Exposure Therapy, what does it consist of?

Anthony Golden
Exposure Therapy, what does it consist of?

It is common for people to have some fears and experience anxiety, a common response to these states can be avoidance behaviors, despite the fact that these types of behaviors aim to reduce the levels of anguish and fear they generate, only what They do partially, however the problem remains latent and tends to increase over time.

Exposure therapy has proven to be an effective way to overcome anxiety and fear problems, so it is very helpful for the treatment of specific phobias, when there is a fear that becomes almost paralyzing, this therapeutic option can be of great of help, especially from the hand of a psychologist, who through a controlled and safe environment can guide the patient in a systematic way to get out of the torment that fear and anguish can represent, because when these states are manifested in their most pathogenic forms can impair the biopsychosocial development of the person, with dangerous consequences for health.


  • What is exposure therapy?
  • How does “habituation” help within exposure therapy?
  • What are the main differences between the different types of exposure therapy?
  • How does exposure therapy work?
    • Exposure Therapy Cycles: General Instructions
      • Exposition
      • Withdrawal if necessary
      • Recovery
      • Repetition
  • What are some of the most commonly used types of exposure therapy?
    • Exposure assisted by the therapist
    • In vivo exposure or actual desensitization
    • Immersion or flood
    • In vivo exposure or actual desensitization
    • Imaginative systematic desensitization or imaginary exposure
    • Exposure therapy with images
    • Virtual mode exposure
    • Interoceptive exposure
    • Group exposure therapy
    • Self exposure
  • Exposure therapy for anxiety management
  • Exposure therapy and treatment of phobias
  • 7 Tips for Making Exposure Therapy Successful
    • Conclution
    • Links
    • Bibliographic references

What is exposure therapy?

It is a process widely used within cognitive behavioral therapy, which consists of modifying the sensitivity to stimuli that produce anguish or fear, through exposure therapy the patient is systematically and safely put in contact with the situation that generates conflict or with the stimuli that trigger anxiety, fear or that produce negative emotions, with which it can establish a new learning: extinction, which contributes to weaken previously learned associations, so that the person has more opportunities to develop a performance above the fear initially established, one of its objectives is desensitization. Generally, exposure is suggested gradually and evaluating different variables and personal factors of the patient, rather than a sudden immersion.

How does “habituation” help within exposure therapy?

"The explanatory mechanisms of fear reduction during practice are related to habituation from the psychophysiological point of view, behaviorally through extinction and cognitively with the modification of expectations." Mathews, Gelder and Johnston, 1985.

When the patient is exposed to the stimulus that causes discomfort, the phenomenon of habituation generally occurs, in turn, the individual realizes that many of his fears and much of his anticipatory anxiety are excessive with respect to the danger they actually pose , That is, they can measure their real level of threat and achieve a modification in their distressing cognitive interpretations, their reactions and their behaviors.

Habituation can contribute to reducing the stimuli that generate anxiety or fear to manageable levels, so it can facilitate adaptation to various situations that represented a problem for the subject, the feeling of self-efficacy that is acquired with progress therapy sessions serve as motivation to keep going. Emotional and cognitive processing helps to implant more realistic beliefs regarding the objects or circumstances that generate so much anguish or stress..

Exposure therapy suggests that when people are aware of and become habituated to their mixed motives, they can make decisions and respond to their fears in more appropriate ways. Exposure can be not only to objects, but to cognitive stimuli, situations or avoidance behaviors, such as traumatic and ruminant thoughts.

What are the main differences between the different types of exposure therapy?

Interventional techniques with exposure therapy may differ in:

  1. The form that the stimulus that generates conflict is presented.
  2. The type of response of the patients.
  3. The type of response induction aids.
  4. The use or not of cognitive control strategies, with which patients learn to modify cognitive responses to stimuli that mainly cause anxiety or fear.

The psychologist assists the patient and determines which technique is the most appropriate depending on different factors, since it is essential to choose the type of exposure therapy, take into account the patient's medical history, his speed of habituation, assess anxiety levels experienced by the subject during the sessions, among some variables to consider, it also has modalities for its application depending on the condition to be treated, this type of exposure therapy follows a rhythm: it can be gradual, through immersions and also through systematic desensitization. Relaxation exercises are highly recommended so that anxiety levels are manageable and in order to associate the objects, activities or situations that generate discomfort with the relaxation itself.

By means of small and well-defined objectives, it is possible to advance step by step, travel great distances and achieve advances in treatment, thereby improving the quality of life of the person, it is hoped that the individual can free himself from fear and anguish that are often like chains, so that you are freer to enjoy your life.

How does exposure therapy work?

