Exposure Therapy: Who is it intended to treat? Exposure therapy, considered a form of behavior therapy, is implemented to treat individuals suffering from a range of anxiety and trauma-induced disorders. This technique involves “exposing” the patient in a safe environment, to the feared situations or objects which evoke an irrational amount of fear and avoidance. Eventually through exposure and over time, the association between fear or anxiety and the objectively benign phobic stimulus becomes weakened and the avoidance behavior diminishes (“What is Exposure Therapy?”, 2014). Avoidance is a learned behavior that people typically employ in order to evade potential threatening situations that they find reminiscent of a trauma that they have experienced, in doing so, this helps them to avoid the possibility of repeated traumatic experiences. For most, this avoidance behavior is a response meant to self-preserve which results in an immediate reduction of anxiety, but as the behavior becomes more extreme, the person’s quality of life becomes more negatively impacted (“What is Exposure Therapy?”, 2014).
The concept of avoidance behavior can best be explained by what O.H. Mower referred to as a two-factor theory of learning, in which anxiety is viewed as a conditioned response that is both developed and maintained by respondent and operant learning (Norcross & Prochaska, 2013). Respondent or classical conditioning is the first factor, in which one acquires a sense of fear to a neutral stimulus such as the sound of a bell, because it has been paired with a shock and the resulting reaction of “fear” is identified as anxiety. The previously neutral sound of the bell eventually becomes a conditioned stimulus which will elicit a feeling of fear on the physiological level automatically. The feeling of anxiety will increase exponentially while in the presence of the conditioned sound, however if one escapes or avoids the sound of the bell, the avoidance behavior is immediately reinforced by the reduction of anxiety. The second factor, known as instrumental or operant conditioning, is referred to as such due to it being “instrumental” in the reduction of anxiety (Norcross & Prochaska, 2013). The avoidance response is activated by the classically conditioned anxiety, however the attrition of anxiety results in the reinforcement of the instrumental avoidance. Essentially, avoidance behavior does immediately gratify the person by reducing their anxiety, but in the long-term, the avoidance behavior will intensify and by default so will the feeling of anxiety.
The exposure therapist must take care in assessing the appropriate level of exposure, whether it be in an intense or incremental fashion, and also whether the patient should be asked to use their imagination or actually face their fear in a real situation. One final decision to bear in mind is how often the avoidance response will be prevented, either totally until the anxiety has completely diminished, or partially. Whatever the verdict on those three decisions, it is paramount that the method of exposure be tailored to each individual patient as to ensure that they do not become overwhelmed as this could potentially prove detrimental to the therapeutic process.
A History of Exposure Therapy Exposure therapy was implemented for the first time during what was known as the behavior therapy movement in the 1950’s by James G. Taylor, a South African psychologist. Taylor treated specific phobia and generalized anxiety with a technique he called situational exposure with response prevention, in which he accompanied his patients in an anxiety-provoking situation and prevented their avoidance response. He may have been the first to utilize this method for the treatment of anxiety, but Taylor did not publish most of his case studies so unfortunately the credit went to the researchers who more frequently published their work (Abramowitz, Deacon, & Whiteside,