Exposure therapy explained

Exposure therapy can sound intense. The idea of confronting something you've spent years avoiding is naturally unsettling. But for many individuals dealing with anxiety, trauma, or phobias, it's a proven and effective approach that can help ease distress and restore confidence.

This article breaks down what exposure therapy involves, how it works, and the kinds of challenges it can address. If you've heard the term during a therapy session or seen it mentioned online, this guide will help you understand the science behind it and whether it might be a good fit for you.

What is exposure therapy?

Exposure therapy is a psychological approach that helps people face the things they fear in a safe, planned environment. Avoidance may offer short-term relief, but over time it can keep fear alive and even make it worse. Exposure works by gently reversing this pattern.

Types of exposure therapy

There are several ways a therapist might introduce exposure into treatment. These are chosen based on the person's needs, the type of fear, and the setting:

• In vivo exposure: This involves directly encountering a feared object or situation in real life. For instance, a person afraid of dogs might visit a dog park with their therapist’s support.

• Imaginal exposure: In this method, a person vividly imagines a feared event or memory. It’s often used in trauma work, where recalling details can help reduce emotional intensity over time.

• Virtual reality exposure:  Virtual environments can simulate situations that are hard to recreate in real life, like flying or public speaking. Research shows this approach is increasingly effective and accessible.

• Interoceptive exposure: Some fears are triggered by bodily sensations, like a racing heart or dizziness. In this case, the therapist guides the person to safely experience those sensations so they become less frightening.

• Narrative or written exposure: Common in trauma therapy, this involves writing or speaking about distressing events to reduce the emotional grip they hold.

Exposure therapy can also be structured in different ways:

• Graded exposure: Starting with situations that cause mild anxiety and gradually working up to more difficult ones.

• Flooding: Jumping straight to highly distressing situations, which may work for some but is often more intense.

• Systematic desensitisation: Combining exposure with calming techniques like deep breathing, which can help the person stay grounded during sessions.

Modern approaches also focus on enhancing learning, such as varying the context or focusing on how expectations about danger are disproven through experience.

What can exposure therapy help with?

This approach is particularly helpful for anxiety-related conditions, including:

• Post-traumatic stress disorder or PTSD: Exposure is a key part of many PTSD treatments, including prolonged exposure therapy. A 2022 review of 65 clinical trials, involving more than 4,000 patients, found that exposure-based therapies showed strong and lasting improvements in PTSD symptoms.

• Phobias: From fears of animals to flying or elevators, gradual exposure helps many people regain confidence in daily life.

• Obsessive-compulsive disorder or OCD: Exposure and response prevention (ERP) involves confronting obsessive fears without performing compulsions, which helps retrain the brain over time.

• Social anxiety disorder:  Exposures might involve initiating conversations, making eye contact, or speaking in front of others to reduce fear of judgment.

• Panic disorder: Exposure to feared physical sensations and panic-inducing environments can help people stop avoiding them.

• Generalised anxiety disorder or GAD: While less commonly treated with exposure alone, some approaches use it to target persistent worry and avoidance of uncertainty.

Benefits of exposure therapy

Several Australian and international research support the effectiveness of exposure therapy. In the RESTORE trial, which is Australia’s largest treatment trial of PTSD, more than half of participants no longer met criteria for PTSD after completing prolonged exposure therapy, whether spread over 10 weeks or delivered intensively across two.

Other key benefits of exposure therapy, when delivered with care and expertise, include:

• Reducing avoidance behaviours that interfere with daily life

• Teaching the brain and body to respond more calmly to previously feared situations

• Building confidence through gradual, repeated experiences of coping successfully

• Shifting unhelpful thought patterns and beliefs that fuel anxiety

• Leading to lasting improvements in symptoms, wellbeing, and overall quality of life

So, how does exposure therapy work?

It might seem strange that doing the very thing that causes distress could help reduce it. But over time, with repeated and supported exposure, the body and mind can learn that fear doesn’t have to stay in charge.

What happens during exposure?

• Habituation: With repetition, the body’s anxiety response naturally lessens. What once felt overwhelming starts to feel manageable.

• Extinction learning: The brain gradually weakens the link between the feared situation and the sense of danger.

• Inhibitory learning: New, more helpful learning begins to take hold. For example, “I can feel anxious and still be okay” becomes more believable.

• Increased self-efficacy: Each success builds confidence. People begin to trust that they can cope, even when they feel scared.

• Cognitive shifts: Facing fears often brings new insights. A person might realise that their worst fears didn’t come true, or that they’re stronger than they thought.

To work well, exposure therapy must be thoughtfully structured. Pacing, timing, and the person’s readiness all matter. A well-trained therapist, especially a trauma psychologist, can ensure that sessions are effective without becoming overwhelming.

Are there any risks or downsides?

Like any form of therapy, exposure isn't suitable for everyone in every situation. Potential challenges include:

• Initial increase in anxiety: Facing fears can be confronting at first. Temporary discomfort is common, but it usually settles with continued sessions.

• Poor fit or timing: People in crisis, with unmanaged medical issues, or who feel unsafe may need to focus on stability first.

• Therapist skill matters: Not all therapists use exposure therapy, and some may not feel confident delivering it. Choosing someone experienced with this approach is important.

• Dropout or avoidance: Because it's challenging work, some people may stop therapy early or resist doing exposures between sessions. Support and collaboration help reduce this risk.

Overall, exposure therapy has a strong safety record, particularly when delivered by a psychologist or mental health professional trained in its use.

Is exposure therapy right for you?

Exposure therapy can be incredibly helpful, but it’s not the right fit for everyone at every stage of their healing. It works best when:

• The main issue involves fear, avoidance, or anxiety

• You feel safe enough to start confronting distressing things

• You’re willing to work at it, even if it’s hard at times

• You’ve got support, whether from a therapist or trusted others

Working with a therapist vs doing it alone

Self-help approaches may be useful for mild fears or avoidance, but exposure therapy is best done with professional guidance. A psychologist can:

• Tailor exposures to your specific goals

• Help you pace sessions so they’re effective but not overwhelming

• Support you through tough moments

• Adjust the approach if something isn’t working

Trying to face deep fears alone can backfire or reinforce the belief that those situations are dangerous. That’s why professional support matters. If you’re considering exposure therapy, talk to your GP or mental health professional. Ask about their experience with anxiety treatments and whether this method might be appropriate for you.