Exposure Therapy?!? Yikes!

In your searches for the best treatment for anxiety and OCD, chances are you have come across Exposure Therapy/Exposure Response Prevention as the main treatment recommended. That is not surprising – exposure is an incredibly useful treatment and works really well to help people overcome their fears. I understand, though, that exposure therapy sounds terrifying. I will be honest that my patients usually state that the impact the fear is having on their lives is far worse than the exposure treatment. But the impact of doing exposure therapy is often that people get their lives back and can finally do the things that had been so daunting.


Exposure therapy is often considered “facing your fears.” Another way of understanding exposure is that it is about testing your fears. We become scientists, in a way, and put some of the scary predictions you have to the test.


You may have an image of a therapist coming to session with some scary items and unexpectedly throwing those at you. Phew! That would be terrifying! That is not how I do exposure therapy at all. My guiding principle in exposure therapy is that you are in charge of everything we do. You get to tell me what you are ready for, what you want to try, and how you would like to do it. At no time will I “force” you to do something without your consent. The therapist and the patient are a true team – we discuss what you would like to do and we come up with some creative ways to try it.

Most patients choose to take a gradual approach to exposure, meaning we start with items that are not too challenging and we work our way up towards more challenging things when you consider yourself ready. There is no extra credit for going fast and no demerits for going slow. Pacing yourself is perfectly fine. As you get better and better at tackling things, you will likely find your confidence grows and you may even look forward to taking on big challenges. That might sound impossible now, but once you get started, you may be surprised how good and how accomplished you feel.

For a great description of exposure therapy versus other therapies for OCD written by OCD experts, read this OCD Foundation newsletter (2019).