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Exposure Therapy
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Understanding Exposure THerapy Basics
Exposure Therapy is a type of cognitive behavioral therapy. Depending on the interventions being used and the mental health condition being treated, exposure therapy is sometimes referred to as Prolonged Exposure Therapy and Exposure & Response Prevention Therapy.
Exposure therapies are evidence-based treatments that help individuals confront and reduce the fear associated with traumatic memories, phobias, or triggers. By facing these fears directly, individuals can decrease their sensitivity over time, leading to reduced symptoms and improved quality of life.
Exposure & Response Prevention (ERP)
Used primarily for OCD, this technique involves exposing individuals to their triggers and teaching them to resist the urge to perform a compulsion.
Prolonged Exposure Therapy (PE)
Particularly effective for PTSD, this therapy involves recounting the traumatic event multiple times until the associated anxiety decreases.
Prolonged Exposure Therapy Protocol
Education and Rationale: The first step involves educating the individual about PTSD and the PE therapy process. The therapist explains how avoidance of trauma-related thoughts, feelings, and situations maintains PTSD symptoms. Understanding the rationale behind exposure therapy is crucial for patient engagement and motivation.
Breathing Retraining: This step involves teaching the individual controlled breathing techniques. The goal is to help them manage immediate anxiety and stress responses. Controlled breathing is a skill that can be used throughout the therapy and in other stressful situations.
Creating a Hierarchy of Fears: The therapist works with the individual to create a list of feared situations, thoughts, and memories related to the trauma. These are then organized into a hierarchy, starting from least to most distressing. This hierarchy guides the exposure exercises.
In Vivo Exposure: In vivo exposure involves gradually confronting real-world situations that are safe but have been avoided because they are trauma-related or trigger PTSD symptoms. The individual is encouraged to engage with these situations according to the hierarchy, starting with less challenging ones and progressively moving to more difficult ones.
Imaginal Exposure: This step involves repeatedly revisiting and recounting the traumatic memory in the presence of the therapist. The individual is encouraged to describe the traumatic event in detail, including their thoughts, feelings, and sensory information. This helps in processing the trauma and reducing its emotional impact.
Processing the Exposure: After each imaginal exposure, the therapist and individual discuss the experience. This processing phase is crucial as it helps the individual understand their reactions and challenge any unhelpful beliefs about the trauma. It also reinforces the learning that occurs during exposure.
Homework Assignments: Homework is an integral part of PE therapy. Individuals are often asked to listen to recordings of their imaginal exposure sessions and to practice in vivo exposures between sessions. This helps to reinforce the skills learned in therapy and accelerates progress.
Regular Review and Assessment: Throughout the therapy, the therapist regularly reviews the individual’s progress. This includes assessing changes in PTSD symptoms and discussing any difficulties encountered during the exposures. Adjustments to the treatment plan are made as needed.
Relapse Prevention and Conclusion: The final phase of PE therapy focuses on maintaining gains, managing any future symptoms, and preventing relapse. The therapist helps the individual develop a plan to continue using the skills learned in therapy and to cope with potential future stressors or trauma reminders.
Prolonged Exposure therapy typically spans over a period of about 8-15 sessions, though this can vary depending on individual needs.
Exposure & Response Prevention Protocol
Assessment and Education: The first step involves a detailed assessment of the individual’s specific obsessions and compulsions. The therapist educates the individual about OCD and the principles of ERP, explaining how avoidance and compulsive behaviors reinforce OCD symptoms.
Identifying Triggers and Compulsions: The therapist works with the individual to identify specific triggers (thoughts, images, objects, situations) that provoke their OCD symptoms and the compulsive behaviors they engage in as a response.
Developing a Hierarchy of Triggers: Together, the therapist and the individual create a hierarchy or list of these triggers, ranking them from least to most anxiety-provoking. This hierarchy is used to guide the exposure exercises in a gradual and controlled manner.
Exposure Exercises: The individual is gradually exposed to their triggers, starting with the least anxiety-provoking and moving towards more challenging ones. These exposures can be in vivo (directly facing real-life situations) or imaginal (vividly imagining the feared scenario).
Response Prevention: Alongside exposure, the individual is taught and encouraged to resist performing their usual compulsive behaviors. The goal is to learn that they can tolerate the anxiety and distress without resorting to compulsions, and that anxiety naturally decreases over time.
Processing the Experience: After each exposure exercise, the therapist helps the individual process the experience, discussing the anxiety levels experienced and the thoughts and feelings that emerged. This helps in understanding and restructuring any maladaptive beliefs related to the obsessions.
Homework Assignments: ERP therapy involves regular homework assignments where the individual practices the exposure exercises and response prevention techniques outside of therapy sessions. This is crucial for the success of ERP, as it allows for more frequent practice and generalization of skills to everyday life.
Regular Review and Adjustment: The therapist regularly reviews the individual’s progress, including any difficulties encountered during the exercises. The treatment plan is adjusted as needed, based on the individual’s progress and tolerance of the exposures.
