Why exposure works
Why exposure works
Exposure therapy, which involves systematically facing your fears with the help of a trained therapist, is considered the treatment of choice for anxiety disorders and obsessive-compulsive related disorders.
It is one of the main ingredients in cognitive-behavioural therapy (CBT), a therapy designed to help you challenge your unhelpful beliefs and change behaviours that reinforce your distress. Exposure therapy can be life-changing for many individuals with anxiety.
But exposure therapy sounds pretty scary! Many people avoid seeing a therapist who does exposure therapy because they are afraid or unsure of what it will involve.
Research even shows that many therapists do not use exposure therapy as part of treatment, due to their own fears about eliciting their patients’ anxiety. This is despite the fact that exposure therapy is actually safe, tolerable and highly effective.
If you have ever considered doing exposure therapy to overcome one of your fears, but you are unsure what to expect, here we explain how exposure therapy works, and why we recommend it to all of our patients with fear-based problems.
1. You learn to tolerate difficult emotions
Stress and anxiety are an unavoidable part of life. People with anxiety disorders and obsessive-compulsive disorders experience quite a bit more emotional turbulence than the average person, and although they experience anxiety on a daily basis, they have a great deal of difficulty dealing with it. This is why a person with anxiety often avoids situations that make them anxious – they are just so sick and tired of feeling that way!
Avoidance is a common coping strategy, but unfortunately it only makes the fear worse over time. This becomes the key rationale for doing exposure-based treatment. Your therapist re-introduces you to situations you have been avoiding so that you can learn to sit with your discomfort, learn that it is not harmful, and that it will eventually pass. Through doing exposure therapy, you learn you don’t need to avoid things in order to cope with difficult emotions.
2. You learn the bad thing doesn’t usually happen; but even if it does, you can probably cope with it
Fears, phobias and obsessive-compulsive problems usually involve a feared consequence or outcome. For example, someone with a specific phobia of vomiting (emetophobia) might worry that if they eat chicken at a restaurant, they will get salmonella, start to feel sick, not make it to the bathroom, and end up vomiting in front of a crowd of people who will judge them and think they are disgusting. During exposure, this person will be encouraged, usually after doing some easier tasks first, to eat some chicken while out in public. Through doing this, they will learn they probably aren’t going to vomit.
But say you do accidentally eat some undercooked chicken - they could still get salmonella, right? In some, albeit rare, cases, the feared consequence actually happens when participating in exposure therapy. The learning then becomes about whether they make it to the bathroom, whether anyone actually judges them, and how well they cope with the adversity. After participating in exposure, clients learn they can actually handle it when things go wrong.
3. You learn to deal with uncertainty
Many people with anxiety struggle to tolerate not knowing. For example, people with generalised anxiety disorder (GAD), will worry a lot about the future and try to get reassurance from loved ones to ease their uncertainty (e.g., “Who is going to be at the party?” “What happens if I don’t get into university?” “What happens if I start to feel anxious?”).
People with anxiety might also plan ahead excessively (e.g., by packing a spare change of clothes in the car whenever they leave the house in case they get stuck somewhere and can’t get home). Doing these things might make them feel better at the time, but in the long run the person never learns that they can cope without doing them, and that they could have figured out a solution even if they weren’t prepared.
So, in exposure, the patient has to drop these “safety behaviours” and face a new challenge without being prepared. Throughout this process, they begin to accept the unknown and learn to cope with uncertainty.
4. Parents learn to cope with their kids’ distress
It is very common that the loved ones of people suffering from anxiety or OCD get caught up in the “cycle” of their anxiety. Parents commonly do this by providing reassurance, letting their child avoid situations, or doing compulsive or safety behaviours for the child. This is usually because parents, of course, don’t like to see their children upset.
Through participating in exposure therapy alongside their child with the help of a therapist, parents learn that their kids can actually handle feeling anxious, and in turn parents learn to tolerate their own discomfort about their child being uncomfortable! This creates a stronger, more resilient family unit who know they can tackle difficult situations together as a team.
This is why exposure therapy is the first-line treatment for anxiety problems. By participating in exposure, you will learn that you are braver, more resilient, and more capable than you ever thought you could be!
Author: Cassie Lavell, Clinical Psychologist at the Children’s Centre for Anxiety & OCD
Useful links:
To learn more about exposure therapy for OCD (known as exposure and response prevention), visit the International OCD Foundation.
The American Psychological Association has a helpful article on different types of exposure therapy for anxiety disorders!
