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Written by:Bisma Anwar, MA, MSc, LMHC

Published On: April 25, 2022

Medically reviewed by: Minkyung Chung, MS, LMHC

Reviewed On: April 25, 2022

Updated On: July 14, 2023


Post-traumatic stress disorder (PTSD) is often associated with veterans who have survived field combat, but the truth is, symptoms of PTSD can become prevalent in anyone’s life after suffering a trauma. PTSD symptoms commonly include nightmares, flashbacks, extreme anxiety, and depression, among other things. PTSD can be an extremely debilitating disorder, often affecting your quality of life.

Many things can cause PTSD, including a bad auto accident, the sudden loss of a loved one, a physical or sexual assault, or surviving a natural disaster. After experiencing a severe traumatic event, chronic PTSD might cause you to take extreme measures to avoid situations that take you back to the traumatic experience.

Prolonged exposure therapy for PTSD is a common, preferred therapy technique that’s used to treat this mental health condition. It’s aimed at directly addressing trauma victims who have increased levels of stress, sometimes even years after the initial traumatic experience.

Exactly how does exposure therapy work for PTSD? Keep reading to discover how exposure therapy can help treat PTSD and to learn more about the different types of exposure therapy that are used.

How Exposure Therapy Helps Treat PTSD

Whereas traditional forms of psychotherapy (talk therapy) focus on talking through the negative feelings and thoughts associated with your PTSD, exposure therapy helps you confront difficult triggers in real-time. When possible, you might even face them head on, in real-life situations. These methods are proven to deliver faster results when compared to more traditional trauma-focused therapies, which may involve visualizing, talking, or thinking about traumatic memories.

In contrast, for many people, exposure therapy is bettersuited to breaking the fear and avoidance patterns that are associated with PTSD. As you’re progressively exposed to your fear or faced with memories of your trauma (in a safe, controlled environment), you’ll learn to process any irrational beliefs and unrealistic fears you have that are associated with the stressor.

Some research suggests that exposure therapy is successful in 75% of people who received this form of therapy to treat their PTSD.

“Exposure therapy is a CBT technique which makes a person confront the things that they fear the most. It ultimately helps decrease the person’s anxiety because they realize they can face their fears rather than avoid them.”

Licensed Mental Health Counselor (LMHC), MA, MSc Bisma Anwar

Methods of Exposure Therapy for PTSD

How does exposure therapy work for PTSD? There are various delivery methods of exposure therapy for PTSD, including:

In vivo exposure

In vivo exposure therapy asks you to directly face the object, activity, or situation that you fear. It’s a very straightforward approach that’s designed to break the mental and emotional patterns associated with your anxiety.

Since in vivo exposure can be a difficult and uncomfortable process, it will likely be used only after you’ve made some progress with other cognitive-behavioral therapies (CBT).

The goal of in vivo therapy is to demonstrate that although you’re experiencing a certain level of anxiety, the consequences of your emotions aren’t as extreme as you might believe. Eventually, you’ll become conditioned to either successfully experience a certain level of anxiety or, in the most successful outcomes, to no longer be provoked by it at all.

Imaginal exposure

Another method of exposure therapy for PTSD, imaginal exposure, asks you to vividly imagine the situation, object, or activity you fear by recalling very specific events from a traumatic experience. Repeated exposure to these imaginings can work to reduce your abnormal fears and emotions. You’ll find that sometimes you can even replace those emotions with more appropriate responses or feelings — such as sadness, regret, or disappointment.

When it’s not safe or it’s impossible to directly confront anxious memories or fearful thoughts in real life, imaginal exposure is an indirect solution that can offer similar results.

Interoceptive exposure

Interoceptive exposure for post-traumatic stress disorder helps by strategically recreating the physical symptoms and sensations that you associate with a feared trigger. It then asks you to see those harmless — albeit likely scary — feelings and/or reactions for what they actually are: just a faster heartbeat, an increase in sweating, some chest pain, or perhaps a dry mouth. You’ll learn that the heightened physical and emotional reactions you experience have made imagined fears appear real, when in reality, you can control them.

With interoceptive exposure, you’ll learn to intercept your somatic symptoms so you can disassociate them from your reality. This type of therapy has offered good results for people who experience panic attacks, dizziness, or pain associations along with their traumatic memories.

Prolonged exposure

With any prolonged exposure therapy for PTSD, you’ll gradually be conditioned to confront or cope with your trauma-related fears over long periods of time. This is accomplished by breaking your association between the memory and your knee-jerk physical or mental reactions. Even though trauma cues might still trigger you, prolonged calm and rational exposure teaches your brain to stop before extreme reactions consume you.

Most PTSD-related therapies focus on learning new behaviors as you face the memory or activity instead of using avoidance as a coping technique. Your therapist is critical in helping you realize and understand that no real danger is associated with your traumatic memories and feelings you experience.

“There are a few different methods of exposure therapy such as in vivo, imaginal, and prolonged exposure. Each technique aims to expose the person to the thing that they fear, whether it’s directly or indirectly. It’s important to go to a therapist who specializes in this type of therapy so that this can be done in a safe and protective environment.”

Licensed Mental Health Counselor (LMHC), MA, MSc Bisma Anwar

How to Find a Therapist for Exposure Therapy

If you or someone you love is challenged with painful memories from a past traumatic experience, you might need to get help learning to process them so you can deal with your post-traumatic stress disorder. If memories are causing an extreme physical or emotional reaction, then you can start by talking to your primary care doctor or a licensed mental health professional. Getting a diagnosis can be the first step on your road to recovery.

There are a variety of anxiety-related disorders that can mimic PTSD, including generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), social anxiety disorder, and panic disorder. This is why an accurate diagnosis is so essential to your treatment plan.

After your diagnosis, a therapy path will be planned and might include individual psychiatric or therapy sessions, group therapy, specific psychological therapies such as cognitive-behavioral therapy (CBT), exposure therapy, or dialectical behavior therapy (DBT). Often, medication can be combined with a therapy technique to further enhance your healing and progress.

It’s important that you take the time to find a therapist who’s directly experienced in exposure therapy. You can ask your primary doctor for a referral, or you can ask a current therapist for a recommendation if they’re not trained in this specific technique.

If you don’t have luck with these options, you can always check with your insurance provider for access to their directory of psychiatrists and psychologists.

Finally, don’t be afraid to ask family and close friends if they know of a good therapist who they would recommend. A general referral from a family member can even lead to a more specific referral of a mental health professional who specializes in exposure therapy for PTSD.

Today, more and more people are reaching out every day for mental health support and guidance. You don’t have to live with the symptoms of PTSD that are interfering in your life, your relationships, and your overall happiness. There is help available, and there are successful forms of treatment that can alleviate your PTSD symptoms so you can heal from your trauma.

Exposure therapy isn’t just for PTSD. There’s also exposure therapy for OCD and exposure therapy for anxiety. If you are experiencing any of these but can’t meet with a therapist in person, consider online therapy options.

See References

Bisma Anwar, MA, MSc, LMHC

Bisma Anwar is the Team Lead for the Talkspace Council of Mental Health Experts. A major focus in her work has been anxiety management and helping her clients develop healthy coping skills, reduce stress and prevent burnout. She serves on the board of a non-profit organization based in NYC called The Heal Collective which promotes advocacy and awareness of mental health issues in BIPOC communities.

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