Exposure therapy

<h2 id="techniques">Techniques</h2>
Exposure therapy is based on the principle of <a href="/facts/Respondent_conditioning/ddtohoz3">respondent conditioning</a> often termed Pavlovian extinction.<a class="footnote-ref" id="fnref:10" href="#fn:10">10</a> The exposure therapist identifies the cognitions, emotions and physiological arousal that accompany a fear-inducing stimulus and then tries to break the pattern of escape that maintains the fear. This is done by exposing the patient to fear-inducing stimuli.<a class="footnote-ref" id="fnref:11" href="#fn:11">11</a> 
This may be done;

<ul><li>using progressively stronger stimuli. Fear is minimized at each of a series of steadily escalating steps or challenges (a <a href="/facts/Exposure_hierarchy/8dvTJ9LV">hierarchy</a>), which can be explicit ("static") or implicit ("dynamic" — see <a href="/facts/Method_of_Factors/D5sbV73C">Method of Factors</a>) until the fear is finally gone.<a class="footnote-ref" id="fnref:12" href="#fn:12">12</a> The patient is able to terminate the procedure at any time.</li>
<li>using <a href="/facts/Flooding_(psychology)/x9LTwweK">flooding therapy</a>, which exposes the patient to feared stimuli starting at the most feared item in a fear <a href="/facts/Exposure_hierarchy/8dvTJ9LV">hierarchy</a>.<a class="footnote-ref" id="fnref:13" href="#fn:13">13</a><a class="footnote-ref" id="fnref:14" href="#fn:14">14</a></li></ul>
There are several types of exposure procedures. 

<ul><li><a href="/facts/In_vivo/kWcWyl6f">in vivo</a> or "real life."<a class="footnote-ref" id="fnref:15" href="#fn:15">15</a> This type exposes the patient to actual fear-inducing situations. For example, if someone fears public speaking, the person may be asked to give a speech to a small group of people.</li>
<li><a href="/facts/Virtual_reality/0psDGsxT">virtual reality</a>, in which technology is used to simulate in vivo exposure.</li>
<li><a href="/facts/Imagination/FD85g9cD">imaginal</a>, where patients are asked to imagine a situation that they are afraid of. This procedure is helpful for people who need to confront feared thoughts and memories.</li>
<li><a href="/facts/Narrative_exposure_therapy/tp3FQ8F4">written exposure therapy</a>, where patients write down their account of the traumatic event</li>
<li><a href="/facts/Interoceptive/bIdIF1xg">interoceptive</a>, in which patients confront feared bodily symptoms such as increased heart rate and shortness of breath. This may be used for more specific disorders such as <a href="/facts/Panic_disorder/jRfhx14r">panic</a> or <a href="/facts/Post-traumatic_stress_disorder/9etKu7bX">post-traumatic stress disorder</a>.</li></ul>
All types of exposure may be used together or separately.<a class="footnote-ref" id="fnref:16" href="#fn:16">16</a><a class="footnote-ref" id="fnref:17" href="#fn:17">17</a><a class="footnote-ref" id="fnref:18" href="#fn:18">18</a> Discussion continues on how best to carry out exposure therapy, including on whether safety behaviours should be discontinued.<a class="footnote-ref" id="fnref:19" href="#fn:19">19</a><a class="footnote-ref" id="fnref:20" href="#fn:20">20</a>

<h3>Exposure and response prevention (ERP)</h3>
In the exposure and response prevention (ERP or EX/RP) form of exposure therapy, the resolution to refrain from the <a href="/facts/Escape_response/AlgghCqD">escape response</a> is to be maintained at all times (not just during specific practice sessions).<a class="footnote-ref" id="fnref:21" href="#fn:21">21</a> Thus, not only does the subject experience <a href="/facts/Habituation/9junujEp">habituation</a> to the feared stimulus, but they also practice a fear-incompatible behavioral response to the stimulus. The distinctive feature is that individuals confront their fears and discontinue their escape response.<a class="footnote-ref" id="fnref:22" href="#fn:22">22</a>
While this type of therapy typically causes some short-term anxiety, this facilitates long-term reduction in obsessive and compulsive symptoms.<a class="footnote-ref" id="fnref:23" href="#fn:23">23</a><a class="footnote-ref" id="fnref:24" href="#fn:24">24</a>: 103 <a class="footnote-ref" id="fnref:25" href="#fn:25">25</a> 
The American Psychiatric Association recommends ERP for the treatment of <a href="/facts/OCD/bIhDh4dz">OCD</a>, citing that ERP has the richest empirical support.<a class="footnote-ref" id="fnref:26" href="#fn:26">26</a> As of 2019, ERP is considered a first-line psychotherapy for OCD.<a class="footnote-ref" id="fnref:27" href="#fn:27">27</a><a class="footnote-ref" id="fnref:28" href="#fn:28">28</a> A 2024 systematic review found that ERP is highly effective in treating pediatric OCD using both in-person and telehealth-based modailites.<a class="footnote-ref" id="fnref:29" href="#fn:29">29</a>
Effectiveness is heterogeneous. Higher efficacy correlates with lower avoidance behaviours, and greater adherence to homework. Using <a href="/facts/SSRI/L6jjcmEH">SSRI</a> meds whilst doing ERP does not appear to correlate with better outcomes.<a class="footnote-ref" id="fnref:30" href="#fn:30">30</a><a class="footnote-ref" id="fnref:31" href="#fn:31">31</a><a class="footnote-ref" id="fnref:32" href="#fn:32">32</a> Discussion continues on how to best conduct ERP.<a class="footnote-ref" id="fnref:33" href="#fn:33">33</a>
Generally, ERP incorporates a <a href="/facts/Relapse_prevention/7MLfuKjj">relapse prevention</a> plan toward the end of the course of therapy.<a class="footnote-ref" id="fnref:34" href="#fn:34">34</a> This can include being ready to re-apply ERP if an anxiety does occur.<a class="footnote-ref" id="fnref:35" href="#fn:35">35</a>