Relapse Prevention and Maintenance: Towards the end of therapy, focus shifts to maintaining the gains achieved, preventing relapse, and managing any future symptoms. The individual is equipped with strategies to cope with potential future triggers and to continue practicing the skills learned in therapy.
ERP is typically conducted over a period of several weeks to months, depending on the individual’s needs. It’s important to note that ERP can be challenging, as it requires facing significant anxiety. Therefore, it should be conducted under the guidance of a trained specialist.
Exposure Therapy Skills
Exposure Therapy for Generalized Anxiety
Interoceptive Exposure: Clients are exposed to bodily sensations associated with panic or anxiety.
Worry Outcome Exposure: Clients are asked to imagine the worst-case scenarios of their worries and then analyze the likelihood and potential coping strategies.
Exposure Therapy for Specific Phobias
Systematic Desensitization: Clients are taught relaxation techniques and then exposed to the phobic stimulus in a stepwise manner, starting from the least fear-inducing to the most.
In Vivo Exposure: Direct real-life exposure to the feared object or situation
Virtual Reality Exposure Therapy
Utilizing virtual reality technology, clients are immersed in a computer-generated environment where they can confront and process their fears in a controlled setting. This method is especially beneficial for individuals who might find real-world exposure challenging or impractical.
Principles & Benefits of Exposure Therapy
The core principle behind exposure therapies is the systematic and gradual exposure to feared stimuli. This exposure helps individuals realize that their fears are often irrational, and over time, the anxiety associated with these fears diminishes.
The Benefits of Exposure Therapy Include:
- Directly addresses specific phobias or traumatic memories.
- Provides tools and strategies to confront and manage fears.
- Exposure Therapy is supported by numerous research studies showcasing its effectiveness.
What Clients Can Expect in Exposure Therapy
During exposure therapy, clients can expect:
Assessment: The therapist will begin by understanding the nature of the client’s fear or anxiety.
Hierarchy of Fears: Together with the therapist, the client will create a list of feared situations, ranking them from least to most anxiety-provoking.
Gradual Exposure: The client will be gradually and systematically exposed to the feared situations, starting with the least anxiety-inducing and moving up the hierarchy.
Support: Throughout the process, the therapist will provide guidance, support, and tools to help the client manage their anxiety during exposure.
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Rebecca Sidoti, LCSW
Owner & Therapist
Ketamine Provider
VR Therapist
OCD & Anxiety Expert
VR Therapist
OCD & Anxiety Expert
Marilyn DeFalco
Licensed Clinical Social Worker
Expert in:
Trauma & PTSD
Stress & Depression
Trauma & PTSD
Stress & Depression
Kristin Justice
Licensed Associate Counselor
Expert in:
Grief & Loss
Stress & Adjustments
Grief & Loss
Stress & Adjustments
Alicia Alarco-Hernandez
Social Work Intern
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609-300-6481
609-300-6481
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Frequently Asked Questions
about Online Therapy in New Jersey
How do I get started as a new client?
Do you offer traditional talk therapy?
of course! though we have some unconventional therapy approaches, we are rooted in evidenced based practices. Talk therapy is a major player in the therapy room! See What we Treat and Integrative Services for more information
Does my insurance cover my visits?
Uur goal it to decrease stress and anxiety, so we understand that the financial commitment to therapy is something to consider! We provide OON billing for clients who decide to bill their insurance for services. A “Superbill” can be provided to you for potential reimbursement of services. To know if you have to OON benefits, you can call your insurance company and ask about the process of receiving these benefits.
Our Insurance Page shares a small blurb about Why We Left Insurance Panels
What is the difference between associate therapists & fully licensed therapists?
See our “Affordable Therapy” Page for info on licensing and costs of therapy.
LAC/LSW are therapists who may practice clinical work under the supervision of a fully licensed therapist.
LPC/LCSW are therapists who have completed the necessary clinical hours post-graduation under supervision and can practice clinical work independently.
What is your cancellation policy?
We ask that clients provide at least 24 hours notice in the event that they need to cancel to avoid the 50% cancellation fee. we understand that life happens and do our best to be flexible & reschedule.
What is Virtual Reality Therapy (VRT)?
VRT is an immersive tool that helps clients to explore environments that can not be traditionally explored in therapy. Visit our VR page for more info and to watch our infomercial
What is VRT used for?
we use VRT to support Exposure Therapy, a long standing traditional therapy modality to treat phobias, anxiety and stress. we send a headset directly to your home so you can access VRT from anywhere.
VRT not only helps with exposure therapy for phobias, but is great for ADHD, mindfulness, PTSD and social anxiety.
How does the process work?
- Fill out a consult request below or reach out to us directly.
- our phone number is 609-300-6481, call or text
- MBD will respond within 24 business hours
- You will get access to the patient portal to complete the intake paperwork
- Once the paperwork is submitted and reviewed we confirm your intake appointment
- Prior to your intake, you will receive a link to access the telehealth session.
Do You Offer Free or Reduced Therapy?
Yes! We offer a sliding scale as well as reduced fee therapy for clients working with out graduate interns. To learn more visit: Reduced Fee Therapy