The sessions generally last from 30 to 120 minutes, since it is often tiring for the person, as it is a form of cognitive training, and as well as after a physical conditioning where you put all your effort: you can end up exhausted but satisfied with yourself. Edmund Bourne says that the phenomenon of: "two steps forward and one step back" is typical in exposure therapy, however it is not a reason to be discouraged, it is to redouble efforts and be more aware that perseverance can be the key for a flattering change.

The vicious cycle of avoidance and flight behaviors can be broken through cycles of exposure therapy, which generally occur in the ways presented below..

Exposure Therapy Cycles: General Instructions


Faces the person with the stimuli that cause discomfort in the modality that the therapist considers appropriate according to the clinical history and psychological assessment.

Withdrawal if necessary

When the person feels that anxiety may get out of control, they are advised to withdraw or temporarily leave the situation until they feel better and then return to the situation. There are circumstances that can generate anxiety and in which it is not possible to physically withdraw, however, mentally you can withdraw to a secluded and quiet place using the imaginative resource. Unlike when there are avoidance or flight behaviors, withdrawing represents an action designed to prevent re-sensitization to the situation.


In case of temporary withdrawal from the conflict situation, it is necessary to wait until anxiety levels are restored to a degree that is manageable and to regain equanimity, breathing techniques and physical movement can help the restoration be quicker.


Exposure to uncomfortable stimuli is repeated, trying to go a little "further this time" and to tolerate a greater degree of anxiety than in the previous exposure. When the level of anguish seems to begin to be uncontrollable, it is withdrawn to later recover, the cycles can be repeated and modify the exposure time and other variables, according to the psychological assessment.



As rough as the patient can tolerate.
Interval between tasksShort.


As long as necessary to facilitate habituation, sessions of 30 to 120 minutes.
Activation on taskHigh grade.

Low grade.

A minimal degree of activation is important during exposure.
Attentional involvementAttention.

Distraction from the cognitive task.

Attention to homework.
Complementary coping strategiesSelf-instructions.

Slow deep breaths.

Presents variables from one patient to another.

What are some of the most commonly used types of exposure therapy?

There are different variants of exposure therapy, the psychologist can determine which technique is best for the patient.

Exposure assisted by the therapist

The psychologist accompanies and helps the patient to specify the objectives according to his evaluation of the clinical history and the progress he identifies through the observations he collects from each session with the patient. In such a way that he establishes a confrontation program in the face of the situation that generates a problem, in a safe way, the psychologist motivates him to go one step beyond anxiety and fear, he can help him modify his cognitions to achieve greater well-being in less time.

In vivo exposure or actual desensitization

It implies the confrontation of the situation that generates conflict in real life.

Immersion or flood

Patients are exposed to the phobic situation and remain in it until the fear dissipates, although it is faster than gradual exposure, it has its restrictions since it is associated with great discomfort on the part of the patient, gradual techniques are generally preferred..

In vivo exposure or actual desensitization

It implies the confrontation of the situation that generates conflict in real life can be gradually or by immersion.

Imaginative systematic desensitization or imaginary exposure

The person visualizes a series of steps that he would follow as a contingency plan in the face of distressing stimuli, using the imaginative resource. It is widely used before trying to face the stimulus that evokes conflict "in vivo". It is common that progressive muscle relaxation is used at the same time.

Exposure therapy with images

It is a recommended option in cases where the actual exposure is difficult to manipulate or when the patient shows serious reluctance to the exposure therapy in the face of the conflicting stimulus "in vivo". As in the previous modality, the individual can try these variants of the technique before the real confrontation, as it could be in the case of specific phobias: aerophobia, arachnophobia, fear of storms, fear of suffering from diseases or experiencing catastrophes.

Virtual mode exposure

An interactive environment is built where the patient has a greater sense of presence, which is more like the exposure "in vivo", the therapist and the patient can control the context. There are some variants that are more immersive than others, such as those with state-of-the-art technology and other more traditional ones such as projectors and monitors. In this method, patients are allowed to choose their degree of exposure, they can manipulate the level of control, their virtual distance and their movements by means of a joystick, just like in a fun video game! With the benefits of the playful aspect in therapy.

Interoceptive exposure

It consists of exposing the patient to unpleasant physical reactions through voluntary induction to the feared psychophysiological stimuli in a controlled and safe environment.

Group exposure therapy

It has been shown to have good results, especially when the groups have good cohesion, it is indicated more often when the patient lives alone or when the people with whom they cohabit will not collaborate with the treatment, however in the case of social phobia it can produce a higher rate of refusals and dropouts from treatment (Olivares, 2005).

Self exposure

It is advisable when the assisted treatment is progressing, in order to promote the independence of the patient with respect to the therapist and to facilitate the maintenance of positive therapeutic results. In this modality there must be certain requirements such as: the establishment of specific goals, the identification of problem behaviors, regular practice, the evaluation of anxiety levels, as well as the planning of conflict situations, this is to make a contingency plan and review it mentally, so that if the person is faced with the stimulus that evokes conflict, they can resort to it and thus generate a more adaptive and functional behavior. It is usually used in conjunction with therapeutic sessions, this leads to a higher recovery rate and maintenance.

