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Mental Health Wiki > Anxiety disorders > Psychological treatments for anxiety disorders > Behaviour therapy (exposure therapy)
Behaviour therapy (exposure therapy)From $1Table of contents
What is behaviour therapy?Behaviour therapy for anxiety disorders mainly relies on a treatment called Exposure. There are a number of different approaches to exposure therapy. However, they are all based on exposing the person to the things that make them anxious. These approaches include: In Vivo ExposureThis involves confronting the feared situation, usually in a gradual way. In vivo means in real life. The treatment usually lasts a number of hours. It can be completed in one long session or across multiple sessions. This treatment might also include being exposed to body sensations of anxiety (like giddiness or shortness of breath). Applied muscle tension is a treatment of this type used for phobias of blood, injection or injury. Virtual Reality ExposureVirtual reality exposure uses a computer program to create the feared situation. It is often used for fears that are difficult to confront in real life, such as fears of flying or heights. Systematic DesensitizationThis involves gradually exposing the person to fearful mental images and thoughts or to actual situations, while the person has relaxed using relaxation training. The exposure starts with situations that produce mild fears and works up to the most fearful. Flooding (also called Implosion).This involves intensive rather than gradual exposure to the situations the person fears. The exposure can be in real life or using mental images. How is it meant to work?Anxiety problems often persist because the person avoids fearful situations. Avoiding these situations means that the person does not have the opportunity to learn that they can cope with the fear. The person needs to learn that their fear will reduce without the need to avoid or escape the situation and that their fears about the situation often do not come true or are not as bad as they thought. Does it work?There are different types of exposure treatments that are specifically designed for different types of anxiety problems. GADThere is no evidence on whether behaviour therapy works for GAD. PTSD and ASDPTSD is often treated using an approach called prolonged exposure, which uses exposure in real life or in imagination to help the person confront memories of their traumatic experiences. There is strong support for this approach across a number of well designed studies. Social PhobiaExposure treatment for social phobia is generally done in groups, where the person has the opportunity to expose themselves to difficult situations like meeting new people or public speaking. A number of studies have found that group exposure treatments for social phobia do work, although one study has found that CBT is more effective. Panic Disorder and AgoraphobiaExposure to body sensations of anxiety has been tested in one study and found to be more helpful than no treatment for panic disorder. In vivo and virtual reality exposure have also been found to be effective in a small number of studies. Panic disorder can also be treated by a type of exposure therapy called applied relaxation, which is similar to systematic desensitisation. One study compared applied relaxation to CBT and found that both produced strong improvements. Specific PhobiasThere is strong evidence that in vivo exposure and virtual reality exposure work for specific phobias. Indeed, exposure is one of the best treatments available for these problems. OCDOCD is treated with a type of exposure called exposure and response prevention. This involves exposing the person to anxiety producing thoughts or situations and then preventing them from using rituals or compulsions to reduce the anxiety. For example, a person might be asked to get dirt on their hands and then not wash them, even though they are worried about being infected. There is strong evidence from a number of good quality studies that this approach works. Are there any risks?Confronting fearful situations can be extremely distressing and is best done with the support of a professional. If exposure is not done carefully it can make a person’s anxiety worse. RecommendationThere is strong evidence that behaviour (exposure) therapies work for PTSD, OCD and specific phobias. There is moderate support that they work with social phobia, panic disorder and agoraphobia. ReferencesAbramowitz JS. Effectiveness of psychological and pharmacological treatments for obsessive-compulsive disorder: A quantitative review. Journal of Consulting and Clinical Psychology 1997; 65:44-52.
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