Exposure therapy

Short description: Treatment method for anxiety disorders

Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the patient to the anxiety source or its context (without the intention to cause any danger). Doing so is thought to help them overcome their anxiety or distress.[1]: 141–142 [2] Numerous studies have demonstrated its effectiveness in the treatment of disorders such as generalized anxiety disorder, social anxiety disorder, obsessive–compulsive disorder (OCD),[3] post-traumatic stress disorder (PTSD),[4] and specific phobias.[5]

As of 2024, focus is particularly on exposure and response prevention (ERP or ExRP) therapy, in which exposure is continued and the resolution to refrain from the escape response is maintained at all times (not just during specific therapy sessions).[6][7][8][9]

## Contents

* 1 Techniques
* 1.1 Exposure and response prevention (ERP)
* 2 Mechanism
* 2.1 Inhibitory learning
* 2.2 Inhibitory retrieval
* 3 Under-use and barriers to use
* 4 Uses
* 4.1 Phobia
* 4.2 Post-traumatic stress disorder
* 4.3 Obsessive–compulsive disorder
* 4.4 Generalized anxiety disorder
* 4.5 Other possible uses of exposure therapy
* 5 History
* 6 Possibly related psychological techniques
* 6.1 Mindfulness
* 6.2 EMDR
* 6.3 Other
* 6.4 Research; Expectations violation
* 7 See also
* 8 Explanatory footnotes
* 9 References

## Techniques

Exposure therapy is based on the principle of respondent conditioning often termed Pavlovian extinction.[10] The exposure therapist identifies the cognitions, emotions and physiological arousal that accompany a fear-inducing stimulus and then tries to break the pattern of escape that maintains the fear. This is done by exposing the patient to fear-inducing stimuli.[11]

This may be done:

* using progressively stronger stimuli. Fear is minimized at each of a series of steadily escalating steps or challenges (a hierarchy), which can be explicit ("static") or implicit ("dynamic" – see Method of Factors) until the fear is finally gone.[12] The patient is able to terminate the procedure at any time.
* using flooding therapy, which exposes the patient to feared stimuli starting at the most feared item in a fear hierarchy.[13][14]

There are several types of exposure procedures:

* In vivo or "real life".[15] This type exposes the patient to actual fear-inducing situations. For example, if someone fears public speaking, the person may be asked to give a speech to a small group of people.
* Virtual reality, in which technology is used to simulate in vivo exposure. Studies suggest that immersive virtual reality has the ability to mimic feared stimuli and patients actually perceive them as real threats.[16]
* Imaginal, where patients are asked to imagine a situation that they are afraid of. This procedure is helpful for people who need to confront feared thoughts and memories.
* Written exposure therapy, where patients write down their account of the traumatic event
* Interoceptive, in which patients confront feared bodily symptoms such as increased heart rate and shortness of breath. This may be used for more specific disorders such as panic or post-traumatic stress disorder.
* Self Distancing- A cognitive strategy typically used alongside exposure therapy where an individual refers to themselves in third person allowing them take a step back and see the fearful stimulus through a less intimidating perspective.[17]

The various types of exposure may be used together or separately.[18][19][20] Discussion continues on how best to carry out exposure therapy, including on whether safety behaviours should be discontinued.[21][22]

### Exposure and response prevention (ERP)

In the exposure and response prevention (ERP or EX/RP) form of exposure therapy, the resolution to refrain from the escape response is to be maintained at all times (not just during specific practice sessions).[23] Thus, not only does the subject experience habituation to the feared stimulus, but they also practice a fear-incompatible behavioral response to the stimulus. The distinctive feature is that individuals confront their fears and discontinue their escape response.[24]

While this type of therapy typically causes some short-term anxiety, this facilitates long-term reduction in obsessive and compulsive symptoms.[25][26]: 103 [9]

The American Psychiatric Association recommends ERP for the treatment of OCD, citing that ERP has the richest empirical support.[27] As of 2019[update], ERP is considered a first-line psychotherapy for OCD.[23][28] A 2024 systematic review found that ERP is highly effective in treating pediatric OCD using both in-person and telehealth-based modailites[29] and a 2025 meta-analysis ranked exposure and response prevention among the top three treatments for children and adolescents with OCD, whether delivered in person or through telehealth.[30]

Effectiveness is heterogeneous. Higher efficacy correlates with lower avoidance behaviours, and greater adherence to homework. Using SSRI meds whilst doing ERP does not appear to correlate with better outcomes.[31][32][33] Discussion continues on how to best conduct ERP.[34]

Generally, ERP incorporates a relapse prevention plan toward the end of the course of therapy.[23] This can include being ready to re-apply ERP if an anxiety does occur.[35]

## Mechanism

Mechanism research has been limited in the field.[36]

Habituation was seen as a mechanism in the past, but is seen more recently as a model of therapeutic process.[37]

### Inhibitory learning

As of 2022, the inhibitory learning model is the most common conjecture of the mechanism which causes exposure therapy efficacy. This model posits that in exposure therapy the unpleasant reactions such as anxiety (that were previously learned during fear conditioning) remain intact - they are not expected to be eliminated - but that they are now inhibited or balanced or overcome by new learning about the situation (for instance that the feared result will not necessarily happen).[22][38][39][40] More research is needed.[41]

