What to Know About Exposure Therapy

Exposure therapy doesn’t always look the same. There are different types of exposure therapy, and your therapist may guide you through one or more approaches depending on what works best for you.

• Imaginal exposure – If you are new to exposure therapy, or if your fear is very intense, your therapist may start you with an imaginal exposure. During an imaginal exposure, your therapist will have you focus on imagining the situation or thing that brings you anxiety.  If you fear taking trains, for example, you may start by watching videos of trains with your therapist. Next, they may ask you to describe what it might be like to ride a train, or write a vivid description and read it. As you repeat the train ride imaginal, your fear should lessen with each exposure.
• In-vivo exposure therapy – “In vivo” is a Latin term for “within the living.” This type of exposure therapy happens in “real life,” meaning you’ll face the feared situation or thing directly. For instance, your therapist will outline all of the steps to getting onto a train with you, from going to the ticket office to boarding and then riding. In vivo exposure then involves going through those situations, at first with your therapist, until you can safely board the train on your own.
• Exposure and response prevention (ERP) – Exposure and response prevention is an effective tool for people with OCD. The “response” part of this therapy involves resisting compulsions following the exposure. For instance, if your fear is getting sick from germs, your therapist may have you practice touching a doorknob without washing your hands for several hours after.

Your therapist will also work with you on setting the right pace for therapy. Some approaches include:

• Graded – With graded exposure therapy, your therapist will ask you to rank the feared situations or things from least to most severe. Exposures will start as mild and gradually increase in intensity.
• Flooding – Flooding involves the opposite approach as graded exposure therapy—with this technique, you’ll work with the most intense exposures first.
• Systemic desensitization – Systemic desensitization combines exposures with relaxation techniques to help tough emotions and fears feel more manageable.
• Virtual Reality – For some situations that are difficult to access, such as speaking in front of a class, asking a professor for an extension, or meeting new people at a party, therapists may set up virtual environments that allow you to practice managing your anxiety before doing an in vivo exposure.