<h2 id="mechanism">Mechanism</h2>
Mechanism research has been limited in the field.<a class="footnote-ref" id="fnref:36" href="#fn:36">36</a>
<a href="/facts/Habituation/9junujEp">Habituation</a> was seen as a mechanism in the past, but is seen more recently as a model of therapeutic process.<a class="footnote-ref" id="fnref:37" href="#fn:37">37</a>

<h3>Inhibitory learning</h3>
As of 2022, the inhibitory learning model is the most common conjecture of the mechanism which causes exposure therapy efficacy. This model posits that in exposure therapy the unpleasant reactions such as anxiety (that were previously learned during fear conditioning) remain intact - they are not expected to be eliminated - but that they are now inhibited or balanced or overcome by new learning about the situation (for instance that the feared result will not necessarily happen).<a class="footnote-ref" id="fnref:38" href="#fn:38">38</a><a class="footnote-ref" id="fnref:39" href="#fn:39">39</a><a class="footnote-ref" id="fnref:40" href="#fn:40">40</a><a class="footnote-ref" id="fnref:41" href="#fn:41">41</a> More research is needed.<a class="footnote-ref" id="fnref:42" href="#fn:42">42</a>

<h3>Inhibitory retrieval</h3>
This model posits that additional associative learning processes, such as counterconditioning and novelty-enhanced extinction may contribute to exposure therapy.<a class="footnote-ref" id="fnref:43" href="#fn:43">43</a><a class="footnote-ref" id="fnref:44" href="#fn:44">44</a>

<h2 id="under-use-and-barriers-to-use">Under-use and barriers to use</h2>
Exposure therapy is seen as under-used in relation to its efficacy.<a class="footnote-ref" id="fnref:45" href="#fn:45">45</a> Barriers to use of exposure therapy by psychologists include it appearing antithetical to mainline psychology,<a class="footnote-ref" id="fnref:46" href="#fn:46">46</a> lack of confidence, and negative beliefs about exposure therapy.<a class="footnote-ref" id="fnref:47" href="#fn:47">47</a>

<h2 id="uses">Uses</h2>
<h3>Phobia</h3>
Exposure therapy is the most successful known treatment for phobias.<a class="footnote-ref" id="fnref:48" href="#fn:48">48</a> Several published meta-analyses included studies of one-to-three-hour single-session treatments of phobias, using imaginal exposure. At a post-treatment follow-up four years later 90% of people retained a considerable reduction in fear, avoidance, and overall level of impairment, while 65% no longer experienced any symptoms of a specific phobia.<a class="footnote-ref" id="fnref:49" href="#fn:49">49</a>
<a href="/facts/Agoraphobia/l56SJ75n">Agoraphobia</a> and <a href="/facts/Social_anxiety_disorder/25XIzJ0o">social anxiety disorder</a> are examples of phobias that have been successfully treated by exposure therapy.<a class="footnote-ref" id="fnref:50" href="#fn:50">50</a>

<h3>Post-traumatic stress disorder</h3>
Exposure therapy in <a href="/facts/Post-traumatic_stress_disorder/9etKu7bX">PTSD</a> involves exposing the patient to PTSD-anxiety triggering stimuli, with the aim of weakening the neural connections between triggers and trauma memories (a.k.a. <a href="/facts/Desensitization_(psychology)/s394oh6R">desensitisation</a>). Exposure may involve:<a class="footnote-ref" id="fnref:51" href="#fn:51">51</a>

<ul><li>a real-life trigger ("in vivo")</li>
<li>an imagined trigger ("imaginal")</li>
<li><a href="/facts/Virtual_reality_exposure_therapy/5Sx0HjJc">Virtual reality exposure</a></li>
<li>a triggered feeling generated in a physical way ("interoceptive")<a class="footnote-ref" id="fnref:52" href="#fn:52">52</a></li></ul>
Forms include:

