Millicent has been teaching at the university level since 2004. She holds a Bachelor's degree in Criminal Justice and a Master's degree in Human Resources.
Phobia and Exposure Therapy
Kathleen is deathly afraid of clowns. This irrational fear, or phobia, of clowns is referred to as coulrophobia. Scientists believe that this fear arises from not knowing who exactly can be found behind the disguises clowns wear. The fear was becoming so debilitating for Kathleen that she started having panic attacks whenever a clown was in her presence. After discussing this issue with her counselor, a decision was made to slowly engage Kathleen in exposure therapy exercises in an effort to calm her fear of clowns and allow her to function normally when she encountered them.
Exposure therapy is a type of cognitive-behavioral therapy (CBT) which primarily focuses on a collaborative relationship between the patient and therapist, using the Socratic method in a structured environment. Exposure therapy sounds just like what it means: the patient will be exposed to the circumstance he or she is fearful of. The therapist and the patient decide together on a plan of action and level of exposure, and the patient is never forced to engage in an activity he is fearful or anxious about.
Effective therapists ensure that all the patient's questions about the exposure are answered, and attempts to ensure a certain level of comfort for the patient prior to he or she engaging in the event.
Who Benefits from Exposure Therapy?
Exposure therapy is a therapy technique that is often used with people who suffer from anxiety-induced conditions such as those created by:
- Phobias - the exhibition of exaggerated fears towards specific stimuli. For example, someone can have a fear of clowns, spiders, snakes, or anything else that doesn't quite make sense for the level of fear it creates. Kathleen's fear of clowns discussed at the beginning of this lesson would fall into the phobias category.
- Post-traumatic stress disorder (PTSD) - an extreme reaction resulting from exposure to a traumatic event or series of events. A soldier who sees his fellow troops killed during active duty might be prone to developing PTSD.
- Panic disorder - fear and physical responses to fear that arises when no real reason to perceive danger is present. Someone with panic disorder experiences extreme physical symptoms to stimuli such as rapid heartbeat and labored breathing.
- Obsessive compulsive disorder - repeatedly engaging in the same behaviors in an endless cycle. An example of OCD can include constantly washing one's hands, so much so that they become raw and damaged.
- Social anxiety disorder - fearing social interactions and social settings where it is required to engage with others. An example of social anxiety would be avoiding malls due to the amount of people present.
- Generalized anxiety disorder - excessively worrying about everyday life. Someone with generalized anxiety disorder may worry needlessly about traffic conditions, the weather, etc.
Types of Exposure Therapy
There are four different types of exposure therapy. These include:
- In Vivo Exposure - this involves having the patient directly confront their fear. For someone with a phobia of spiders, this could involve having them touch a spider, or for someone who has panic attacks in crowded areas, this may involve having them spend time in these areas.
- Imaginal Exposure - using the imagination to recreate and face the feared event or circumstance. For example, someone with social anxiety disorder might be asked to imagine themselves at a large party with lots of people and describe their mental and physical reactions to this imagined event.
- Virtual Reality Exposure - this would involve using technology to place the person into the feared circumstance. For example, someone who fears flying might be placed into a simulation type of virtual environment where they feel as though they are on an actual airplane.
- Interoceptive Exposure - bringing on sensations that are feared on purpose by making the person engage in an activity that brings on the symptoms. For example, someone who hates to be in crowded places and experiences rapid heartbeat while being there, might be instructed to run on a treadmill and experience this rapid heartbeat under controlled conditions.
Levels of Exposure Therapy
As there are different types of exposure therapy, there are also different levels of exposure therapy which include:
- Gradual exposure - slowly introducing the feared event or circumstance and gradually increasing the exposure.
- Flooding - immediately having the person face the most intense fear and gradually working backwards.
- Systematic desensitization - combining exposure therapy with relaxation techniques to alleviate some of the physical symptoms brought on by the exposure.
Exposure therapy is used to expose someone to fears that have a debilitating effect. A type of cognitive-behavioral therapy, exposure therapy emphasizes a collaborative approach between therapist and patient. This type of therapy is especially effective with patients who suffer from anxiety-provoking conditions such as phobias, PTSD, and panic disorder.
There are four different types of exposure therapy that are commonly used. These include in vivo exposure, imaginal exposure, virtual realty exposure, and interoceptive exposure. In addition to these types, there are also different levels of exposure therapy such as gradual exposure, flooding, and systematic desensitization.
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