How to Add Exposure Therapy with your Clients

  Sunday, September 26, 2021

A very old notion implies that the only way to overcome a fear is to face it. For people with usual, everyday worries and anxieties, this proves to be very helpful each time. However, this method does not have much standing when it comes to clinically diagnosed anxiety disorders. Not because it doesn't work, but because not many mental health professionals are aware of its efficacy. In the world of therapy, this is known as exposure therapy, where a therapist may introduce the patient to specific scenarios that induce feelings of fear anxiety in the hopes of slowly working through them. It is a more intense version of facing your fears. 

The work on exposure therapy began in the early 1900s, including behaviorists like Ivan Pavlov. Pavlov was famous for his work on classical conditioning. In 1920, Mary Cover Jones, called the "mother of behavior therapy," used conditioning techniques to change responses people had in regards to their fears. This research eventually led to more work on desensitization therapy and exposure therapy. Exposure therapy works through several techniques, each ranging in different intensity and based on what mental health issues it's tackling. 

Does Exposure Therapy Work?

 A 2013 study focused on the effects of PTSD on 1931 veterans. The published research talked about minimizing the symptoms of PTSD and depression through exposure therapy. Similarly, many published studies have shown that exposure therapy has worked, and patients have preferred it more than any other treatment. Exposure therapy has been known to treat the following:

  • Anxiety Disorders
  • PTSD
  • Obsessive-Compulsive Disorder (OCD)
  • Minor Trauma 
  • Phobias 
  • Panic Attacks 
  • Social Anxiety 

Introducing this treatment to your practice can be very beneficial. Sometimes patients may not respond to any other type of treatment, making things difficult for you. Exposure therapy is relatively new and effective, which makes it worth trying. 

Types of Exposure Therapy 

There are different types of methods for going about treating someone with exposure therapy. Usually, it is up to you as a therapist to ensure the best possible approach given the intensity of your patient's disorder. You may even use a combination of two or three methods, first starting out with the least discomforting. 

Following are the different methods:

Imaginal -  In this sort of exposure, a person is instructed to mentally confront a fear or event by visualizing it in their head.

In Vivo - A person is exposed to real-life objects and circumstances when using this sort of exposure.

Virtual Reality - This sort of exposure combines aspects of both imaginal and in vivo exposure to place a person in situations that appear natural but are not.

Interoceptive - This focuses on creating physical responses that people associate with panic or distress.

Your Role as a Therapist 

Let us now discuss what you, like a therapist or a mental health professional, can do for your patients treated with this therapy. As an example case, imagine that you have a patient that is afraid of the water. Maybe it's a phobia that has been there from childhood or due to some past underlying trauma. Your goal is to help the patient work through that fear and reach a point where they can control their reaction to this phobia whenever it comes up. 

A Clear Mindset in the Beginning 

Diving into this therapy, both you and your patient should be clear about one thing. The objective of this therapy is not to expect that the anxiety or fear will go away and never return again. Instead, it is supposed to be thought of as a step-by-step process to eventually become habituated to that situation over time. Habituation implies that eventually, a person may become accustomed to being in that situation. 

It is essential to remind your patient that this fear or anxiety is something they need to accept throughout the process. It shouldn't be treated dismissively or even to say that the person can't be normal with it. Results will come when the work is put in. They can't be rushed. 

For someone with a fear of water, it doesn't mean that they should stop going to public pools, lakes, or out altogether. In fact, you may discuss with your patient all their anxieties and fears about the water in detail, so you have a clear picture of where they are coming from. Keep reminding them that just because they have this fear does not mean they stop living life. 

Promote Learning, the Healing will Follow 

Exposure therapy is deeply rooted in conditioned Learning and learning through experience. The good part is that you, as a therapist, get to control the amount and intensity of the exposure. After detailed sessions with your patient, you should feel equipped to make a lengthy plan of how you can start introducing their fears in their environment. Not everyone will be the same, so the plan is custom-made for each individual. It can start out as Imaginal and then eventually proceed to In Vivo.

Each experience needs to stand out - a patient needs to learn something about themself every time they come in close quarters of these situations. This is an excellent way to introduce multiple variations of the same experiment so that the patient can build experiences in different contexts. If they don't learn, there is no point in repeating the action. This is the basic tenant of behavioral psychology

Patients need to learn to identify these new responses of their mind and body and categorize them as positive. For a person being slowly introduced to bodies of water, they need to retrieve feelings other than trauma. For example, they may remember that the cold water felt nice on a hot day. They felt light or relaxed. They may even remember the sound of waves bobbing up and down, hitting the boundary walls. With each different level of intensity, there needs to be a new thing learned. 

Stay Above Board

Your patient is afraid of water, so you may gravitate towards choosing scenarios that require big enough bodies of water. Since this exposure also requires the patient to become used to other people being in the water with them, there needs to be ample space to move around. It may be a pool from a rec center or a public swimming pool. It is essential to have all authorization from the general organization and from the patient. 

This will require extra work on your part, going through hoops sometimes to simulate real-life scenarios for your patients. This means that their safety needs to be guaranteed to avoid causing further trauma or exacerbate the situation in any other direction. 

Constant Reinforcement is Key 

We are all human, so, naturally, we tend to forget whatever we just learned. Our learned response may be treating us great at the moment, but as soon as we are removed from that situation, all the old feelings come rushing in. As a therapist, you know that the key to progress is consistency. Hence, an excellent way to keep that determination alive is to ensure that your patient shows up and does the work. Motivate them to try out these situations on their own as well. 

Your patient can go sit by the pool a couple of days a week, for an hour, to try to refresh all the responses that they learned with you. This can also promote a speedy recovery.

Celebrate the Little Things

Recovery is a never-ending battle and an uphill one if you really think about it. As you progress, things may sometimes become more challenging as you start to face those fears deep inside of you. Our first response to recovery is through the body and then the mind. Our mind is harder to convince too. Hence, you must allow your patients to celebrate even the smallest of successes in recovery. 

The thing with anxiety disorders or phobias like that with water is that they never really leave. They tend to come back. So there needs to be a different way to gauge success rather than having the patient tell you on a scale of 1 to 10 how scared are they now. That is not a good measure of recovery. 

We aren't here for fear reduction because that is simply not realistic. Instead, the goal is fear control. Patients learn to control how they respond to anxiety-inducing situations. Those are the things that need to celebrate. To keep track of their own personal wins, you can recommend your patients to keep an online daily journal where they can write down their progress. Journaling on line is more effortless since you can get to it no matter where you are. 

Exposure therapy, if done right, can bring wonders to your practice and your patients. There are courses you can take to become certified in this method of treatment. It will help you further your desire to really help people live better lives. 

Health Disclaimer

JournalOwl is not intended to be a substitute for professional advice, diagnosis, medical treatment, medication, or therapy. Always seek the advice of your physician or qualified mental health provider with any questions you may have regarding any mental health symptoms or conditions. JournalOwl is not authorized to make recommendations about medication or serve as a substitute for professional advice. You should never disregard professional psychological or medical advice, or delay in seeking treatment, based on anything you read on JournalOwl’s website or platform.

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