<ul><li><a href="/facts/Flooding_(psychology)/x9LTwweK">Flooding</a> – exposing the patient directly to a triggering stimulus, while simultaneously making them not feel afraid.</li>
<li><a href="/facts/Systematic_desensitisation/WpsjsFTL">Systematic desensitisation</a> (a.k.a. "graduated exposure") – gradually exposing the patient to increasingly vivid experiences that are related to the trauma, but do not trigger post-traumatic stress.</li>
<li><a href="/facts/Narrative_exposure_therapy/tp3FQ8F4">Narrative exposure therapy</a> - creates a written account of the traumatic experiences of a patient or group of patients, in a way that serves to recapture their self-respect and acknowledges their value. Under this name it is used mainly with refugees, in groups.<a class="footnote-ref" id="fnref:53" href="#fn:53">53</a> It also forms an important part of <a href="/facts/Cognitive_processing_therapy/YgPXfprs">cognitive processing therapy</a> and is conditionally recommended for treatment of PTSD by the <a href="/facts/American_Psychological_Association/907fEfuc">American Psychological Association</a>.<a class="footnote-ref" id="fnref:54" href="#fn:54">54</a></li>
<li><a href="/facts/Prolonged_exposure_therapy/Qa2g4A09">Prolonged exposure therapy</a> (PE) - a form of <a href="/facts/Behavior_therapy/2N1n5BKp">behavior therapy</a> and <a href="/facts/Cognitive_behavioral_therapy/LRALDkkU">cognitive behavioral therapy</a> designed to treat <a href="/facts/Post-traumatic_stress_disorder/9etKu7bX">post-traumatic stress disorder</a>, characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is a repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous (despite being objectively safe). Additional procedures include processing of the trauma memory and breathing retraining. The <a href="/facts/American_Psychological_Association/907fEfuc">American Psychological Association</a> strongly recommends PE as a first-line psychotherapy treatment for PTSD.<a class="footnote-ref" id="fnref:55" href="#fn:55">55</a></li></ul>
Researchers began experimenting with <a href="/facts/Virtual_reality_therapy/5Sx0HjJc">Virtual reality exposure (VRE) therapy</a> in PTSD exposure therapy in 1997 with the advent of the "Virtual Vietnam" scenario. Virtual Vietnam was used as a graduated exposure therapy treatment for Vietnam veterans meeting the qualification criteria for PTSD. A 50-year-old Caucasian male was the first veteran studied. The preliminary results concluded improvement post-treatment across all measures of PTSD and maintenance of the gains at the six-month follow up. Subsequent open clinical trial of Virtual Vietnam using 16 veterans, showed a reduction in PTSD symptoms.<a class="footnote-ref" id="fnref:56" href="#fn:56">56</a><a class="footnote-ref" id="fnref:57" href="#fn:57">57</a>
This method was also tested on several active duty Army soldiers, using an immersive computer simulation of military settings over six sessions. Self-reported PTSD symptoms of these soldiers were greatly diminished following the treatment.<a class="footnote-ref" id="fnref:58" href="#fn:58">58</a> [dubious – discuss] Exposure therapy has shown promise in the treatment of <a href="/facts/Co-morbid/tX5TvuKJ">co-morbid</a> PTSD and <a href="/facts/Substance_abuse/e3jLXFsF">substance abuse</a>.
In the area of PTSD, historic barriers to the use of exposure therapy include that clinicians may not understand it, are not confident in their own ability to use it, or more commonly, see significant <a href="/facts/Contraindication/HawhU8x9">contraindications</a> for their client.<a class="footnote-ref" id="fnref:59" href="#fn:59">59</a><a class="footnote-ref" id="fnref:60" href="#fn:60">60</a>

