An introduction to exposure therapy - an effective evidence-based treatment for fear.
Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.
Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.
An editable Microsoft PowerPoint version of the resource.
Exposure is an effective evidence-based treatment for fear. This information handout describes the key principles of exposure therapy. Clients who are nervous about attempting exposure will find it helpful to understand the theory behind the approach.
This resource is designed to help clients:
Fears of specific objects or situations.
Fear associated with traumatic events.
Fear associated with particular bodily sensations.
Fears involving contamination harm.
Use the handout as a psychoeducation tool to explain exposure therapy to clients.
Encourage clients to reflect on their difficulties and the relevance of exposure therapy to them.
Explore whether exposure therapy might be helpful.
Exposure therapy is a behavioral intervention widely used in the treatment of anxiety-related disorders. It is grounded in the principle that avoidance of feared stimuli maintains anxiety over time, while approaching feared stimuli helps promote new learning and reduces distress. Early conceptualizations of exposure therapy were rooted in classical conditioning, with fear considered a learned association between a neutral stimulus and an aversive outcome. Repeated exposure without the feared consequence was thought to extinguish the conditioned fear response (Foa & Kozak, 1986; Marks, 1978). This view emphasized habituation — the natural reduction of fear that occurs over time when individuals remain in anxiety-provoking situations — as the primary mechanism of change.
More recent theoretical developments challenge the idea that fear is “unlearned” through extinction, instead proposing that exposure therapy works by creating new, inhibitory learning. According to the inhibitory learning model, fear associations are not erased but are overridden by new learning that signals safety or the absence of threat (Craske et al., 2014). Effective exposure tasks therefore rely less on fear reduction within a session and more on maximizing discrepancy between expected and actual outcomes. Brewin (2015) offers a complementary account with the retrieval competition model, which suggests that therapy strengthens adaptive memories so that they are more easily retrieved than fear-based ones. These memory-based models are supported by neurobiological and cognitive research showing that trauma and anxiety can distort memory encoding, retrieval, and integration, which exposure therapy helps to recalibrate (Brewin, Gregory, Lipton, & Burgess, 2010).
Clinical research continues to refine best practices for implementing exposure. Strategies such as varying the context of exposure, eliminating safety behaviors, and focusing on expectancy violation have all been found to improve outcomes (Kircanski et al., 2012; Culver, Stoyanova, & Craske, 2011). Moreover, evidence suggests that helping clients understand the rationale for exposure, preparing them to tolerate initial distress, and reinforcing new learning through reflection are critical elements of success (Abramowitz, Deacon, & Whiteside, 2011). Exposure therapy is effective across a range of disorders, including specific phobias, panic disorder, obsessive compulsive disorder (OCD), social anxiety, and post-traumatic stress disorder (PTSD), and can be adapted to suit individual client needs. It is one of the most rigorously supported interventions in cognitive behavioral therapy (CBT), with decades of empirical evidence demonstrating its efficacy and safety.