### Inhibitory retrieval

This model posits that additional associative learning processes, such as counterconditioning and novelty-enhanced extinction may contribute to exposure therapy.[42][43]

## Under-use and barriers to use

Exposure therapy is seen as under-used in relation to its efficacy.[44] Barriers to use of exposure therapy by psychologists include it appearing antithetical to mainline psychology,[44] lack of confidence, and negative beliefs about exposure therapy.[45]

## Uses

### Phobia

Exposure therapy is the most successful known treatment for phobias.[46] Several published meta-analyses included studies of one-to-three-hour single-session treatments of phobias, using imaginal exposure. At a post-treatment follow-up four years later 90% of people retained a considerable reduction in fear, avoidance, and overall level of impairment, while 65% no longer experienced any symptoms of a specific phobia.[15]

Agoraphobia and social anxiety disorder are examples of phobias that have been successfully treated by exposure therapy.[47]

### Post-traumatic stress disorder

Exposure therapy in PTSD involves exposing the patient to PTSD-anxiety triggering stimuli, with the aim of weakening the neural connections between triggers and trauma memories (a.k.a. desensitisation). Exposure may involve:[20]

* a real-life trigger ("in vivo")
* an imagined trigger ("imaginal")
* Virtual reality exposure
* a triggered feeling generated in a physical way ("interoceptive")[lower-alpha 1]

Forms include:

* Flooding – exposing the patient directly to a triggering stimulus, while simultaneously making them not feel afraid.
* Systematic desensitisation (a.k.a. "graduated exposure") – gradually exposing the patient to increasingly vivid experiences that are related to the trauma, but do not trigger post-traumatic stress.
* Narrative exposure therapy \- creates a written account of the traumatic experiences of a patient or group of patients, in a way that serves to recapture their self-respect and acknowledges their value. Under this name it is used mainly with refugees, in groups.[48] It also forms an important part of cognitive processing therapy[citation needed] and is conditionally recommended for treatment of PTSD by the American Psychological Association.[48]
* Prolonged exposure therapy (PE) - a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder, characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is a repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous (despite being objectively safe). Additional procedures include processing of the trauma memory and breathing retraining. The American Psychological Association strongly recommends PE as a first-line psychotherapy treatment for PTSD.[49]
* S.H.A.R.E (Survivors Healing from Abuse: Recovery through Exposure) - exposure-based group therapy that specifically focuses on providing services for previously incarcerated women that are at high risk of developing PTSD because of them being sexually assaulted.[50]

Researchers began experimenting with Virtual reality exposure (VRE) therapy in PTSD exposure therapy in 1997 with the advent of the "Virtual Vietnam" scenario. Virtual Vietnam was used as a graduated exposure therapy treatment for Vietnam veterans meeting the qualification criteria for PTSD. A 50-year-old Caucasian male was the first veteran studied. The preliminary results concluded improvement post-treatment across all measures of PTSD and maintenance of the gains at the six-month follow up. Subsequent open clinical trial of Virtual Vietnam using 16 veterans, showed a reduction in PTSD symptoms.[51][52]

This method was also tested on several active duty Army soldiers, using an immersive computer simulation of military settings over six sessions. Self-reported PTSD symptoms of these soldiers were greatly diminished following the treatment.[53] Exposure therapy has shown promise in the treatment of co-morbid PTSD and substance abuse.

In the area of PTSD, historic barriers to the use of exposure therapy include that clinicians may not understand it, are not confident in their own ability to use it, or more commonly, see significant contraindications for their client.[54][55]

### Obsessive–compulsive disorder

Exposure and response prevention (also known as exposure and ritual prevention; ERP or EX/RP) is a variant of exposure therapy that is recommended by the American Academy of Child and Adolescent Psychiatry (AACAP), the American Psychiatric Association (APA), and the Mayo Clinic as first-line treatment of OCD citing that it has the richest empirical support for both youth and adolescent outcomes.[27][56]

ERP is predicated on the idea that a therapeutic effect is achieved as subjects confront their fears, but refrain from engaging in the escape response or ritual that delays or eliminates distress.[24] In the case of individuals with OCD or an anxiety disorder, there is a thought or situation that causes distress. Individuals usually combat this distress through specific behaviors that include avoidance or rituals. However, ERP involves purposefully evoking fear, anxiety, and or distress in the individual by exposing him/her to the feared stimulus.[15] The response prevention then involves having the individual refrain from the ritualistic or otherwise compulsive behavior that functions to decrease distress. The patient is then taught to tolerate distress until it fades away on its own, thereby learning that rituals are not always necessary to decrease distress or anxiety. Over repeated practice of ERP, patients with OCD expect to find that they can have obsessive thoughts and images but not have the need to engage in compulsive rituals to decrease distress.[27][56]

The AACAP's practice parameters for OCD recommends cognitive behavioral therapy, and more specifically ERP, as first line treatment for youth with mild to moderate severity OCD and combination psychotherapy and pharmacotherapy for severe OCD.[56] The Cochrane Review's examinations of different randomized control trials echoes repeated findings of the superiority of ERP over waitlist control or pill-placebos, the superiority of combination ERP and pharmacotherapy, but similar effect sizes of efficacy between ERP or pharmacotherapy alone.[57]

