Real life exposure

What are real life exposures?

Real life exposure, sometimes called "exposure in-vivo", is the primary type of exposure therapy and also the most commonly used psychotherapeutic techniques since the 1960s in treating different anxiety disorders, particularly specific phobia, agoraphobia, social anxiety and obsessive-compulsive disorder. In vivo exposure is the most effective way to overcome fear in real-life situations that you may have avoided because of anxiety. Like for all exposures, an exposure hierarchy will be put in place, noting the feared situations from the least to the most feared. This is done to be able to do gradual exposure, by facing the situations that you have anxiety about and then gradually going up to the most distressing situation that provokes high levels of anxiety.

Overview of how it is done

Similair to all exposures, your therapist will first give you psychoeducation about the nature of anxiety, going through what is physically really happening in your body. The therapist will also help you see how what you do and what you think are related to your anxiety; how avoidance behaviors may feel like they help in the short run but unfortunately makes the problem worse in the long run (read more about Psychoducation in this article). One early exercise is often self monitoring (by observing and writing down your own feelings, thoughts and behaviors).

It is done through repeated continuous exposures, by directly confronting what triggers your anxiety, in a gradual manner. Your therapist will never force you to do anything but will be there to guide you, and help you notice thoughts and how it is making you feel and if you get impulses to do safety behaviors (see separate article). Your therapist will also ask you to rate the degree of anxiety on a scale from 0 to 10 (or 0 to 100). All of this will help you through the exposure and the conscious observation to accept the fears and to disconfirm the beliefs about what you’re afraid will happen.

For example, if you have the fear of snakes, the exposure will be initially to look at for example videos of snakes and then gradually, after working through the hierarchy, doing an exposure to an actual snake, often in the therapist’s office. As your anxiety and fear will peak, you will probably start having catastrophic thoughts and you may want to escape the situation. The therapist wil help you to accept your fear, and guide you in noticing what you to think and feel. After some time, you will experience something new, that nothing bad actually happens and you see that the situation is safe.