<h3>Obsessive compulsive disorder</h3>
Exposure and response prevention (also known as exposure and ritual prevention; ERP or EX/RP) is a variant of exposure therapy that is recommended by the American Academy of Child and Adolescent Psychiatry (AACAP), the American Psychiatric Association (APA), and the Mayo Clinic as first-line treatment of <a href="/facts/Obsessive%E2%80%93compulsive_disorder/bIhDh4dz">OCD</a> citing that it has the richest empirical support for both youth and adolescent outcomes.<a class="footnote-ref" id="fnref:61" href="#fn:61">61</a><a class="footnote-ref" id="fnref:62" href="#fn:62">62</a>
ERP is predicated on the idea that a <a href="/facts/Psychotherapy/n2hDjaop">therapeutic</a> effect is achieved as subjects confront their fears, but refrain from engaging in the escape response or ritual that delays or eliminates distress.<a class="footnote-ref" id="fnref:63" href="#fn:63">63</a> In the case of individuals with OCD or an anxiety disorder, there is a thought or situation that causes distress. Individuals usually combat this distress through specific behaviors that include avoidance or rituals. However, ERP involves purposefully evoking fear, anxiety, and or distress in the individual by exposing him/her to the feared stimulus.<a class="footnote-ref" id="fnref:64" href="#fn:64">64</a> The response prevention then involves having the individual refrain from the ritualistic or otherwise compulsive behavior that functions to decrease distress. The patient is then taught to tolerate distress until it fades away on its own, thereby learning that rituals are not always necessary to decrease distress or anxiety. Over repeated practice of ERP, patients with OCD expect to find that they can have obsessive thoughts and images but not have the need to engage in <a href="/facts/Compulsive_behavior/89bgqdzs">compulsive rituals</a> to decrease distress.<a class="footnote-ref" id="fnref:65" href="#fn:65">65</a><a class="footnote-ref" id="fnref:66" href="#fn:66">66</a>
The AACAP's practice parameters for OCD recommends cognitive behavioral therapy, and more specifically ERP, as first line treatment for youth with mild to moderate severity OCD and combination psychotherapy and pharmacotherapy for severe OCD.<a class="footnote-ref" id="fnref:67" href="#fn:67">67</a> The <a href="/facts/Cochrane_(organisation)/UlmdJ1H8">Cochrane Review</a>'s examinations of different randomized control trials echoes repeated findings of the superiority of ERP over waitlist control or pill-placebos, the superiority of combination ERP and pharmacotherapy, but similar effect sizes of efficacy between ERP or pharmacotherapy alone.<a class="footnote-ref" id="fnref:68" href="#fn:68">68</a>

<h3>Generalized anxiety disorder</h3>
There is empirical evidence that exposure therapy can be an effective treatment for people with <a href="/facts/Generalized_anxiety_disorder/FJRBB4fM">generalized anxiety disorder</a>, citing specifically in vivo exposure therapy (exposure through a real-life situation),<a class="footnote-ref" id="fnref:69" href="#fn:69">69</a> which has greater effectiveness than imaginal exposure in regards to generalized anxiety disorder. The aim of in vivo exposure treatment is to promote emotional regulation using systematic and controlled therapeutic exposure to traumatic stimuli.<a class="footnote-ref" id="fnref:70" href="#fn:70">70</a> Exposure is used to promote fear tolerance.<a class="footnote-ref" id="fnref:71" href="#fn:71">71</a>
Exposure therapy is also a preferred method for children who struggle with anxiety.<a class="footnote-ref" id="fnref:72" href="#fn:72">72</a>

<h3>Other possible uses of exposure therapy</h3>
Exposure therapy has been posited as potentially helpful for other uses, including substance abuse disorders,<a class="footnote-ref" id="fnref:73" href="#fn:73">73</a> overeating, binge eating, and obesity,<a class="footnote-ref" id="fnref:74" href="#fn:74">74</a><a class="footnote-ref" id="fnref:75" href="#fn:75">75</a><a class="footnote-ref" id="fnref:76" href="#fn:76">76</a> and <a href="/facts/Depression_(mood)/GDNFWm1L">depression</a>.<a class="footnote-ref" id="fnref:77" href="#fn:77">77</a><a class="footnote-ref" id="fnref:78" href="#fn:78">78</a>[timestamp needed]<a class="footnote-ref" id="fnref:79" href="#fn:79">79</a>[timestamp needed]

