How Exposure Therapy Treats Post-Traumatic Stress Disorder

In Vivo, Imaginal, Interoceptive and Prolonged Exposure Methods

Senior man in therapy
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Exposure therapy has been found to effectively address the symptoms of post-traumatic stress disorder (PTSD), as well as symptoms of other anxiety disorders.

With this roundup of different forms of exposure therapy, find out which treatment is right for you.

What Is Exposure Therapy?

Exposure therapy is considered a behavioral treatment for PTSD. This is because exposure therapy targets learned behaviors that people engage in (most often the avoidance) in response to situations or thoughts and memories that are viewed as frightening or anxiety-provoking.

For example, a rape survivor may begin to avoid relationships or going out on dates for fear that she will be attacked again.

It is important to recognize that this learned avoidance serves a purpose. When a person experiences a traumatic event, he may begin to act in ways to avoid threatening situations with the goal of trying to prevent that traumatic experience from happening again.

In many ways, this avoidance is a safety-seeking or protective response. However, as this avoidance behavior becomes more extreme, a person's quality of life may lessen. He may lose touch with family or experience difficulties at work or in relationships.

In addition, avoidance can make PTSD symptoms stick around longer or even intensify. That is, because a person is avoiding certain situations, thoughts, or emotions, he doesn't have the opportunity to learn that these situations may not be quite as threatening as they seem.

In addition, by avoiding thoughts, memories and emotions, a person doesn't let himself fully process those experiences.

The goal of exposure therapy then is to help reduce a person's fear and anxiety, with the ultimate goal of eliminating avoidance behavior and increasing quality of life. This is done by actively confronting the things that a person fears.

By confronting feared situations, thoughts and emotions, a person can learn that anxiety and fear will lessen on its own.

So, how does a person actively confront feared situations, thoughts and emotions during exposure therapy? A number of methods may be used by a therapist. These are described below.

In Vivo Exposure

In vivo exposure refers to the direct confrontation of feared objects, activities or situations by a person under the guidance of a therapist. For example, a woman with PTSD who fears the location where she was assaulted may be assisted by her therapist in going to that location and directly confronting those fears (as long as it is safe to do so).

Likewise, a person with social anxiety disorder who fears public speaking may be instructed to directly confront those fears by giving a speech.

Imaginal Exposure

In imaginal exposure, a client is asked to imagine feared images or situations.

Imaginal exposure can help a person directly confront feared thoughts and memories. Imaginal exposure may also be used when it is not possible or safe for a person to directly confront a feared situation.

For example, it would not be safe to have a combat veteran with PTSD directly confront a combat situation again. Therefore, he may be asked to imagine a feared combat situation that he experienced.

Interoceptive Exposure

Interoceptive exposure was originally designed to treat panic disorder. However, there is evidence that it may be successful in the treatment of PTSD as well. It is designed to help people directly confront feared bodily symptoms often associated with anxiety, such as an increased heart rate and shortness of breath. The therapist may assist this by having a person (in a controlled and safe manner) hyperventilate for a brief period of time, exercise, breath through a straw or hold his breath.

Prolonged Exposure

Prolonged exposure therapy is a combination of the above three methods. It has been found to be very effective for PTSD sufferers and involves an average of 8 to 15 sessions for about 90 minutes per session. Prolonged exposure therapy consists of education about trauma and what you will be doing, learning how to control your breathing (interoceptive exposure), practicing in the real world (in vivo exposure) and talking about your trauma (imaginal exposure).

Finding a Therapist Who Does Exposure Therapy

As indicated previously, exposure therapy has been found to be a very effective treatment for PTSD. In addition, methods for delivering exposure therapy to people is continuing to advance. In particular, some therapists are beginning to use virtual reality technology to help people confront the things they fear most.

Yet, it is important to recognize that some people are hesitant to go through exposure therapy because it might sound scary to confront fears. Exposure therapy is like any other treatment for PTSD. It requires a tremendous commitment and can be difficult at times. A major part of most treatments for PTSD is confronting and connecting with feared situations, thoughts and feelings. The way in which this is done in each treatment simply differ.

Therefore, it is very important to find the right treatment and therapist for you. You can find out more information about treatment providers in your area who might offer exposure therapy through the Anxiety Disorder Association of America. 


Cahill, S.P., & Foa, E.B. (2005). Anxiety disorders: Cognitive-behavioral therapy section of Anxiety disorders. In B.J. Sadock, & V.A. Sadock (Eds.), Kaplan and Sadock's Comprehensive Textbook of Psychiatry, 8th ed., vol. 1 (pp. 1788–1799). Philadelphia: Lippincott Williams and Wilkins.

Keane, T.M., & Barlow, D.H. (2002). Posttraumatic stress disorder. In D.H. Barlow (Ed.), Anxiety and its disorders, 2nd edition (pp. 418-453). New York, NY: The Guilford Press.

Wald, J., & Taylor, S. (2007). Efficacy of interoceptive exposure therapy combined with trauma-related exposure therapy for posttraumatic stress disorder: A pilot study. Journal of Anxiety Disorders, 21, 1050-1060.

"Prolonged Exposure Therapy." U.S. Department of Veterans Affairs, PTSD: National Center for PTSD (2015).

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