Exposure therapy is a technique commonly used to treat phobias, anxiety disorders, post-traumatic stress disorder, or PTSD, and is sometimes used as part of addiction treatment. Exposure therapy is one component of cognitive behavioral therapy, or CBT.
The idea behind exposure therapy is simple: avoiding what we fear only makes the fear worse. And from a practical perspective, avoiding something we’re afraid of can damage our lives much more than the object of our fears ever could. First, avoiding things that cause fear or anxiety can be incredibly inconvenient and hold us back from achieving our goals. If you have an intense fear of meeting new people, traveling on planes or in cars, or even leaving the house, achieving your goals in life will always be limited by these fears. Confronting them lets you do more.
Second, avoidance is a major contributor to addiction. It’s quite common, for example, for people who experience intense social anxiety to drink or use drugs as a way of coping. They don’t want to feel that intense anxiety and they know ow important social connection is, so they use a little chemical help to avoid facing the anxiety of social situations. That’s a common cause of alcohol addiction in particular.
A similar phenomenon happens with people struggling with PTSD. They experience intrusive thoughts or memories of the traumatic event. They may also avoid situations that remind them of the trauma. It’s common for people with PTSD to use substances to avoid those thoughts that may lead to panic. In fact, more than half of people with PTSD are thought to struggle with substance abuse.
Taking back control over your life requires learning to confront whatever causes you fear or anxiety. That’s easy to say and hard to do. Fear is paralyzing. Sometimes we can’t move, or even breathe, so how do you confront your fear?
There are three main strategies therapists use when employing exposure therapy–flooding, graded exposure, and systematic desensitization. Flooding is basically when you are overwhelmed by the experience you fear. For example, if you’re afraid of flying, you might take a ride in a two-person aircraft. The idea behind flooding is that you can only be terrified for so long. The first few minutes in the aircraft are likely to be terrifying, but as time goes on, you begin to accept you’re not in any real danger. You become used to the experience and gradually the fear subsides. After that, geting on a commercial flight is no big deal.
Sometimes jumping right in the deep end is just too much. In these cases, the therapist might prefer a graded exposure approach. In a graded exposure approach, instead of immediately getting into a small aircraft, someone might start by looking at pictures taken in flight, or reading descriptions of flying. Then, they can gradually move to more vivid stimuli, taking small steps until they can actually tolerate boarding a plane.
Along with these strategies, it often helps to use systematic desensitization. You prepare by learning to relax deeply, which might involve methodically relaxing certain parts of the body, or doing some slow deep breathing. Once you can easily get into a relaxed state, you begin the graded exposure. Instead of white-knuckling it through your initial terror, though, you intentionally enter a state of relaxation. When you’re able to relax at one level of anxiety, you can move to the next stimulus and try again.
Exposure therapy is often used in addiction treatment too. One use is for co-occurring conditions, such as anxiety disorders, obsessive-compulsive disorder, and PTSD. A large percentage of people seeking treatment for addiction will have at least one of these, and successfully treating addiction requires treating the co-occurring disorder too.
Another major problem for people recovering from addiction is cravings. Cravings can be caused by anything you associate with drinking or drug use, including people, places, paraphernalia, smells, or the substances themselves. Contact with any of these can flip a switch in the brain that says it’s time to use again. Exposure therapy can help extinguish the automatic response to triggers by confronting them in a safe supportive environment, where you can practice systematic desensitization. So someone recovering from an opioid addiction might look at a picture of a syringe and practice a relaxation technique until the craving passes, then later try something more challenging.
One cutting edge way therapists are starting to use exposure therapy is through virtual reality, or VR. There is only so much you can do in a therapist’s office. You know, for example, that even if the therapist shows you a bottle of whisky, you’re not going to sit there and drink it during your session. VR offers a solution to this. VR environments are not only very realistic, but also highly customizable. You can create an environment very similar to one in which you would have drank or used drugs, and fill it with triggers of varying degrees of difficulty. When you leave therapy, you will have already practiced controlling your cravings in an environment similar to what you might face in real life.
As simple as exposure therapy seems, you should only do it under the guidance of a professional therapist with experience treating anxiety, phobias, PTSD and other other conditions using exposure therapy. If it’s done in a way that doesn’t make sense for your specific situation, you might end up making your fear even worse. If done correctly though, you will not only overcome a fear that has held you back, but you will also feel a greater sense of confidence and self-efficacy.
If you’re struggling with addiction or an anxiety disorder, The Dawn Medical Rehab and Wellness center can help. We are one of Thailand’s most respected addiction treatment and wellness centers. We use cutting-edge treatment modalities, including VR, to provide personalized care to treat addiction, depression, anxiety, bipolar disorder, personality disorders, PTSD, and executive burnout. See our contact page to reach us by phone or email.