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Justin K. Hughes, Licensed Professional Counselor: Dallas CBT and Exposure Therapy for OCD, Anxiety, Addictions & More
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Justin's Blog

The 4 Types of Exposure Therapy

1/30/2019

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In Vivo Exposure
Directly facing feared objects or situations, examples include:


Getting on a flight, touching a doorknob that feels “contaminated,” not going back to check a lock, or going to a social gathering.


Good exposure attempts to match the content and detail of a person's fear as close as possible. So, for example, if a person fears “going crazy” in a social setting, the best exercise will be working up to facing that, not just exposing to the thought or word. On the other hand, if the fear is that a person will have inappropriate impulses (to harm, sexually, etc.), sitting with the intrusive thought and being present will serve best.

Imaginal Exposure

Imaginal exposure involves accessing the content of fears and anxieties through cognitive means. For example, a fear that someone will fail, make the wrong decision, harm someone, die, or choose the wrong relationship are not accessed by activating these life occurrences. They are addressed imaginally.

There are many ways to practice Exposure imaginally, but the most common are writing scripts, stories, listening to recordings, watching videos, or using visualization.

To be clear, Imaginal exposure often is the most confusing and hardest to grasp of exposure practices, as it seems to be creating negative thoughts or “bringing” unrealistic and negative thoughts on- the seeming antithesis of most of psychology and cognitive therapy. But what is really done here is only facing what a person is already experiencing, thinking and feeling.

Interoceptive Exposure

Intentionally bringing up physical sensations that are feared, such as:

Heart racing, shortness of breath, sweaty palms.


​Ways to do this when a person's health allows are breathing through a cocktail straw, breathing rapidly, or sitting up quickly.


Virtual Reality (VR) Exposure
With the advent of new technology, we have a recently emerging type of exposure.  Some may class Virtual Reality into imaginal exposure, but it can be seen as a cross between in vivo (situational) and imaginal.  This is especially helpful with treating disorders such as Flying Phobia, where the access to an actual plane and flight to practice can be cost-prohibitive and difficult.
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What Is Exposure Therapy & How Do You Do It?

1/30/2019

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What is Exposure Therapy?
Exposure therapy is a psychological treatment that is practiced in Behavioral and Cognitive Behavioral Therapy (CBT).  It is indicated as a first line treatment for a number of disorders such as

  • Panic
  • PTSD
  • BDD
  • GAD
  • Even recent evidence for depression
It is considered the “gold standard,” or best treatment for
  • Phobias
  • OCD
  • Social Anxiety (some types)
A very natural tendency occurs when we experience fear- to avoid, neutralize, and suppress fearful thoughts and experiences.  However, such responses tend to reinforce fear when not responding in-context to an an actual immediate threat.
Exposure therapy helps clients to systematically confront fearful stimuli along with changing fearful responses.  This relearning increases confidence and decreases disruption in life. Over time, discomfort and fear typically decreases through active engagement rather than avoidance, suppression, neutralization, or ritualization.
The evidence base is very strong for its use and effectiveness, though it is currently only applied a minority of the time in clinical settings.

How Do You Do Exposure Therapy?
The principles of exposure may be simple, but the specifics- personalized to any one individual- involve many working parts.  
Assessment
  • When diagnosed through functional assessment with a problem that exposure can help (think, OCD and phobias, not addictions and ADHD), treatment then begins the planning phase.
  • Don’t underestimate the necessary time to have a good plan!  
Education
  • Education on the function of the problem and how treatment works
Planning
  • Tracking/Monitoring- catching the key ways the problem exists
  • Core Fears- recognizing what core fears are to be tested through exposure
  • SUDS scale use (and Urge / Willingness)
  • Hierarchy- developing a list
  • Targets- prioritization and commitments
  • Goals/Values
Exposure
  • Exercises- the formal practice of exposure
  • Review and incorporation of learning
Cognitive Therapy
  • As needed, identifying unrealistic/false  beliefs and replacing these to varying degrees is usually helpful
  • However, without confronting fears “talk therapy” in a traditional sense may not be helpful
Adjunct supports
  • ACT (Acceptance and Commitment Therapy)
  • MI (Motivational Interviewing)
  • Mindfulness
  • DBT (Dialectical Behavior Therapy)
  • Family Therapy
  • Monitoring for detours, treating first priority concerns first
Relapse prevention and long-term recovery

  • Setting realistic expectations and planning for long term success
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    The Jog:

    A Psychotherapists' thoughts on healthy living.  

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    Disclaimer:

    All Content on this Site, justinkhughes.com, was created for informational purposes only. Content is not intended as a substitute for professional advice, treatment, or diagnosis.  Always seek the advice of your own personal health provider who is qualified to treat you, along with asking them any questions you may have regarding medical or other conditions. Never disregard professional medical advice or delay in seeking it because of something you have viewed on justinkhughes.com. Also, due to the sensitive nature of topics and material covered through this Site, which contains very descriptive and/or advanced content, you may not want to use justinkhughes.com. The Site and its Content are provided on an "as is" basis.  Some posts are written for specific populations (OCD, Christians, Professionals)- with the intent to remain respectful to all- some content may not fit or go counter to your beliefs, perspectives, and what is explored for you in a professional counseling session with Justin K. Hughes, MA, LPC.  The posts are intended solely for the population they are written to and can be designated by their titles and tags.
    Links to external educational content are taken at your own risk. Justin K. Hughes, MA, LPC is not responsible for external content.  

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    Justin K. Hughes, MA, LPC of Dallas Counseling, PLLC participates in the Amazon Services LLC Associates Program.  This means that some links on this site will produce a small commission from Amazon.com and affiliated sites.  I NEVER link products I don't use or clinically find benefit in.  Many of them have been recommended for years inside and outside therapy sessions.  You are under no obligation to purchase any book, product or service recommended on this site.  However, they are provided on this site only educationally and are not meant to be interpreted as treatment or therapy in any way.  I am not responsible for the quality or experience of any items purchased through affiliate links, as they are entities completely separate of myself.  

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​Justin K. Hughes, MA, LPC
Owner, Dallas Counseling, PLLC 

justin@dallascounseling.com
P: 469-490-2002

17330 Preston Road, Suite 102D
Dallas, TX 75252
 
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