### Generalized anxiety disorder

There is empirical evidence that exposure therapy can be an effective treatment for people with generalized anxiety disorder, citing specifically in vivo exposure therapy (exposure through a real-life situation),[15] which has greater effectiveness than imaginal exposure in regards to generalized anxiety disorder. The aim of in vivo exposure treatment is to promote emotional regulation using systematic and controlled therapeutic exposure to traumatic stimuli.[58] Exposure is used to promote fear tolerance.[59]

Exposure therapy is also a preferred method for children who struggle with anxiety.[60] Researchers suggest that it is cruical for children to start this form of therapy from an early age to provide effective treatment that will follow them through adulthood.[61]

### Other possible uses of exposure therapy

Exposure therapy has been posited as potentially helpful for other uses, including substance abuse disorders,[62] overeating, binge eating, and obesity,[63][64][65] and depression.[66][67] [68] </ref> Interventions such as H.O.M.E (How to Observe and Modify Emotions) have been created and are specifically designed to help regulate ones emotions and those that may be at risk for getting an eating disorder.[69] This also has the ability to help those that may be going through depression by allowing them to safely be exposed to certain triggers. Exposure therapy has also been found effective in treating separation anxiety and panic disorder.[70] In cases of separation anxiety, gradual exposure helps individuals become more comfortable with being apart from attachment figures. For panic disorder, exposure techniques can reduce sensitivity to physical sensations that might otherwise trigger panic attacks.

## History

The 9th century Persian polymath Abu Zayd al-Balkhi wrote about 'tranquilizing fear' by 'forcing oneself to repeatedly expose one's hearing and sight to noxious things' and to 'moved again and again near the thing it is scared of until it becomes used to it and loses its fear.'[71]

The use of exposure as a mode of therapy began in the 1950s, at a time when psychodynamic views dominated Western clinical practice and behavioral therapy was first emerging. South African psychologists and psychiatrists first used exposure as a way to reduce pathological fears, such as phobias and anxiety-related problems, and they brought their methods to England in the Maudsley Hospital training program.[24]

Joseph Wolpe (1915–1997) was one of the first psychiatrists to spark interest in treating psychiatric problems as behavioral issues. He sought consultation with other behavioral psychologists, among them James G. Taylor (1897–1973), who worked in the psychology department of the University of Cape Town in South Africa. Although most of his work went unpublished, Taylor was the first psychologist known to use exposure therapy treatment for anxiety, including methods of situational exposure with response prevention—a common exposure therapy technique still being used.[24] Since the 1950s, several sorts of exposure therapy have been developed, including systematic desensitization, flooding, implosive therapy, prolonged exposure therapy, in vivo exposure therapy, and imaginal exposure therapy.[24]

Exposure and response prevention (ERP) traces its roots back to the work of psychologist Vic Meyer in the 1960s. Meyer devised this treatment from his analysis of fear extinguishment in animals via flooding and applied it to human cases in the psychiatric setting that, at the time, were considered intractable.[72] The success of ERP clinically and scientifically has been summarized as "spectacular" by prominent OCD researcher Stanley Rachman decades following Meyer's creation of the method.[73]

## Possibly related psychological techniques

### Mindfulness

A 2015 review pointed out parallels between exposure therapy and mindfulness, stating that mindful meditation "resembles an exposure situation because [mindfulness] practitioners 'turn towards their emotional experience', bring acceptance to bodily and affective responses, and refrain from engaging in internal reactivity towards it."[74] Imaging studies have shown that the ventromedial prefrontal cortex, hippocampus, and the amygdala are all affected by exposure therapy; imaging studies have shown similar activity in these regions with mindfulness training.[74]

### EMDR

Eye movement desensitization and reprocessing (EMDR) includes an element of exposure therapy (desensitization), though whether this is an effective method or not, is controversial.[75]

### Other

Desensitization and extinction also involve exposure to a cause of disturbance.

### Research; Expectations violation

Research has been undertaken on the therapy impact of a focus on the mismatch between threat expectancy before exposure and what actually occurs in exposure, but this has not produced clearly positive results.[76][77][78]

## See also

* Catharsis
* EMDR
* Desensitization (psychology)
* Extinction (psychology)

Note: This topic belongs to "Psychology " portal

## Explanatory footnotes

1. ↑ For example, a person with panic disorder may be told to run in place, causing their heart to race, so that they can see that this feeling is not dangerous.

