Imaginal Exposure & Borderline Personality Disorder

Imaginal exposure is a technique that has shown promising results.

Man talking with therapist in therapy
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Question: What Can I Expect from Imaginal Exposure?

I’ve been in a dialectical behavior therapy program for the past three years and I’ve made a lot of progress. My therapist recently told me that he thinks I am ready to start working through some of the things from my childhood that probably led me to have borderline personality disorder in the first place. One way we will be working on this is called “imaginal exposure.” What does this mean, and how will this help me get over my past?


Imaginal exposure is one part of an approach to treatment called cognitive behavioral therapy (CBT). CBT therapy focuses on the idea that most psychological problems can be traced back to early learning experiences and those experiences affect how we interpret and react to things that happen to us later in life.

CBT is an empirically supported treatment - meaning it has been extensively researched and scientifically proven - for borderline personality disorder. BPD can be related to traumatic experiences.

Whether it was an experience from when you were a toddler that you have forgotten or something horrific that happened while a teenager, these incidents may be responsible for some or all aspects of your BPD.

In the CBT model, part of the reason that traumatic experiences from the past continue to trouble us today is that we learn to avoid thinking about them. This is natural, since past events can cause very painful emotions and we try not to live in the past.

But because we try to push away thoughts about the occurrences and avoid anything that reminds us of those experiences, we actually prevent ourselves from learning that the memories won’t harm us and that we are safe. Imaginal exposure aims to bring these experiences to the surface so that you can reframe how you think about and react to those memories.

By shifting those reactions, your reactions and behaviors in other situations may also be improved.

How Imaginal Exposure Works

Imaginal exposure is one way that CBT therapists address this problem. In imaginal exposure, you will be asked to imagine yourself back in one of your traumatic events. You will be asked to try to “re-live” the event in your mind’s eye, with all of the feelings, sensations, smells, sights and sounds that happened during the event.

Usually imaginal exposure is done in your therapy session. Your doctor will guide you through the process, helping to keep you on track and secure. They will be very careful not to push you to a point of fear or discomfort, as they understand how awful it can be to think of these traumatic experiences. It is important to do imaginal exposure under the guidance of a therapist -- this is not something to attempt on your own or with a friend.

Over time, you may find that you are having less intense reactions to the memories of the past events.

There is a great deal of research demonstrating that imaginal exposure is an effective way to reduce trauma-related symptoms. It doesn’t work for everyone, but many people have significantly fewer issues and can better manage their borderline personality disorder after completing exposure therapy.


Foa E, Hembree E, Rothbaum B. Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences, Therapist Guide. New York: Oxford University Press, 2007.

Nemeroff CB, Bremner JD, Foa EB, Mayberg HS, North CS, Stein MB. “Posttraumatic Stress Disorder: A State-of-the-science Review.” Journal of Psychiatric Research, 40(1):1-21, 2006.

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