<h2 id="history">History</h2>
The 9th century Persian polymath <a href="/facts/Abu_Zayd_al-Balkhi/AqWPJTnb">Abu Zayd al-Balkhi</a> wrote about 'tranquilizing fear' by 'forcing oneself to repeatedly expose one's hearing and sight to noxious things' and to 'moved again and again near the thing it is scared of until it becomes used to it and loses its fear.'<a class="footnote-ref" id="fnref:80" href="#fn:80">80</a>
The use of exposure as a mode of therapy began in the 1950s, at a time when <a href="/facts/Psychodynamics/JIuNdo0E">psychodynamic</a> views dominated Western clinical practice and <a href="/facts/Behaviour_therapy/2N1n5BKp">behavioral therapy</a> was first emerging. South African psychologists and psychiatrists first used exposure as a way to reduce pathological fears, such as phobias and anxiety-related problems, and they brought their methods to England in the <a href="/facts/Maudsley_Hospital/sIxqygD4">Maudsley Hospital</a> training program.<a class="footnote-ref" id="fnref:81" href="#fn:81">81</a>
<a href="/facts/Joseph_Wolpe/MbJFX9Xf">Joseph Wolpe</a> (1915–1997) was one of the first psychiatrists to spark interest in treating psychiatric problems as behavioral issues. He sought consultation with other behavioral psychologists, among them James G. Taylor (1897–1973), who worked in the psychology department of the <a href="/facts/University_of_Cape_Town/a8rCGMht">University of Cape Town</a> in South Africa. Although most of his work went unpublished, Taylor was the first psychologist known to use exposure therapy treatment for <a href="/facts/Anxiety/Geekl883">anxiety</a>, including methods of situational exposure with response prevention—a common exposure therapy technique still being used.<a class="footnote-ref" id="fnref:82" href="#fn:82">82</a>
Since the 1950s, several sorts of exposure therapy have been developed, including <a href="/facts/Systematic_desensitization/WpsjsFTL">systematic desensitization</a>, <a href="/facts/Flooding_(psychology)/x9LTwweK">flooding</a>, implosive therapy, <a href="/facts/Prolonged_exposure_therapy/Qa2g4A09">prolonged exposure therapy</a>, in vivo exposure therapy, and imaginal exposure therapy.<a class="footnote-ref" id="fnref:83" href="#fn:83">83</a>
Exposure and response prevention (ERP) traces its roots back to the work of psychologist <a href="/facts/Vic_Meyer/LAx3Kecq">Vic Meyer</a> in the 1960s. Meyer devised this treatment from his analysis of <a href="/facts/Extinction_(psychology)/sKmrjKa8">fear extinguishment</a> in animals via <a href="/facts/Flooding_(psychology)/x9LTwweK">flooding</a> and applied it to human cases in the psychiatric setting that, at the time, were considered intractable.<a class="footnote-ref" id="fnref:84" href="#fn:84">84</a> The success of ERP clinically and scientifically has been summarized as "spectacular" by prominent OCD researcher <a href="/facts/Stanley_Rachman/z27ShlWJ">Stanley Rachman</a> decades following Meyer's creation of the method.<a class="footnote-ref" id="fnref:85" href="#fn:85">85</a>

<h2 id="possibly-related-psychological-techniques">Possibly related psychological techniques</h2>
<h3>Mindfulness</h3>
A 2015 review pointed out parallels between exposure therapy and <a href="/facts/Mindfulness/3v40h59U">mindfulness</a>, stating that mindful meditation "resembles an exposure situation because [mindfulness] practitioners 'turn towards their emotional experience', bring acceptance to bodily and affective responses, and refrain from engaging in internal reactivity towards it."<a class="footnote-ref" id="fnref:86" href="#fn:86">86</a> Imaging studies have shown that the <a href="/facts/Ventromedial_prefrontal_cortex/DCIbjRMk">ventromedial prefrontal cortex</a>, <a href="/facts/Hippocampus/X7CqbP8X">hippocampus</a>, and the <a href="/facts/Amygdala/AAy2mHb5">amygdala</a> are all affected by exposure therapy; imaging studies have shown similar activity in these regions with mindfulness training.<a class="footnote-ref" id="fnref:87" href="#fn:87">87</a>

<h3>EMDR</h3>
<a href="/facts/Eye_movement_desensitization_and_reprocessing/dRFbyS8w">Eye movement desensitization and reprocessing</a> (EMDR) includes an element of exposure therapy (desensitization), though whether this is an effective method or not, is controversial.<a class="footnote-ref" id="fnref:88" href="#fn:88">88</a>

<h3>Other</h3>
<a href="/facts/Desensitization_(psychology)/s394oh6R">Desensitization</a> and <a href="/facts/Extinction_(psychology)/sKmrjKa8">extinction</a> also involve exposure to a cause of disturbance.

<h2 id="research">Research</h2>
Exposure therapy can be investigated in the laboratory using Pavlovian <a href="/facts/Extinction_(psychology)/sKmrjKa8">extinction</a> paradigms. Using rodents such as rats or mice to study extinction allows for the investigation of underlying neurobiological mechanisms involved, as well as testing of pharmacological adjuncts to improve extinction learning.<a class="footnote-ref" id="fnref:89" href="#fn:89">89</a><a class="footnote-ref" id="fnref:90" href="#fn:90">90</a>

<h2 id="see-also">See also</h2>
<ul><li><a href="/facts/Catharsis/DSTQq1nu">Catharsis</a></li>
<li><a href="/facts/EMDR/dRFbyS8w">EMDR</a></li>
<li><a href="/facts/Desensitization_(psychology)/s394oh6R">Desensitization (psychology)</a></li>
<li><a href="/facts/Extinction_(psychology)/sKmrjKa8">Extinction (psychology)</a></li></ul>
<ul>
<li>Psychology portal</li></ul>
<h2 id="explanatory-footnotes">Explanatory footnotes</h2>

