A New Take on Exposure Therapy (and Why You Don’t Have to Fear Exposure)
I have feelings when I read or hear misinformation about exposure therapies (often coming from well-meaning but misinformed therapists). This comes from a place of protection and desire for people who are suffering to have access to (and not fear) the very thing that can help them reclaim their lives from the vice grip of fear and anxiety. I have spent over 15 years helping people recover from phobias, obsessions and compulsions, and painful traumatic memories. I have witnessed some of the most incredible healing journeys and transformations, and all of it was made possible by exposure therapies.
Today, I want to share some common misconceptions about exposure therapies and help you understand why you don’t need to fear these life-changing interventions. Before we get to that, here’s a brief description of exposure therapy.
What is exposure therapy?
Exposure therapy is a form of cognitive behavioral therapy (CBT) designed to help people gradually face what they fear—whether it’s germs, vomiting, driving, going to see a doctor, or remembering painful and scary traumatic experiences. Problems with anxiety are really problems of escape and avoidance behaviors. You can think of it this way: when we fear something, we naturally avoid it, and that’s highly adaptive when something is objectively dangerous. For example, if someone drops of box of venomous snakes in the room and sets them free, the emotion of fear and the associated urge to escape the situation will undoubtedly save my life. However, when this natural fear-escape pathway gets turned on in non-life-threatening situations, you can imagine how habitual avoidance—as a strategy for escaping anxiety or discomfort—can begin to close doors on opportunities, resulting in a life that begins to feel smaller and smaller over time.
Here’s another way to think about it:
Exposure therapy works by helping your brain and body relearn safety.
Your anxious mind says: “This thing is dangerous. Stay away.”
The very normal part of you that wants to avoid discomfort says: “Okay, I won’t go there.”
But what if the thing you’re avoiding—public places, certain foods, a painful memory—isn’t actually dangerous? And what if all of the accumulating avoidance is making it difficult for you to live your life in a meaningful way?
In exposure therapy, you decide what fears you want to be face, in order to live the life you want to live (i.e., travel/getting on an airplane, taking your child to the playground, going to a neighborhood festival with your family). You slowly begin to test out your fears by approaching them, one at a time. Over time, when you avoid less, you get to experience new learning: This feels scary, but it isn’t actually dangerous. I can feel the fear and still do the thing I want to do, and the more I do it, the less afraid I feel!
For phobias and OCD, this looks like Exposure and Response Prevention (ERP)—where you gradually resist urges to engage in avoidance and compulsions, like cleaning, checking, or mentally reviewing. For trauma recovery, exposure might involve revisiting memories or situations that feel dangerous but are safe now, so your nervous system can process and heal. In exposure therapy, you only approach objectively safe situations; the goal is never to approach situations that have a high likelihood of danger.
How Does it Work?
Exposure therapies help people target the very thing that maintains their anxiety—avoidance. People engaging in exposure therapies with a properly trained therapist will learn to slowly and systematically move toward the places, situations, and activities of their choosing—even when doing so puts you in contact with anxiety. As you begin to avoid less and move toward the life you want, slowly beginning to face your fears, you learn—through direct experience—that you can tolerate the discomfort without needing to escape, and the feelings of discomfort that you feel as you approach these previously feared situations begins to change over time. In short, it’s all about new learning. Avoidance prevents new learning. As you reduce avoidance over time, you have access to lessons about what is actually safe and what you can tolerate, in order to live a full, reach, and meaningful life. Also, spoiler alert, the anxiety you feel will lessen over time (the fancy word for this is habituation).
Exposure therapy is a collaborative process, in which a therapist well-versed in exposure therapies will help guide the client in choosing to slowly move toward their fears at a pace that is challenging, but doable. Exposure is not something that therapists do to clients; it is a process by which therapists can give clients options to begin facing their fears in safe ways. A properly paced exposure therapy promotes agency; it should feel empowering and even a bit exciting along the way (you are getting your life back, after all!).
Common Misconceptions about Exposure Therapy
Exposure therapy is cruel; it floods the nervous system and leads to high drop out rates
Exposure therapy is not the same as “flooding.” An experienced therapist will properly pace exposures, resulting in an experience that is challenging, but not unbearable. As a client engaging in exposure therapy, you should feel empowered to challenge yourself while exercising full autonomy over what you are ready to approach in your therapy. The sweet spot: exposures that are difficult but doable. When therapy is properly paced, my clients feel empowered, experience a growing sense of confidence, and even begin to feel excited about what they might be able to accomplish next. With the right support and expertise, exposure therapies are well-tolerated and highly effective.
Exposure therapy is robotic, cold, and detached
There is no reason for any therapy to be robotic, cold, and detached. Exposure therapy is a straight forward, step-by-step approach that can certainly be delivered in a manualized, detached manner, but no-thank-you-absolutely-not! An experienced therapist who is well-trained in exposure therapies and has strong relational skills can make exposure therapy dynamic, engaging, exciting, and even playful. It’s all about finding the right support and expertise!
Exposure therapy is retraumatizing
I can’t say this loudly enough: This is absolutely false. Exposure therapy, conducted by a properly trained and experienced therapist, does not retraumatize people. Unfortunately, even well-meaning but misinformed therapists often perpetuate this idea and may even actively dissuade their clients from facing their fears and/or approaching traumatic memories, in order to heal.
With the right support and expertise, exposure therapy is properly paced; it is conducted thoughtfully, compassionately, and in a safe environment that promotes emotional processing and healing. Is it difficult, at times? Yes. Should it feel retraumatizing? Absolutely not.
Exposure is designed to help us learn about what is safe and what we can tolerate, in order to live a full, rich, and meaningful life; it is not designed to make people suffer and should not feel unbearable.
When People Complete Exposure Therapy
Exposure therapy is one of the most powerful ways for people to recover.
When clients complete exposure therapy, they often say things like:
“I never thought I could do that—and now I can.”
“My whole world has opened up again.”
“I’m not constantly waiting for something bad to happen.”
They find freedom from rituals and avoidance. They stop organizing their life around anxiety. They build confidence in their ability to tolerate discomfort—and trust in themselves. And most importantly, they start living more fully: parenting more freely, traveling and experiencing adventure, dining out without dread, attending concerts and community events, showing up in relationships with more authenticity and presence and less fear.
be. psychotherapy can help
If you are curious about exposure therapy, be. psychotherapy can help. Even if your fear is currently drowning out much of your access to feelings of hope, we can help. We offer exposure therapies for phobias, OCD, and posttraumatic stress. Reach out today for more information: sara@bepsychotherapy.com; 443-470-3124