Updated: Aug 21, 2022
Learn what exposure is used for, how it works, and get tools and worksheets.
It seems like the most logical way to protect yourself from a fear would be to avoid it. That makes a lot of sense in the short-term.
In fact, it’s an important defense mechanism that humans learned over thousands of years.
However, fears and avoidance can sometimes get out of hand, making a situation worse. For example, if someone spends most of their day worried they’ll run into a spider, they may not get much else done.
That’s where exposure comes in. Exposure therapies and techniques help people gradually face their fears so they no longer need to avoid or worry about them.
Such treatments help with phobias, anxiety disorders, post-traumatic stress disorder (PTSD) and more.
Need resources right away? Skip ahead to here take a look at our anxiety and PTSD bundle including common exposure techniques.
Here’s a look at common exposure techniques, what they’re used for, and specific treatments that include them.
There are several structured therapies that treat certain anxiety conditions with exposure. They all include all or some of the following techniques.
The most common treatment that includes exposure is called cognitive behavioral therapy (CBT). A key element of CBT is talking about thoughts, fears, and feelings.
I often find that simply talking through thoughts about a topic exposes people to their fears. For example, if someone is afraid of dogs, then talking through this fear can be a helpful first step of exposure.
Those with PTSD tend to push away thoughts and memories of their trauma. In CBT, we start to bring them back into our awareness by processing them. (Processing is simply talk therapy that’s focused on a specific topic.) This is typically the first exposure technique I use with my clients.
One of the most common exposure techniques is called “imaginal exposure.” This is done in various ways.
It’s more or less what it sounds like. The patient “imagines,” their fear. It’s also sometimes described as exposure to one’s own thoughts.
This might happen through thinking of a memory you’ve been avoiding, or imagining a worst-case scenario about the future.
Imaginal exposure may happen inwardly, out loud in therapy, or through written assignments between sessions.
In trauma-focused CBT, which is used with children and teens, it happens creatively. For example, kids may write a play about a bad memory, or create a piece of art that represents how they felt during a trauma.
The basic idea behind imaginal exposure is to allow the person to face the feelings that come up behind the fear. By understanding and working through these feelings, the fear and related anxiety will start to dissipate.
More details on these techniques are included below, within the therapies that use them.
In-vivo is French for “in real life.” If you’ve heard of exposure techniques or seen them portrayed in movies they were likely in this form.
If someone has a fear of heights, their therapist may assign in-vivo homework activities to face this fear. It could start as simply as standing on a short hill, and work all the way up to visiting a rooftop.
This doesn’t happen all at once, but will take place over several days, weeks, or even months. I’ve found that many clients take anywhere from a few homework activities up to several weeks worth to overcome fears.