<h2 id="references">References</h2>

<ol>
<li id="fn:1">Myers KM, Davis M (February 2007). "Mechanisms of fear extinction". Molecular Psychiatry. 12 (2): 120–150. doi:10.1038/sj.mp.4001939. PMID 17160066. <a href="https://doi.org/10.1038%2Fsj.mp.4001939" target="_blank">https://doi.org/10.1038%2Fsj.mp.4001939</a> <a href="#fnref:1" class="footnote-back-ref">↩</a></li>
<li id="fn:2">Joseph JS, Gray MJ (2008). "Exposure Therapy for Posttraumatic Stress Disorder". Journal of Behavior Analysis of Offender and Victim: Treatment and Prevention. 1 (4): 69–80. doi:10.1037/h0100457. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:2" class="footnote-back-ref">↩</a></li>
<li id="fn:3">Huppert JD, Roth DA (2003). "Treating obsessive-compulsive disorder with exposure and response prevention". The Behavior Analyst Today. 4 (1): 66–70. doi:10.1037/h0100012. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:3" class="footnote-back-ref">↩</a></li>
<li id="fn:4">Forman-Hoffman V, Cook Middleton J, Feltner C, Gaynes BN, Palmieri Weber R, Bann C, Viswanathan M, Lohr KN, Baker C (2018-05-17). Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update (Report). Agency for Healthcare Research and Quality (AHRQ). doi:10.23970/ahrqepccer207. <a href="https://effectivehealthcare.ahrq.gov/topics/ptsd-adult-treatment-update/research-2018" target="_blank">https://effectivehealthcare.ahrq.gov/topics/ptsd-adult-treatment-update/research-2018</a> <a href="#fnref:4" class="footnote-back-ref">↩</a></li>
<li id="fn:5">Böhnlein J, Altegoer L, Muck NK, Roesmann K, Redlich R, Dannlowski U, Leehr EJ (January 2020). "Factors influencing the success of exposure therapy for specific phobia: A systematic review". Neuroscience and Biobehavioral Reviews. 108: 796–820. doi:10.1016/j.neubiorev.2019.12.009. PMID 31830494. <a href="https://doi.org/10.1016%2Fj.neubiorev.2019.12.009" target="_blank">https://doi.org/10.1016%2Fj.neubiorev.2019.12.009</a> <a href="#fnref:5" class="footnote-back-ref">↩</a></li>
<li id="fn:6">Himle JA, Grogan-Kaylor A, Hiller MA, Mannella KA, Norman LJ, Abelson JL, Prout A, Shunnarah AA, Becker HC, Russman Block SR, Taylor SF, Fitzgerald KD (January 2024). "Exposure and response prevention versus stress management training for adults and adolescents with obsessive compulsive disorder: A randomized clinical trial". Behaviour Research and Therapy. 172: 104458. doi:10.1016/j.brat.2023.104458. PMC 11639395. PMID 38103359. S2CID 266285353. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639395" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639395</a> <a href="#fnref:6" class="footnote-back-ref">↩</a></li>
<li id="fn:7">Song Y, Li D, Zhang S, Jin Z, Zhen Y, Su Y, Zhang M, Lu L, Xue X, Luo J, Liang M, Li X (November 2022). "The effect of exposure and response prevention therapy on obsessive-compulsive disorder: A systematic review and meta-analysis". Psychiatry Research. 317: 114861. doi:10.1016/j.psychres.2022.114861. PMID 36179591. S2CID 252530334. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:7" class="footnote-back-ref">↩</a></li>
<li id="fn:8">Wynn G, Ursano R (2017). "Posttraumatic Stress Disorder". Reference Module in Neuroscience and Biobehavioral Psychology. doi:10.1016/B978-0-12-809324-5.05378-5. ISBN 978-0-12-809324-5. <a href="978-0-12-809324-5" target="_blank">978-0-12-809324-5</a> <a href="#fnref:8" class="footnote-back-ref">↩</a></li>
<li id="fn:9">"International OCD Foundation | Exposure and Response Prevention (ERP)". <a href="https://iocdf.org/about-ocd/treatment/erp/" target="_blank">https://iocdf.org/about-ocd/treatment/erp/</a> <a href="#fnref:9" class="footnote-back-ref">↩</a></li>
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<li id="fn:21">Hezel DM, Simpson HB (January 2019). "Exposure and response prevention for obsessive-compulsive disorder: A review and new directions". Indian Journal of Psychiatry. 61 (Suppl 1): S85 – S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18. PMC 6343408. PMID 30745681. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343408" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343408</a> <a href="#fnref:21" class="footnote-back-ref">↩</a></li>
<li id="fn:22">Abramowitz JS, Deacon BJ, Whiteside SP (2011). Exposure Therapy for Anxiety: Principles and Practice. Guilford Press. ISBN 978-1-60918-017-1.[page needed] <a href="978-1-60918-017-1" target="_blank">978-1-60918-017-1</a> <a href="#fnref:22" class="footnote-back-ref">↩</a></li>
