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Common Myths About Exposure Therapy for Anxiety

Facing your fears gradually.

Key points

  • Behavioral therapy addresses anxiety by slowly confronting triggers.
  • Exposure therapy should be done in collaboration with a mental health professional.
  • Family members or friends should never introduce situations to make someone "get over" their anxiety.

In trying to address the myth that cognitive behavioral therapy only focuses on thoughts (it doesn’t), I have been describing different parts of behavioral therapy. Cognitive behavioral therapy focuses on how people think but also on what people do (their behavior). In this post, I will talk about exposure therapy, including some common myths about this treatment.

First, exposure therapy is used primarily to treat anxiety disorders. These disorders include social anxiety, generalized anxiety disorder and related disorders such as post-traumatic stress disorder and obsessive-compulsive disorder. Exposure therapy usually involves developing something called a hierarchy. A hierarchy is a list of situations that provoke anxiety, ordered from lowest anxiety to highest anxiety level and is specific to each client. The idea is to have the client start experiencing the lower levels first before progressing to the higher levels. This has several benefits. Clients develop a sense of mastery and accomplishment as they successfully go through each level. Clients also learn how to cope with anxiety as well as cope with each situation.

Now, exposure therapy can also help a client challenge negative thoughts. By gaining new experience, they gather evidence that they can cope with what they previously feared. This new evidence can help them counteract previous negative thoughts and come to believe more realistic thoughts.

I would like to address some common myths I have come across related to exposure therapy. The most harmful myth is that because exposure therapy has been shown to be effective in research studies, all people with anxiety need to do is just face their fears. I have seen this lead to some heartbreaking behavior from friends and relatives of people with anxiety and some of this behavior could constitute abuse. For example, many people with anxiety are afraid of going out by themselves. I have seen cases where family or friends took the person with anxiety to a public place and then abandoned them there so they could “learn to get over their anxiety.” I have also seen family and friends surprise a person with anxiety with what they feared, such as taking a person afraid of heights to a high place without telling them or having a surprise party for someone with social anxiety. While these situations involve a person being surprised by something they fear without agreeing, similar situations can involve a person technically agreeing but only after extreme pressure from family or friends. For example, someone may agree to attend a family reunion with a family member who sexually harassed them but only after other family members told them to “get over it”, “move on” and “focus on forgiveness”. In this case, the person who was harassed is forced to re-experience the trauma but not in a way to which they fully and freely agreed. Please do not do anything like this. It can actually have the opposite effect and make the person’s anxiety worse.

Image by Sawan Juggessur from Pixabay
Source: Image by Sawan Juggessur from Pixabay

Exposure therapy always needs to be conducted with a licensed, experienced mental health professional. A big difference between true exposure therapy and the situations described in the previous paragraph is the consent of the client. Clients are not subjected to a feared situation if they do not agree to it in therapy; the situations in the previous paragraph involve a client being forced into a situation they did not agree to experience. Therapists trained in exposure therapy are acutely aware of always making sure the client is in control and not pressured into anything. Another key difference is the type of activities. In exposure therapy, the client starts with easy situations before progressing to harder situations. The examples in the previous paragraph involve forcing someone to face anxiety that they are not yet ready to face.

I have also come across the myth that exposure therapy is fast. While exposure therapy can sometimes improve anxiety in a few weeks to months, that is not always the case. Exposure therapy for specific phobias, that focus on anxiety related to particular animals or locations, for example, can progress faster than treatment for other anxiety disorders. But each client is different and some clients need more time on certain parts of the hierarchy. While exposure therapy is a key, effective part of cognitive behavioral therapy, it should always be conducted with a licensed mental health provider.

To find a therapist, please visit the Psychology Today Therapy Directory.

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