## References

1. ↑ "Mechanisms of fear extinction". Molecular Psychiatry 12 (2): 120–150. February 2007. doi:10.1038/sj.mp.4001939. PMID 17160066.
2. ↑ "Exposure Therapy for Posttraumatic Stress Disorder". Journal of Behavior Analysis of Offender and Victim: Treatment and Prevention 1 (4): 69–80. 2008. doi:10.1037/h0100457.
3. ↑ Huppert, Jonathan D.; Roth, Deborah A. (2003). "Treating obsessive-compulsive disorder with exposure and response prevention.". The Behavior Analyst Today 4 (1): 66–70. doi:10.1037/h0100012.
4. ↑ Forman-Hoffman, Valerie; Cook Middleton, Jennifer; Feltner, Cynthia; Gaynes, Bradley N.; Palmieri Weber, Rachel; Bann, Carla; Viswanathan, Meera; Lohr, Kathleen N. et al. (2018-05-17). ﻿Psychological and Pharmacological Treatments for Adults With Posttraumatic Stress Disorder: A Systematic Review Update﻿ (Report). Agency for Healthcare Research and Quality (AHRQ). doi:10.23970/ahrqepccer207. https://effectivehealthcare.ahrq.gov/topics/ptsd-adult-treatment-update/research-2018.
5. ↑ "Factors influencing the success of exposure therapy for specific phobia: A systematic review". Neuroscience and Biobehavioral Reviews 108: 796–820. January 2020. doi:10.1016/j.neubiorev.2019.12.009. PMID 31830494.
6. ↑ Himle, Joseph A.; Grogan-Kaylor, Andrew; Hiller, Matthew A.; Mannella, Kristin A.; Norman, Luke J.; Abelson, James L.; Prout, Aileen; Shunnarah, Angela A. et al. (January 2024). "Exposure and response prevention versus stress management training for adults and adolescents with obsessive compulsive disorder: A randomized clinical trial". Behaviour Research and Therapy 172. doi:10.1016/j.brat.2023.104458. PMID 38103359.
7. ↑ Song, Yuqi; Li, Dongxu; Zhang, Shuyu; Jin, Zirong; Zhen, Yuanyuan; Su, Yiyang; Zhang, Muzi; Lu, Liuyang et al. (November 2022). "The effect of exposure and response prevention therapy on obsessive-compulsive disorder: A systematic review and meta-analysis". Psychiatry Research 317. doi:10.1016/j.psychres.2022.114861. PMID 36179591.
8. ↑ Wynn, G.H.; Ursano, R.J. (2017). "Posttraumatic Stress Disorder". Reference Module in Neuroscience and Biobehavioral Psychology. doi:10.1016/B978-0-12-809324-5.05378-5. ISBN 978-0-12-809324-5.
9. ↑ 9.0 9.1 "International OCD Foundation | Exposure and Response Prevention (ERP)". https://iocdf.org/about-ocd/treatment/erp/.
10. ↑ Cure and care of neuroses: theory and practice of behavioral psychotherapy. New York: Wiley. 1981. ISBN 978-0-471-08808-0. [page needed]
11. ↑ "Is exposure a necessary condition for fear-reduction?". Behaviour Research and Therapy 19 (3): 227–232. 1981. doi:10.1016/0005-7967(81)90006-1. PMID 6117277.
12. ↑ Behavioral Modification: Principles and Procedures (4th ed.). Thomson/Wadsworth. 2008. p. 552.
13. ↑ "Exposure and fear-reduction". Behaviour Research and Therapy 21 (2): 151–152. 1983. doi:10.1016/0005-7967(83)90160-2. PMID 6838470.
14. ↑ "Behaviour therapy in phobic and obsessional disorders". Psychiatric Developments 1 (4): 351–365. 1983. PMID 6144099.
15. ↑ 15.0 15.1 15.2 15.3 "Exposure Therapy for Anxiety Disorders". Psychiatric Times 28 (9). 6 September 2011. https://www.psychiatrictimes.com/view/exposure-therapy-anxiety-disorders. Retrieved 2021-09-22.
16. ↑ Ramsey, Kesley A.; Essoe, Joey Ka-Yee; Boyle, Nathan; Patrick, Ainsley K.; McGuire, Joseph F. (2025-08-01). "Immersive Virtual Reality Exposures for the Treatment of Childhood Anxiety" (in en). Child Psychiatry & Human Development 56 (4): 1117–1128. doi:10.1007/s10578-023-01628-4. ISSN 1573-3327. https://doi.org/10.1007/s10578-023-01628-4.
17. ↑ Bilek, Emily L.; Meyer, Allison E.; Tomlinson, Rachel; Chen, Carol (2025-02-01). "Pilot Study of Self-Distancing Augmentation to Exposure Therapy for Youth Anxiety" (in en). Child Psychiatry & Human Development 56 (1): 153–165. doi:10.1007/s10578-023-01540-x. ISSN 1573-3327. PMID 37231323. PMC 10212740. https://doi.org/10.1007/s10578-023-01540-x.
18. ↑ "Prolonged exposure therapy: past, present, and future". Depression and Anxiety 28 (12): 1043–1047. December 2011. doi:10.1002/da.20907. PMID 22134957.
19. ↑ "Exposure therapy". https://my.clevelandclinic.org/health/treatments/25067-exposure-therapy.
20. ↑ 20.0 20.1 "What Is Exposure Therapy?". American Psychological Association (APA). https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy.
21. ↑ "Safety Behaviors". https://www.psychologytools.com/resource/safety-behaviors.
22. ↑ 22.0 22.1 "Delivering More Effective Exposure Therapy In CBT". https://www.psychologytools.com/articles/delivering-more-effective-exposure-therapy-in-cbt/.
