The 4 Types of Exposure Therapy

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.