<li id="fn:23">"Ten Things You Need To Know To Overcome OCD". Beyond OCD. Retrieved 2020-08-17. <a href="https://beyondocd.org/expert-perspectives/articles/ten-things-you-need-to-know-to-overcome-ocd" target="_blank">https://beyondocd.org/expert-perspectives/articles/ten-things-you-need-to-know-to-overcome-ocd</a> <a href="#fnref:23" class="footnote-back-ref">↩</a></li>
<li id="fn:24">Abramowitz JS, Deacon BJ, Whiteside SP (2011-03-14). "Treatment Planning II: Hierarchy Development and Treatment Engagement". Exposure Therapy for Anxiety: Principles and Practice. Guilford Press. ISBN 978-1-60918-017-1. <a href="978-1-60918-017-1" target="_blank">978-1-60918-017-1</a> <a href="#fnref:24" class="footnote-back-ref">↩</a></li>
<li id="fn:25">"International OCD Foundation | Exposure and Response Prevention (ERP)". <a href="https://iocdf.org/about-ocd/treatment/erp/" target="_blank">https://iocdf.org/about-ocd/treatment/erp/</a> <a href="#fnref:25" class="footnote-back-ref">↩</a></li>
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<li id="fn:27">Hezel DM, Simpson HB (January 2019). "Exposure and response prevention for obsessive-compulsive disorder: A review and new directions". Indian Journal of Psychiatry. 61 (Suppl 1): S85 – S92. doi:10.4103/psychiatry.IndianJPsychiatry_516_18. PMC 6343408. PMID 30745681. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343408" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343408</a> <a href="#fnref:27" class="footnote-back-ref">↩</a></li>
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<li id="fn:52">For example, a person with panic disorder may be told to run in place, causing their heart to race, so that they can see that this feeling is not dangerous. <a href="/wiki/Panic_disorder" target="_blank">/wiki/Panic_disorder</a> <a href="#fnref:52" class="footnote-back-ref">↩</a></li>
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<li id="fn:65">Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB (July 2007). "Practice guideline for the treatment of patients with obsessive-compulsive disorder" (PDF). The American Journal of Psychiatry. 164 (7 Suppl): 5–53. PMID 17849776. <a href="http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd.pdf" target="_blank">http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd.pdf</a> <a href="#fnref:65" class="footnote-back-ref">↩</a></li>
<li id="fn:66">Geller DA, March J (January 2012). "Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder". Journal of the American Academy of Child and Adolescent Psychiatry. 51 (1): 98–113. doi:10.1016/j.jaac.2011.09.019. PMID 22176943. <a href="https://doi.org/10.1016%2Fj.jaac.2011.09.019" target="_blank">https://doi.org/10.1016%2Fj.jaac.2011.09.019</a> <a href="#fnref:66" class="footnote-back-ref">↩</a></li>
<li id="fn:67">Geller DA, March J (January 2012). "Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder". Journal of the American Academy of Child and Adolescent Psychiatry. 51 (1): 98–113. doi:10.1016/j.jaac.2011.09.019. PMID 22176943. <a href="https://doi.org/10.1016%2Fj.jaac.2011.09.019" target="_blank">https://doi.org/10.1016%2Fj.jaac.2011.09.019</a> <a href="#fnref:67" class="footnote-back-ref">↩</a></li>
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<li id="fn:69">Kaplan JS, Tolin DF (6 September 2011). "Exposure Therapy for Anxiety Disorders". Psychiatric Times. 28 (9). Retrieved 2021-09-22. <a href="https://www.psychiatrictimes.com/view/exposure-therapy-anxiety-disorders" target="_blank">https://www.psychiatrictimes.com/view/exposure-therapy-anxiety-disorders</a> <a href="#fnref:69" class="footnote-back-ref">↩</a></li>
<li id="fn:70">Parsons TD, Rizzo AA (September 2008). "Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis". Journal of Behavior Therapy and Experimental Psychiatry. 39 (3): 250–261. doi:10.1016/j.jbtep.2007.07.007. PMID 17720136. S2CID 6688068. <a href="/wiki/Doi_(identifier)" target="_blank">/wiki/Doi_(identifier)</a> <a href="#fnref:70" class="footnote-back-ref">↩</a></li>
<li id="fn:71">"Instead of teaching patients to resist, control or "fix" their fear or anxiety, exposure is used to promote 'fear tolerance' given that fear and anxiety are universal, inevitable and safe." Exposure Therapy for Anxiety, Second Edition (2019), p18, Abramowitz, Deacon and Whiteside <a href="#fnref:71" class="footnote-back-ref">↩</a></li>