23. ↑ 23.0 23.1 23.2 "Exposure and response prevention for obsessive-compulsive disorder: A review and new directions". Indian Journal of Psychiatry 61 (Suppl 1): S85–S92. January 2019. doi:10.4103/psychiatry.IndianJPsychiatry_516_18. PMID 30745681.
24. ↑ 24.0 24.1 24.2 24.3 24.4 Abramowitz, Jonathan S.; Deacon, Brett J.; Whiteside, Stephen P. H. (2011). Exposure Therapy for Anxiety: Principles and Practice. Guilford Press. ISBN 978-1-60918-017-1. [page needed]
25. ↑ "Ten Things You Need To Know To Overcome OCD" (in en-US). https://beyondocd.org/expert-perspectives/articles/ten-things-you-need-to-know-to-overcome-ocd.
26. ↑ "Treatment Planning II: Hierarchy Development and Treatment Engagement". Exposure Therapy for Anxiety: Principles and Practice. Guilford Press. 2011-03-14. ISBN 978-1-60918-017-1. https://books.google.com/books?id=pnoznH2c7esC&pg=PT103.
27. ↑ 27.0 27.1 27.2 "Practice guideline for the treatment of patients with obsessive-compulsive disorder". The American Journal of Psychiatry 164 (7 Suppl): 5–53. July 2007. PMID 17849776. http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/ocd.pdf.
28. ↑ "The best treatment for OCD is CBT which typically includes exposure and response prevention (ERP) and some degree of more cognitive interventions." "Relapse Prevention in the Treatment of OCD". https://iocdf.org/expert-opinions/expert-opinion-relapse-prevention/.
29. ↑ Steele, Dale W.; Caputo, Eduardo L.; Kanaan, Ghid; Zahradnik, Michael L.; Brannon, Elizabeth; Freeman, Jennifer B.; Balk, Ethan M.; Trikalinos, Thomas A. et al. (2024-12-06). ﻿Diagnosis and Management of Obsessive Compulsive Disorders in Children: A Systematic Review﻿ (Report). Agency for Healthcare Research and Quality (AHRQ). doi:10.23970/ahrqepccer276. https://effectivehealthcare.ahrq.gov/products/obsessive-compulsive-disorder/research.
30. ↑ Steele, Dale W.; Kanaan, Ghid; Caputo, Eduardo L.; Freeman, Jennifer B.; Brannan, Elizabeth H.; Balk, Ethan M.; Trikalinos, Thomas A.; Adam, Gaelen P. (2025-03-01). "Treatment of Obsessive-Compulsive Disorder in Children and Youth: A Meta-Analysis" (in en). Pediatrics 155 (3). doi:10.1542/peds.2024-068992. ISSN 0031-4005. https://publications.aap.org/pediatrics/article/155/3/e2024068992/200215/Treatment-of-Obsessive-Compulsive-Disorder-in.
31. ↑ Kim, Hyunsik; Wheaton, Michael G.; Foa, Edna B.; Simpson, H. Blair (May 2023). "Identifying trajectories of symptom change in adults with obsessive compulsive disorder receiving exposure and response prevention therapy". Journal of Anxiety Disorders 96. doi:10.1016/j.janxdis.2023.102711. PMID 37148799.
32. ↑ Wheaton, Michael G.; Rosenfield, Benjamin; Rosenfield, David; Marsh, Rachel; Foa, Edna B.; Simpson, H. Blair (October 2023). "Predictors of EX/RP alone versus EX/RP with medication for adults with OCD: Does medication status moderate outcomes?". Journal of Obsessive-Compulsive and Related Disorders 39. doi:10.1016/j.jocrd.2023.100850. PMID 38054078.
33. ↑ Simpson, Helen Blair; Maher, Michael; Page, Jessica R.; Gibbons, Carly J.; Franklin, Martin E.; Foa, Edna B. (March 10, 2010). "Development of a Patient Adherence Scale for Exposure and Response Prevention Therapy". Behavior Therapy 41 (1): 30–37. doi:10.1016/j.beth.2008.12.002. PMID 20171325.
34. ↑ Ong, Clarissa W.; Petersen, Julie M.; Terry, Carina L.; Krafft, Jennifer; Barney, Jennifer L.; Abramowitz, Jonathan S.; Twohig, Michael P. (April 2022). "The 'how' of exposures: Examining the relationship between exposure parameters and outcomes in obsessive-compulsive disorder". Journal of Contextual Behavioral Science 24: 87–95. doi:10.1016/j.jcbs.2022.03.009.
35. ↑ "Relapse Prevention in the Treatment of OCD". https://iocdf.org/expert-opinions/expert-opinion-relapse-prevention/.
36. ↑ "On the importance of identifying mechanisms and active ingredients of psychological treatments". Behaviour Research and Therapy 170. November 2023. doi:10.1016/j.brat.2023.104425. PMID 37913558.
37. ↑ Benito, Kristen G.; Walther, Michael (July 2015). "Therapeutic process during exposure: Habituation model". Journal of Obsessive-Compulsive and Related Disorders 6: 147–157. doi:10.1016/j.jocrd.2015.01.006. PMID 26258012.
38. ↑ "Maximizing exposure therapy: an inhibitory learning approach". Behaviour Research and Therapy 58: 10–23. July 2014. doi:10.1016/j.brat.2014.04.006. PMID 24864005.
39. ↑ "Inhibitory learning.". Clinical handbook of fear and anxiety: Maintenance processes and treatment mechanisms. American Psychological Association.. pp. 265–285. https://psycnet.apa.org/record/2019-52029-015.
