Exposure therapy is one of my client’s least favourite types of therapy when first introduced, but most beneficial, and once they get started, most clients say it was much easier than they thought. It’s usually the anticipation that is worse than reality; and if interested, you can read about anticipatory anxiety.
Exposure therapy has been around for a long time. It was a theory developed by Ivan Pavlov in the early 20th century and has evolved over the years into its present form within Cognitive Behavioural Therapy (CBT).
If you have attended therapy with me or taken one of my courses, you will have come across it already as part of the homework I set. You would have undertaken behavioural experiments where you are slowly and systemically exposed to things that cause you anxiety or that you are avoiding altogether.
The therapy is based on the principle of habituation. This is the process where the fear response decreases when the fear source is encountered repeatedly. For example, the first time you sat behind the wheel of a car, you were probably terrified, but the more you exposed yourself to driving, as opposed to avoiding it, the more you habituated to it, and now you get in the car and drive.
Here are some key aspects of exposure therapy:
- It’s a structured treatment process.
- It involves gradual and repeated exposure to the source of fear.
- It’s conducted in a safe and controlled environment.
- It’s guided by a trained therapist.
- It helps you overcome panic attacks.
Panic Attacks Self-help
Dr Ryan’s online self-help course for Panic Attacks
Types of Exposure Therapy
There are different types of exposure therapy: in vivo and imaginal.
In vivo exposure involves facing the actual source of fear. For example, if someone fears dogs, they might gradually spend time around them.
Imaginal exposure involves imagining the fear source. This is often used when the fear source is not easily accessible or is a past traumatic event. I personally get clients, regardless of the type of fear, to use imaginal exposure until they habituate before facing the fear in real life.
Exposure Therapy for Treating Panic Attacks
The goal of exposure therapy for panic attacks is to reduce the fear response. This is achieved by repeatedly exposing the individual to the source of fear. For example, if you get panic attacks in large shopping centres, the goal is for you to go into the shopping centre in a very controlled and managed way, to feel some anxiety, be able to control it, and then increase your exposure.
You start to do this in exposure therapy by creating a fear hierarchy.
Creating a Fear Hierarchy
This is a list of fear sources, ranked from least to most frightening. If going into the shopping centre is terrifying for you, it would be at the top of the fear hierarchy and not something we would even consider doing until you see that you can successfully manage other situations first. We build success into this equation, as early success is a great motivator.
The least frightening thing is the first thing you start with on your fear hierarchy. That might be going to a small familiar corner shop, or it could be walking to the corner shop but not entering, either walking back or walking past.
To start your exposure therapy, you rank on a scale of, let’s say, 1 – 10 how anxiety-provoking this is for you, and you might mark it at a 7.
You think you should expose yourself to fear, either imaginary or in vivo, practice relaxation techniques as you do it, and rank your fear level afterwards. You keep repeating the same thing over and over until you habituate and no longer consider it a frightening experience or an experience that would result in a panic attack.
Then, you move to the next thing on your list.
How to create your own fear hierarchy
You can use my image below as a basis for your fear hierarchy.
The Role of the Therapist
The therapist plays a crucial role in exposure therapy. They guide the individual through the exposure process.
The therapist ensures the exposure is conducted in a safe and controlled environment and provides support and encouragement throughout the process.
The therapist also helps the individual develop coping strategies. These strategies help manage anxiety during exposure and in real-life situations.
The Effectiveness of Exposure Therapy for Panic
Exposure therapy has proven to be highly effective for treating panic attacks. It’s backed by extensive research and clinical practice.
Conclusion
Exposure therapy can help you get your life back and stop avoiding aspects of it. Although it sounds cliched, it gives you a sense of control and achievement when you are no longer afraid to do things that you once considered normal.