• Dr. Nicole Amoyal Pensak

An Exposure a Day, Keeps the Doctor Away (for Anxiety)...

Updated: Mar 4, 2019


If you are one of the 40 million people (18.1%; per year) with anxiety in the United States, you’re in luck. Because anxiety is so common, effective treatments are available to help you manage your anxiety. While there technically is no “cure” for anxiety, there are great treatments to help bring your anxiety down to a manageable level. Technically, a cure for anxiety wouldn’t be helpful because anxiety serves a very adaptive function to help us survive (yes, I know it does not feel that way when you are having a panic attack).


The behavioral response to experiencing anxiety is to avoid. This makes sense, because anxiety is designed to protect us from danger. Thus, anxiety acts as an alarm system to alert us to danger, so we can avoid/ flee from what is dangerous. Evolutionarily speaking, we are wired this way to run from predators (as caveman did back in the day). However, rarely do we encounter such equivalent forms of danger in modern day times. Thus, we have developed faulty alarm systems that go off, are reinforced through avoidance, and then lead to anxiety disorders over time. Avoidance, while an intuitive response, actually exacerbates anxiety in the long-run. However, there is a very effective treatment for anxiety- Cognitive Behavioral Therapy with Exposure. CBT with Exposure helps you to gradually face your fears, going against the natural response to avoid the trigger when you are feeling anxious.



While exposure therapy is a very effective form of therapy for anxiety disorders, it is still not widely accessible to patients. There are many reasons why exposure therapy, although extremely effective, is not the standard of care. Some reasons include that many therapists are not specially trained in exposure-based therapies. In addition, exposure is counter intuitive and some therapists may be reluctant to offer exposure therapy because they are afraid of inducing anxiety in their patients. The untrained therapist will avoid this type of therapy. However, research supports that CBT with Exposure is an effective treatment for patients with anxiety.


Exposure is a systematic, gradual form of therapy that helps patients’ face their fears. The underlying mechanism of action is to desensitize an anxious response that is elicited by a stimuli or “trigger.” By repeated ‘exposure’ to various levels of the stimuli, the anxiety response is reduced over time- and this is called habituation. Some research suggests that habituation is not necessary during exposures. This means that even if anxiety is not reduced during exposures, 'new learning' while experiencing fear during exposures is effective. While the active ingredient in what makes exposures so effective in managing anxiety, the bottom line is that exposure is key.


For example, let’s say you are afraid of dogs. In CBT with Exposure therapy, you would first rank order a list of potential ‘exposures’ with dogs (from least anxiety provoking to most anxiety provoking). Then, you would complete the exposure activities in session and work your way up a hierarchy of exposures (again from least anxiety provoking to most anxiety provoking). Then, you would have to complete each exposure exercise long enough and then repeated enough times that the maximum anxiety rating during the exposures would be low (typically 3 or lower). (Again, this may or may not be necessary in some forms of exposure- for example acrophobia). In addition, some research suggests that variable exposures (e.g., not going in order of hierarchy can also be effective). A typical example of one order of exposures could be 1. to imagine petting a dog, 2. look at a picture of a dog, 3. be in the same room as a dog, and 4. finally, pet a dog. These exposures would be completed with a trained professional and over the course of several therapy sessions. *Do not try this at home because you could actually condition yourself to have more anxiety if you do not complete the exposures correctly. While this is an oversimplified description of exposure therapy, it is meant to portray the gradual desensitization process.


Exposure therapy is especially effective for treatment of Obsessive Compulsive Disorder, Post-traumatic Stress Disorder, Social Anxiety Disorder, Generalized Anxiety Disorder, Phobias, and Panic Disorder. If you are experiencing symptoms of anxiety and looking for effective treatment, search for a psychotherapist that has had specialized training in and conducts Cognitive Behavioral Therapy with Exposure based treatment.


Once you receive treatment, maintaining a certain level of exposure/ anxiety management is key. In general, try to push yourself to engage in activities that make you nervous or uncomfortable. You can try a One-Exposure-a-Day challenge! Remember, you have to stay in the uncomfortable situation long enough so that your initial peak anxiety comes down to almost no anxiety. Have an opportunity to give a speech in public? Take it! Raise your hand in class and participate. Delay washing your hands after shaking someone’s hand- if you are afraid of germs or contamination. Go to that party. Speak up in that meeting. Pitch that idea to your boss. Ask that special person out on a date. Hike that mountain. Run that 5k. You get the idea. In this way, essentially, you are building your resilience. That is the premise of exposure therapy. However, for anxiety disorders, it is much more in-depth and guided by a trained professional. If you have questions or would to see if Cognitive Behavioral Therapy with Exposure is right for you, contact Dr. Pensak for a free, brief consultation.


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NICOLE AMOYAL PENSAK PHD

LICENSED CLINICAL PSYCHOLOGIST

609-283-2056

210 Broad Street
Red Bank, New Jersey 07701

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