40. ↑ "The Inhibitory Learning Approach to Exposure and Response Prevention". https://iocdf.org/expert-opinions/the-inhibitory-learning-approach-to-exposure-and-response-prevention/.
41. ↑ Lebois, Lauren A.M.; Seligowski, Antonia V.; Wolff, Jonathan D.; Hill, Sarah B.; Ressler, Kerry J. (7 May 2019). "Augmentation of Extinction and Inhibitory Learning in Anxiety and Trauma-Related Disorders". Annual Review of Clinical Psychology 15: 257–284. doi:10.1146/annurev-clinpsy-050718-095634. PMID 30698994.
42. ↑ Craske, Michelle G.; Treanor, Michael; Zbozinek, Tomislav D.; Vervliet, Bram (May 2022). "Optimizing exposure therapy with an inhibitory retrieval approach and the OptEx Nexus". Behaviour Research and Therapy 152. doi:10.1016/j.brat.2022.104069. PMID 35325683. https://resolver.caltech.edu/CaltechAUTHORS:20220318-999075000.
43. ↑ Brevers, Damien; Philippot, Pierre (3 November 2023). "An inhibitory retrieval approach for maximizing exposure therapy in elite sport". Journal of Applied Sport Psychology 35 (6): 941–959. doi:10.1080/10413200.2023.2166154.
44. ↑ 44.0 44.1 "It's all in the name: why exposure therapy could benefit from a new one". Current Psychology 42 (25): 21641–21647. June 2022. doi:10.1007/s12144-022-03286-6. PMID 35669210.
45. ↑ "Barriers to the use of exposure therapy by psychologists treating anxiety, obsessive-compulsive disorder, and posttraumatic stress disorder in an Australian sample". Journal of Clinical Psychology 79 (4): 1156–1165. April 2023. doi:10.1002/jclp.23470. PMID 36449416.
46. ↑ "Empirically supported psychological interventions: controversies and evidence". Annual Review of Psychology 52 (1): 685–716. 2001. doi:10.1146/annurev.psych.52.1.685. PMID 11148322.
47. ↑ "Cognitive mediation of clinical improvement after intensive exposure therapy of agoraphobia and social phobia". Depression and Anxiety 27 (3): 294–301. March 2010. doi:10.1002/da.20651. PMID 20037922.
48. ↑ 48.0 48.1 "Narrative Exposure Therapy (NET)". American Psychological Association. https://www.apa.org/ptsd-guideline/treatments/narrative-exposure-therapy.
49. ↑ "Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD) in adults.". Washington, D.C.: American Psychological Association. 2017. https://www.apa.org/ptsd-guideline/ptsd.pdf.
50. ↑ Bull, Chelsey; Steely-Smith, Mollee; Bossard, MeeSoh; Karlsson, Marie E.; Bridges, Ana J.; Zielinski, Melissa J. (February 2025). "To SHARE or not to SHARE: Exploring incarcerated women’s decisions about enrolling in exposure-based group therapy." (in en). Psychological Services 22 (1): 81–91. doi:10.1037/ser0000861. ISSN 1939-148X. https://doi.apa.org/doi/10.1037/ser0000861.
51. ↑ Rizzo, Albert; Rothbaum, Barbara O; Graap, Ken (2011). "Virtual reality applications for combat-related posttraumatic stress disorder". in Figley, Charles R.; Nash, William P.. Combat Stress Injury: Theory, Research, and Management. Routledge. pp. 183–204. ISBN 978-1-135-91933-7.
52. ↑ Rizzo, Albert; Roy, Michael J.; Hartholt, Arno; Costanzo, Michelle; Highland, Krista Beth; Jovanovic, Tanja; Norrholm, Seth D.; Reist, Chris et al. (2017). "Virtual Reality Applications for the Assessment and Treatment of PTSD". Handbook of Military Psychology. pp. 453–471. doi:10.1007/978-3-319-66192-6_27. Template:DTIC. ISBN 978-3-319-66190-2.
53. ↑ "Virtual reality exposure therapy for active duty soldiers". Journal of Clinical Psychology 64 (8): 940–946. August 2008. doi:10.1002/jclp.20512. PMID 18612993.
54. ↑ "A survey of psychologists' attitudes towards and utilization of exposure therapy for PTSD". Behaviour Research and Therapy 42 (3): 277–292. March 2004. doi:10.1016/S0005-7967(03)00138-4. PMID 14975770. https://digitalcommons.trinity.edu/cgi/viewcontent.cgi?article=1006&context=psych_faculty.
55. ↑ "Factors Associated with Choice of Exposure Therapy for PTSD". International Journal of Behavioral Consultation and Therapy 5 (3–4): 294–310. 2009. doi:10.1037/h0100890. PMID 22545029.
56. ↑ 56.0 56.1 56.2 "Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder". Journal of the American Academy of Child and Adolescent Psychiatry 51 (1): 98–113. January 2012. doi:10.1016/j.jaac.2011.09.019. PMID 22176943.
57. ↑ "Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents". The Cochrane Database of Systematic Reviews 2006 (4). October 2006. doi:10.1002/14651858.CD004856.pub2. PMID 17054218.
58. ↑ "Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis". Journal of Behavior Therapy and Experimental Psychiatry 39 (3): 250–261. September 2008. doi:10.1016/j.jbtep.2007.07.007. PMID 17720136.