<li id="fn:72">Whiteside SP, Deacon BJ, Benito K, Stewart E (May 2016). "Factors associated with practitioners' use of exposure therapy for childhood anxiety disorders". Journal of Anxiety Disorders. 40: 29–36. doi:10.1016/j.janxdis.2016.04.001. PMC 4868775. PMID 27085463. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868775" target="_blank">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868775</a> <a href="#fnref:72" class="footnote-back-ref">↩</a></li>
<li id="fn:73">McHugh RK, Kosiba JD, Chase AR (2022). "Exposure Therapy in the Treatment of Substance Use Disorders". Clinical Guide to Exposure Therapy. pp. 261–276. doi:10.1007/978-3-031-04927-9_14. ISBN 978-3-031-04926-2. <a href="978-3-031-04926-2" target="_blank">978-3-031-04926-2</a> <a href="#fnref:73" class="footnote-back-ref">↩</a></li>
<li id="fn:74">Boutelle KN, Eichen DM, Virzi NE (2022). "Exposure Exercises for Overeating, Binge Eating, and Obesity". Clinical Guide to Exposure Therapy. pp. 299–316. doi:10.1007/978-3-031-04927-9_16. ISBN 978-3-031-04926-2. <a href="978-3-031-04926-2" target="_blank">978-3-031-04926-2</a> <a href="#fnref:74" class="footnote-back-ref">↩</a></li>
<li id="fn:75">University of Otago (2014-06-16). "Bulimia burden exposed". www.otago.ac.nz. Retrieved 2024-04-02. <a href="https://www.otago.ac.nz/profiles/bulimia-burden-exposed" target="_blank">https://www.otago.ac.nz/profiles/bulimia-burden-exposed</a> <a href="#fnref:75" class="footnote-back-ref">↩</a></li>
<li id="fn:76">McIntosh VV, Jordan J, Carter FA, Luty SE, McKenzie JM, Bulik CM, Frampton CM, Joyce PR (April 2005). "Three Psychotherapies for Anorexia Nervosa: A Randomized, Controlled Trial". American Journal of Psychiatry. 162 (4): 741–747. doi:10.1176/appi.ajp.162.4.741. ISSN 0002-953X. PMID 15800147. <a href="/wiki/Virginia_McIntosh" target="_blank">/wiki/Virginia_McIntosh</a> <a href="#fnref:76" class="footnote-back-ref">↩</a></li>
<li id="fn:77">Hayes AM, Yasinski C, Alpert E (2022). "The Application of Exposure Principles to the Treatment of Depression". Clinical Guide to Exposure Therapy. pp. 317–345. doi:10.1007/978-3-031-04927-9_17. ISBN 978-3-031-04926-2. <a href="978-3-031-04926-2" target="_blank">978-3-031-04926-2</a> <a href="#fnref:77" class="footnote-back-ref">↩</a></li>
<li id="fn:78">Springer KS, Colin DF (2020). The Big Book of Exposures: Innovative, Creative, and Effective CBT-Based Exposures for Treating Anxiety-Related Disorders. Oakland, CA: New Harbinger Publications. ISBN 978-1-68403-373-7. <a href="978-1-68403-373-7" target="_blank">978-1-68403-373-7</a> <a href="#fnref:78" class="footnote-back-ref">↩</a></li>
<li id="fn:79">Richard DC, Lauterbach D (2006). Handbook of Exposure Therapies Hardcover. Elsevier. ISBN 978-0-08-046781-8. <a href="978-0-08-046781-8" target="_blank">978-0-08-046781-8</a> <a href="#fnref:79" class="footnote-back-ref">↩</a></li>
<li id="fn:80">Sustenance of the soul, al-Balkhi, p49 <a href="#fnref:80" class="footnote-back-ref">↩</a></li>
<li id="fn:81">Abramowitz JS, Deacon BJ, Whiteside SP (2011). Exposure Therapy for Anxiety: Principles and Practice. Guilford Press. ISBN 978-1-60918-017-1.[page needed] <a href="978-1-60918-017-1" target="_blank">978-1-60918-017-1</a> <a href="#fnref:81" class="footnote-back-ref">↩</a></li>
<li id="fn:82">Abramowitz JS, Deacon BJ, Whiteside SP (2011). Exposure Therapy for Anxiety: Principles and Practice. Guilford Press. ISBN 978-1-60918-017-1.[page needed] <a href="978-1-60918-017-1" target="_blank">978-1-60918-017-1</a> <a href="#fnref:82" class="footnote-back-ref">↩</a></li>
<li id="fn:83">Abramowitz JS, Deacon BJ, Whiteside SP (2011). Exposure Therapy for Anxiety: Principles and Practice. Guilford Press. ISBN 978-1-60918-017-1.[page needed] <a href="978-1-60918-017-1" target="_blank">978-1-60918-017-1</a> <a href="#fnref:83" class="footnote-back-ref">↩</a></li>
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<li id="fn:88">"Eye Movement Desensitization and Reprocessing for Post-Traumatic Stress Disorder". Society of Clinical Psychology. 6 March 2017. <a href="https://www.div12.org/treatment/eye-movement-desensitization-and-reprocessing-for-post-traumatic-stress-disorder/" target="_blank">https://www.div12.org/treatment/eye-movement-desensitization-and-reprocessing-for-post-traumatic-stress-disorder/</a> <a href="#fnref:88" class="footnote-back-ref">↩</a></li>
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</ol>

Exposure therapy open-in-new

Exposure therapy