Exposure therapies were originally developed to treat specific disorders such as OCD and phobias. Over time they have adapted and changed. In this post I'm going to outline some exposure techniques and talk briefly about their development and application.
One of the best known techniques is systematic desensitization (SD). Dr. Joseph Wolpe spent some time as an MD working with traumatized soldiers suffering from war neurosis (now called PTSD). Wolpe and his colleagues developed SD in the 1950s for the treatment of phobias. The application of the therapy requires the client to develop a hierarchy of fears that derive from the feared or traumatic event. Working with the therapist, the client is initially exposed to the least feared item in the hierarchy by imagination. Alongside this, the client is taught relaxation techniques and how to apply them during gradual exposure to fear-producing images. Exposures are brief, repetitive and will only ever focus on one fear. Once mastery over a lower-level fear is achieved, the next in the hierarchy will be tackled, and so on.
The early 1980s saw increasing use of a technique known as ‘direct therapeutic exposure'. Better known as ‘flooding' because of the way the technique immerses the client into the feared situation in a real-life situation, the client first learns relaxation and other coping techniques. Thereafter, moderate to strong fear-producing cues are confronted by the client with the therapist, who encourages the client to use the techniques they have been taught and to stick with the situation. Part of the rationale for flooding is the fact that the fight-or-flight mechanism cannot sustain itself at peak levels for a protracted period of time. The longer the person remains in the feared situation the more their level of anxiety must subside.
A specific aspect of flooding known as prolonged exposure (PE) can be used in the treatment of PTSD. The treatment process usually involves a series of 90-minute imagined and real life exposures. Generally, the first couple of sessions will be devoted to gathering information, teaching the client about the nature of PTSD and explanations as to the purpose and rationale of the therapy. Thereafter, a typical therapy session will require the client to close their eyes and to relive the traumatic experience(s) out loud. They are encouraged to verbalize all the sights, sounds, smells, noises and other sensations (emotions, thoughts) associated with events. The sessions are audio-recorded and the client listens to the recording everyday between sessions. A record of perceived anxiety levels is kept as the client listens to the recording. Typically, the initial recordings are quite high, but over time the level of associated anxiety diminishes.