59. ↑ "Instead of teaching patients to resist, control or "fix" their fear or anxiety, exposure is used to promote 'fear tolerance' given that fear and anxiety are universal, inevitable and safe." Exposure Therapy for Anxiety, Second Edition (2019), p18, Abramowitz, Deacon and Whiteside
60. ↑ "Factors associated with practitioners' use of exposure therapy for childhood anxiety disorders". Journal of Anxiety Disorders 40: 29–36. May 2016. doi:10.1016/j.janxdis.2016.04.001. PMID 27085463.
61. ↑ Ramsey, Kesley A.; Essoe, Joey Ka-Yee; Boyle, Nathan; Patrick, Ainsley K.; McGuire, Joseph F. (2025-08-01). "Immersive Virtual Reality Exposures for the Treatment of Childhood Anxiety" (in en). Child Psychiatry & Human Development 56 (4): 1117–1128. doi:10.1007/s10578-023-01628-4. ISSN 1573-3327. https://doi.org/10.1007/s10578-023-01628-4.
62. ↑ McHugh, R. Kathryn; Kosiba, Jesse D.; Chase, Alexandra R. (2022). "Exposure Therapy in the Treatment of Substance Use Disorders". Clinical Guide to Exposure Therapy. pp. 261–276. doi:10.1007/978-3-031-04927-9_14. ISBN 978-3-031-04926-2.
63. ↑ Boutelle, Kerri N.; Eichen, Dawn M.; Virzi, Nicole E. (2022). "Exposure Exercises for Overeating, Binge Eating, and Obesity". Clinical Guide to Exposure Therapy. pp. 299–316. doi:10.1007/978-3-031-04927-9_16. ISBN 978-3-031-04926-2.
64. ↑ University of Otago (2014-06-16). "Bulimia burden exposed" (in en). https://www.otago.ac.nz/profiles/bulimia-burden-exposed.
65. ↑ McIntosh, Virginia V.W.; Jordan, Jennifer; Carter, Frances A.; Luty, Suzanne E.; McKenzie, Janice M.; Bulik, Cynthia M.; Frampton, Christopher M.A.; Joyce, Peter R. (April 2005). "Three Psychotherapies for Anorexia Nervosa: A Randomized, Controlled Trial". American Journal of Psychiatry 162 (4): 741–747. doi:10.1176/appi.ajp.162.4.741. ISSN 0002-953X. PMID 15800147. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.162.4.741.
66. ↑ Hayes, Adele M.; Yasinski, Carly; Alpert, Elizabeth (2022). "The Application of Exposure Principles to the Treatment of Depression". Clinical Guide to Exposure Therapy. pp. 317–345. doi:10.1007/978-3-031-04927-9_17. ISBN 978-3-031-04926-2.
67. ↑ The Big Book of Exposures: Innovative, Creative, and Effective CBT-Based Exposures for Treating Anxiety-Related Disorders. Oakland, CA: New Harbinger Publications. 2020. ISBN 978-1-68403-373-7.
68. ↑ Handbook of Exposure Therapies Hardcover. Elsevier. 2006. ISBN 978-0-08-046781-8.
69. ↑ Gardini, Valentina; Grandi, Silvana; Tomba, Elena (January 2025). "A Novel Transdiagnostic Approach to the Prevention of Eating Disorders Using Virtual Reality: Preliminary Evaluation of the H.O.M.E. Intervention" (in en). Clinical Psychology & Psychotherapy 32 (1). doi:10.1002/cpp.70040. ISSN 1063-3995. PMID 39898880. PMC 11789710. https://onlinelibrary.wiley.com/doi/10.1002/cpp.70040.
70. ↑ "All You Need to Know About Exposure Therapy". https://anxietychecklist.com/exposure-therapy-anxiety.
71. ↑ Sustenance of the soul, al-Balkhi, p49
72. ↑ "Modification of expectations in cases with obsessional rituals". Behaviour Research and Therapy 4 (4): 273–280. November 1966. doi:10.1016/0005-7967(66)90023-4. PMID 5978682.
73. ↑ "The history of obsessive-compulsive disorder". http://www.ocdhistory.net/20thcentury/behaviortherapy.html.
74. ↑ 74.0 74.1 "The neuroscience of mindfulness meditation". Nature Reviews. Neuroscience 16 (4): 213–225. April 2015. doi:10.1038/nrn3916. PMID 25783612.
75. ↑ "Eye Movement Desensitization and Reprocessing for Post-Traumatic Stress Disorder". Society of Clinical Psychology. 6 March 2017. https://www.div12.org/treatment/eye-movement-desensitization-and-reprocessing-for-post-traumatic-stress-disorder/.
76. ↑ Pittig, Andre; Heinig, Ingmar; Goerigk, Stephan; Richter, Jan; Hollandt, Maike; Lueken, Ulrike; Pauli, Paul; Deckert, Jürgen et al. (Mar 1, 2023). "Change of Threat Expectancy as Mechanism of Exposure-Based Psychotherapy for Anxiety Disorders: Evidence From 8,484 Exposure Exercises of 605 Patients". Clinical Psychological Science 11 (2): 199–217. doi:10.1177/21677026221101379. https://journals.sagepub.com/doi/10.1177/21677026221101379.
77. ↑ "Maximizing expectancy violation and exposure outcomes in patients with PTSD". European Journal of Psychotraumatology 16 (1). 2025. doi:10.1080/20008066.2024.2447183. PMID 39773369.
78. ↑ Gromer, Daniel; Hildebrandt, Lea K.; Stegmann, Yannik (Jun 29, 2023). "The Role of Expectancy Violation in Extinction Learning: A Two-Day Online Fear Conditioning Study". Clinical Psychology in Europe 5 (2). doi:10.32872/cpe.9627. PMID 37732150. PMC 10508258. https://cpe.psychopen.eu/index.php/cpe/article/view/9627.

