Let’s rebrand exposure therapy
Exposure therapy is effective and can be an ultimately very positive experience, but I sometimes experience friction proposing it to clients, or strange looks from my colleagues. After all, who out there wants to be exposed? I run accross ads every day that try to sell me a product to “limit exposure” or “reduce liability.”
The phrase “exposure” signals a bygone era of therapies that do practices like “conditioning” and “contingency management” on their patients, where patients are subjects to be manipulated into wellness and/or acceptable-ness. Autistic people in particular are rightfully wary of this kind of language because of legacies of harm associated with some kinds of behavior therapy.
Exposure Therapy need not be practiced from a stale, top-down stance. It can and should be - and very often is - a gentle, collaborative experience. But the name is just…wrong.
What is actually happening in exposure therapy: a person is willingly approaching, in small planned steps, something they’ve been avoiding because the avoidance has become its own problem. That could be a situation, like the dentist, a feeling, like a racing heart, a thought, like the uncertainty of whether you hurt someone’s feelings, or a memory, as in an overwhelming past experience. There can be no coercion for it to work; if you aren’t moving towards something with agency, you won’t feel that you own the outcome. It is just another thing you were forced to endure.
Coming out the other side of a feared experience feeling capable, safe, and in your full autonomy is an experience well worth the effort. New experiences are a reliable way to dislodge stuck patterns. It’s so much easier to let go of costly protective strategies when you have experienced in your own body that you don’t need that kind of protection.
A proposed rebrand listed here is SAFE - CBT (Supported Approach of Feared Experiences): https://pmc.ncbi.nlm.nih.gov/articles/PMC9161762/
I haven’t heard this catch on yet. I will be doing what I can to see if SAFE can get some traction.
Exposure therapy (or let’s call it SAFE) is very well researched as an effective treatment for OCD, Phobias, Panic Disorder, and PTSD. It is always a method I offer due to it’s tendency to work well. The forms of exposure therapy include:
for OCD: Exposure and Response Prevention (ERP), which involves approaching a trigger of obsessions while practicing skills to refrain from compulsions and manage the intense emotions that arise.
for OCD, phobias and panic: Imaginal exposure, in which you write a story of your fear and try to stay present with the feelings that arise
For phobias and PTSD: In Vivo Exposure, in which we gradually approach the subject of fear in a number of ways (ie, stories, photos, sensory information, location) and stay with that stimuli until our body becomes calm again
For OCD and Panic: interoceptive exposure, in which we do actions to generate body sensations (such as racing heart), that tend to induce panic or obsessions, and engage in skills to surf the experience safely and not get caught up in thoughts.
For PTSD and real event OCD: prolonged exposure, in which you tell the story of a difficult memory multiple times in order to gain new perspective on it and release stuck emotions. This is often done in conjunction with exposure to feared triggers out in the world, in small steps. Written Exposure Therapy (WET) is an alternative form of this therapy.
I offer complimentary skills building and readiness work to support people with giving this kind of therapy a try. Not because I want anyone exposed, but because I want effective methods to be accessible to everyone. I want freedom and autonomy for my clients.
If this kind of exposure therapy sounds worth a try, check out the rest of my site or contact me here.