Exposure therapy for anxiety management

"It is vital that the patient take control over his experience and over important elements of the environment, such as sources of threat, because self-control is essential for health and well-being." Dr. Mansell. Journal of Anxiety Disorders

Anxiety is an evil that is gaining epidemic force in our time, with respect to pathological anxiety, the effectiveness of contact with the anxiety-producing element has been observed gradually as a treatment. Exposure therapy has been shown to be highly successful in treating generalized anxiety disorder (GAD), panic states, panic attacks, eating disorders (ED), obsessive-compulsive disorder (OCD), dependencies or addictions, post-traumatic stress disorder (PTSD) in which narrative-type exposure is also used, while in hypochondria, for example, interoceptive class exposure is usually chosen. People who suffer from social anxiety can benefit from this type of treatment and thus restore their functionality in case it has limited them in the academic or professional field, for example.

Often the patient is provided with other types of resources so that he can manage his anxiety levels such as: relaxation techniques, breathing control, systematic desensitization and cognitive reconstruction techniques. It can act on the behaviors of the avoidance and rebound process, on catastrophic cognitions, autonomic activation and states of panic, among others. In people who show high values ​​of anxiety and fear, brain activity is affected, which is reflected in avoidance and flight behaviors, as well as in the rejection of confrontation.

Exposure therapy and treatment of phobias

It is one of the most researched and used in the treatment of persistent and unreasonable fears linked to specific situations, such as phobias, it has been proven throughout clinical experience and research that exposure to the frightening stimulus contributes to overcome specific ones, such as arachnophobia, social phobia and aerophobia, to name a few. Constant work and motivation on the part of the patient can be key for the patient to have a good prognosis.

In exposure therapy the person faces the phobic situation through a series of activities that progressively brings him closer to the feared circumstance or object, it is generally preferred over the immersion mode, since the progressive way It can be adapted according to the assessment of different variables that the clinician takes into account.

7 Tips for Making Exposure Therapy Successful

  1. Establish a bond of trust and support with the therapist.
  2. Dare to get out of your comfort zone and take risks.
  3. Confront resistance. Going forward with your exposure therapy sessions can be tiring, generates anguish, fear, in some sessions you advance more and in others a little less, however, when you are at this point it is good to remember that if you are constant you can free yourself from that constant discomfort that your fears and anxiety generate.
  4. Keep in mind the importance of retiring on time and recovering. While it is true that it is important to try to take one more step at a time, it is good to withdraw from the situation if the anxiety becomes inordinately overwhelming. Supersaturation or overexposure can re-sensitize to a phobic situation.
  5. Establish a contingency plan. It is convenient that you plan what you would do in case of finding yourself in a situation of extreme anxiety or stress.
  6. Acknowledge your efforts. When you are making progress, you can try to pamper yourself a little, rewarding your small successes can lead you to achieve greater achievements.
  7. Practicing as often as indicated can be like a form of training and like when doing physical conditioning, to achieve results, perseverance is required, it is necessary to be willing to challenge anxiety more and more, even if this involves sensations uncomfortable, it can free you from living bound by certain fears and anxieties that you can learn to handle.


Anxiety is a phenomenon that is increasing and is involved in various conditions, so it is necessary to implement techniques for its proper management. Through exposure therapy, systematically defined objectives are set, and treatment can gradually advance, thereby enabling the person to establish new learning, thus freeing himself of the fears and anguish that often result as chains for his life. development, their equanimity, health and happiness.

Exposure therapy has proven to be an excellent therapeutic resource for the treatment of phobias, patients who adhere to the treatment tend to be successful, with which they can be freer to live fully by modifying the reactions and behaviors of anxiety due to more states. manageable, by learning and building behaviors that are more adaptive and functional to their context. It can be used in combination with other therapeutic approaches that can provide the person with more resources.


  • https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy
  • http://www.cognitivoconductual.org/contenidos-especiales/terapia_de_exposicion.pdf
  • https://mmhaler.files.wordpress.com/2012/08/caballo-2007-manual-para-el-tratamiento-cognitivo-conductual-de-los-trastornos-psicolc3b3ológicos-vol-1.pdf
  • http://www.montrealcbtpsychologist.com/userfiles/373150/file/French/Therapie%20par%20l%27exposition.pdf
  • https://neurosciencenews.com/ocd-exposure-therapy-3062/

Bibliographic references

  • Bourne, E. and Garano, L. (2012). Cope With Anxiety: 10 Simple Ways To Relieve Anxiety, Fears, And Worries. Barcelona: Amat.
  • Labrador E., F. J. (2008). Behavior modification techniques. Barcelona: Pyramid Psychology

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