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Psychotherapy (list)

Schools|

| Psychodynamic|

* Psychoanalysis
* Adlerian therapy
* Analytical therapy
* Mentalization-based treatment
* Transference focused psychotherapy

|

Cognitive and
behavioral|

* Clinical behavior analysis
* Acceptance and commitment therapy
* Functional analytic psychotherapy
* Cognitive behavioral therapy
* Cognitive therapy
* Dialectical behavior therapy
* Mindfulness-based cognitive therapy
* Rational emotive behavior therapy

Humanistic|

* Emotionally focused therapy
* Existential therapy
* Focusing
* Gestalt therapy
* Logotherapy
* Person-centered therapy

Other|

* Art therapy
* Dance therapy
* Feminist therapy
* Music therapy
* Narrative therapy
* Play therapy
* Reality therapy
* Systemic therapy
* Transactional analysis
* List

Integrative|

* Eclectic psychotherapy
* Integrative psychotherapy
* Multimodal therapy
* Transtheoretical model

Approaches|

* Brief psychotherapy
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* Online counseling
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* Self-help
* Support groups

Research|

* Clinical formulation
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* Common factors theory
* Discontinuation
* History
* Practitioner–scholar model

Techniques|

| Behaviour therapy|

* Aversion therapy
* Chaining
* Contingency management
* Shaping
* Stimulus control
* Token economy
* Counterconditioning
* Desensitization/Exposure therapy
* Systematic desensitization

|

Other individual therapy|

* Autogenic training
* Biofeedback
* Cognitive restructuring
* Emotion regulation
* Free association
* Homework
* Hypnotherapy
* Modeling

Group psychotherapy|

* Co-therapy
* Couples therapy
* Family therapy
* Psychodrama
* Sensitivity training

People|

* Philippe Pinel (1745–1826)
* Josef Breuer (1842–1925)
* Sigmund Freud (1856–1939)
* Pierre Janet (1859–1947)
* Alfred Adler (1870–1937)
* Sándor Ferenczi (1873–1933)
* Carl Jung (1875–1961)
* Ludwig Binswanger (1881–1966)
* Melanie Klein (1882–1960)
* Otto Rank (1884–1939)
* Karen Horney (1885–1952)
* Harry Stack Sullivan (1892–1949)
* Fritz Perls (1893–1970)
* Anna Freud (1895–1982)
* Donald Winnicott (1896–1971)
* Wilhelm Reich (1897–1957)
* Milton H. Erickson (1901–1980)
* Jacques Lacan (1901–1981)
* Erik Erikson (1902–1994)
* Carl Rogers (1902–1987)
* Viktor Frankl (1905–1997)
* George Kelly (1905–1967)
* Rollo May (1909–1994)
* Virginia Axline (1911–1988)
* Carl Whitaker (1912–1995)
* Albert Ellis (1913–2007)
* James Bugental (1915–2008)
* Joseph Wolpe (1915–1997)
* Virginia Satir (1916–1988)
* Aaron T. Beck (b. 1921)
* Salvador Minuchin (1921–2017)
* Hans Herrman Strupp (1921–2006)
* Paul Watzlawick (1921–2007)
* Haim Ginott (1922–1973)
* Ogden Lindsley (1922–2004)
* Arthur Janov (1924–2017)
* Eugene Gendlin (1926–2017)
* R. D. Laing (1927–1989)
* Jean Baker Miller (1927–2006)
* Otto F. Kernberg (b. 1928)
* Nathan Azrin (1930–2013)
* Irvin D. Yalom (b. 1931)
* Arnold Lazarus (1932–2013)
* Lorna Smith Benjamin (b. 1934)
* Marsha M. Linehan (b. 1943)
* Vittorio Guidano (1944–1999)
* Les Greenberg (b. 1945)
* William R. Miller (b. 1947)
* Steven C. Hayes (b. 1948)
* Michael White (1948–2008)
* Jeffrey Young (b. 1950)
* Peter Fonagy (b. 1952)

Associations|

* Association for the Advancement of Psychotherapy
* Association for Applied Psychophysiology and Biofeedback
* Association for Behavioral and Cognitive Therapies
* Association for Behavior Analysis International
* European Association for Psychotherapy
* Society for Psychotherapy Research
* World Council for Psychotherapy

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