after treatment.¹¹

Researchers think this might be because people with anxiety have trouble with certain learning processes that exposure therapy relies on. To improve outcomes, therapists can focus on optimizing these learning processes, but it may be anxiety inducing.

When is exposure therapy not recommended?

Research has been conducted into whether certain kinds of exposure therapy should be undertaken if a person has other mental health issues.¹² These include dissociation, borderline personality disorder (BPD), psychosis, thoughts of suicide or self-harm, substance abuse, or major depression. People with these co-occurring issues seem to respond positively to exposure therapy, but more studies in this area are recommended.

Just like in other forms of therapy, it’s important to consider a person’s readiness and willingness to engage in exposure therapy. If they’re not ready or willing to face their fears, it may not be appropriate at that time.

Exposure therapy should be done with the guidance of a mental health professional. A therapist can help you determine whether exposure therapy is a good fit for your mental health concerns and goals. Find a licensed provider near you today.

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The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.