What is exposure therapy?
Exposure literally means ‘exposure’. Exposure therapy is a form of cognitive behavioral therapy in which you are confronted with what you are afraid of and what you would prefer to avoid.
Theory behind exposure therapy
Avoiding something you are afraid of is very understandable. In the short term, this makes you feel less anxious, but in the long term, the fear persists and sometimes even increases. In exposure therapy, you do not avoid the fear, but rather expose yourself to it. Often this exposure happens gradually, and sometimes you work directly on your biggest fear.
The goal of this exposure is that the anxiety and tension will gradually decrease. You learn to get used to triggers that evoke tension. As a result, the anxiety that arises from these triggers (such as situations, scents, colors, people, or memories) can start to extinguish. You also learn to think differently, which can also help reduce anxiety symptoms.
Exposure treatments can be divided into two groups, with a different approach:
- Imaginary exposure, also known as in vitro exposure (in thought)
- Exposure in vivo (in reality)
How did exposure therapy originate?
The founder of exposure therapy was the South African psychiatrist Joseph Wolpe. In the 1950s, he developed the technique of systematic desensitization. In this process, people with phobias were gradually exposed to triggers that provoked anxiety, while simultaneously learning relaxation techniques.
In the 1970s, American psychologist Arnold Lazarus developed the technique of direct exposure.
Trauma processing technique
In the 1980s, the theory of ‘emotional processing’ was developed by Foa and Kozak to apply exposure techniques in the treatment of trauma.
In the Netherlands, Agnes van Minnen in particular has put imaginal exposure on the map as a trauma processing technique.
How does exposure therapy work?
Imaginary exposure
Imaginary exposure is a widely used trauma processing technique that is also called ‘prolonged exposure.’ With imaginary exposure, you are once again exposed to a memory in your thoughts. You are asked to recount the unpleasant past experience in great detail, and subsequently, this is repeated over and over, with the emphasis increasingly placed on the most distressing moments.
The ultimate goal of imaginal exposure is to reduce fear and to correct any incorrect or negative thoughts about the event.
In vivo exposure
Exposure in vivo can be used for more types of problems, not just trauma-related ones. It is applied when you experience a lot of anxiety that the unpleasant event from back then will happen again in the present.
In vivo exposure involves actually practicing with things that evoke anxiety yourself. You are gradually exposed to triggers in the present, for example, with a certain scent, sound, or location. The goal is to experience that the feared disaster from the past no longer occurs in the present, so that the anxiety and the need for avoidance will decrease.
For which symptoms is exposure therapy used?
Exposure can be helpful with:
- Anxiety and phobias
- Avoiding and evading what you are afraid of
- Flashbacks
- Worrying
- Panic symptoms
- Nightmares
- Obsessive thoughts
Due to these symptoms, you may experience a lot of physical tension.
Where can I undergo exposure therapy?
Exposure therapy can be found at many different institutions and therapists in the Netherlands. It is a commonly used method. There is no overarching overview, so you will have to search for it yourself.
Some organizations also offer Virtual Reality (VR) treatment; exposure with VR goggles and headphones.
Where can I find more information about exposure therapy?
Reading tips
- Trauma and Processing Techniques – Martijn Stöfsel
- Exposure manual – Arnold van Emmerik and Anja Greeven
- Overcome your fears with exposure therapy – article on psycholoog.nl
Viewing recommendations
Watch tip
Exposure therapy explained
Video by VGCt
In collaboration with
Martijn Stöfsel
Clinical psychologist/psychotherapist, NtVP psychotrauma therapist and supervisor VGCt and schema therapy. Martijn works in his own psychotherapy and education practice Stöfsel, Psychotherapy & Coaching and teaches at various continuing education institutes.
