Exposure Therapy: Learning to Feel Safe

As discussed in previous posts, a core component of cognitive-behavioral therapy (CBT) is overcoming avoidance and starting to face your fears. This is known as “exposure therapy” and is one of the most effective treatments for anxiety disorders such as panic disorder, social anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder, generalized anxiety disorder and specific phobia.

Exposure therapy is based on the idea that all of us learn by association. For example, imagine someone who is struggling with social anxiety disorder. They may associate social interactions with an increased likelihood of being rejected or judged negatively. In short, their brains have formed an association: social interactions = rejection. Consequently, they avoid social situations like parties, dating, lunch with co-workers, etc. Exposure therapy is based in research demonstrating that by systematically and repeatedly engaging in social interactions without rejection, the brain can learn a new association: social interactions ≠ rejection.

This simple idea, that effective treatment for anxiety disorder involves new learning is supported by decades of research. The field of psychology has learned a tremendous amount about anxiety disorders, how exposure therapy leads to new learning, and even the brain regions and genes that are involved in this type of learning.

How exposure therapy works

Together, you and your therapist will develop a list of situations or sensations that elicit anxiety, what you are concerned will happen (e.g., social rejection), and all the factors that either increase or decrease your expectation that the negative event (e.g., social rejection) will occur.

Then, your therapist will work with you on ways to systematically expose yourself to these situations or sensations, in order to learn that certain feared outcomes are unlikely to occur. As you repeatedly face these situations in the absence of the negative outcome, your brain begins to form a new association, and your anxiety will decrease. You will do these exposures both within session with your therapist and between sessions for “homework”.

Although it sounds simple, our brains can be stubborn. It takes repeated practice and specific strategies to help our brains let go of the fear association (e.g., social interactions = rejection) and learn a new, less threatening association (social interactions ≠ rejection).

Examples of exposure therapy

Here are just a few examples of exposure exercises. Your therapist will work with you to develop individualized exposure exercises based on your specific fears.

For an individual with Panic Disorder who fears having a heart attack, exposures may involve exercise or caffeine intake to induce a rapid heartbeat.

For someone with social anxiety disorder exposures may include starting conversations with strangers, giving presentations at work or school, or asking someone on a date.

For someone with post-traumatic stress disorder exposures may involve detailed discussions about the trauma memory, going to places that remind you of the trauma, etc.

For obsessive-compulsive disorder, exposures may involve deliberately exposing oneself to germs or dirt without cleaning or bringing up intrusive thoughts about harming others.

Common questions

“I’ve tried to face my fears before, but I’m still struggling”.

It takes repeated practice in order for exposure therapy to be successful. Occasionally facing your fears is unlikely to significantly reduce your anxiety. In addition, exposure therapy involves specific strategies to enhance the new learning that underlies successful treatment. That is why it is best to work with a qualified exposure therapist.

In addition, many people often inadvertently conduct exposures with “safety behaviors or safety signals”. These are behaviors or objects that reduce anxiety or the expectation that the feared event might occur. For example, someone with panic disorder may take a short acting anti-anxiety drug when they start to feel anxious, while someone with social anxiety disorder may push themselves to initiate a conversation but keep their hands in their pockets so no one can see their hands shake from anxiety. Although these behaviors reduce anxiety in the short-term, they also reduce the amount of new learning that takes place. Rather than learning that your feared outcome didn’t occur, you only learn that your feared outcome is less likely because you engaged in the safety behavior (e.g., taking a benzodiazepine). Your therapist will work with you to identify and reduce these safety behaviors.

“This sounds scary. I don’t think I can do it”.

Your therapist will work with you to gradually confront feared situations and sensations. Many individuals find exposure therapy extremely gratifying, as they begin to feel empowered after facing their fear. After a few weeks, you may find yourself excited to try new exposure exercises, and amazed at how your life begins to open up once again. Exposure therapy is one of the most effective treatments for anxiety disorders and has been used with thousands of individuals.

Find out more

If you are interested in learning more about exposure therapy, please contact us to for more information or to schedule a consultation.

Michael Treanor, Ph.D., Psychological Assistant | Behavioral Associates Los Angeles

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Behavioral Associates Los Angeles is a group of cognitive-behavioral therapists specializing in the treatment of anxiety and mood disorders. To find out more, contact us by phone at 310-205-0523 or by email at treatment@behavioralassociatesla.com.

You can also request an appointment with a Behavioral Associates LA psychologist by submitting a brief patient assessment form on our Website. Our clinical staff will follow up with you within 24 hours of submission.