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Exposure Therapy in Oakland, CA (Bay Area)

Exposure therapy is an evidenced-based treatment for anxiety.  It involves working together to help you confront situations that you fear and avoid.  Although avoidance may reduce feelings of fear in the short term, it exacerbates fear in the long term.  The goal of exposure therapy is to practice experiencing a tolerable level of emotional and physiological discomfort while staying mindfully present.  This enables you to learn that the fear you have developed is disproportionate to the situation and that you can trust yourself to effectively manage your anxiety.  As you build confidence, you can overcome avoidance and live your life more fully.  Exposure therapy is a collaborative and supportive process.

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Exposure therapy for anxiety, phobias, and more. 

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Exposure therapy has been scientifically demonstrated to be a successful treatment, or treatment component, for a range of problems, including phobias, panic attacks, social anxiety, obsessive compulsive disorder, and generalized anxiety.

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  • What Are The Different Types of Exposure Therapy?
    Exposure therapy can be practiced in different ways and at different paces. The approach I use, called graded exposure, involves us working together to construct a fear hierarchy. The hierarchy is a list of your specific feared situations ranked according to difficulty. We begin with mildly or moderately difficult exposures, then progress to harder ones. There are several variations of exposure therapy including: In Vivo Exposure: directly facing a feared situation in real life Imaginal Exposure or Virtual Reality (VR) Exposure: vividly imagining the feared situation or using VR to simulate being in the feared environment Interoceptive Exposure: deliberately bringing on physical sensations that are harmless, yet feared, in order to learn that they are tolerable and safe Adapted from American Psychological Association Div. 12 (Society of Clinical Psychology)
  • What Makes Exposure Therapy Effective?
    Exposure therapy can be effective in several ways, including: Habituation: Over time, people find that their reactions to feared objects or situations decrease. Extinction: Exposure can help weaken your previously learned associations between feared objects, activities, or situations and bad outcomes. Self-efficacy: Exposure can help show you that you are capable of confronting your fears and can manage the feelings of anxiety. Emotional processing: During exposure, you can learn new, more realistic beliefs about feared objects, activities or situations, and can become more comfortable with the experience of fear. Adapted from American Psychological Association Div. 12 (Society of Clinical Psychology)
  • Will You Force Me To Do Things I Don’t Want To Do During Exposure Therapy?
    Exposure Therapy is a collaborative process. My goal as your therapist is to help you overcome your fear so that you can live your life more freely. In order to help you get there, I will encourage you to challenge yourself in therapy. However, I will never force you to do any exposure tasks that you do not feel willing and motivated to do. This is important for two reasons: 1) Your trust in me is essential for you to make progress. 2) Exposure therapy is simply not effective if you are “white knuckling” your way through your exposure tasks. The brain does not learn anything new or useful from this kind of experience. In order for exposure to be effective, you must be able to stay present and mindful of what is happening during the exposure task. This is when new learning occurs and how fear becomes more tolerable.
  • What Is Exposure And Response Prevention Therapy (ERP)?
    ERP is a type of Exposure Therapy that is specifically used to treat Obsessive Compulsive Disorder. This difference between Exposure Therapy and ERP is that with ERP we are not only gradually exposing you to the feared situation, we are also intentionally reducing or preventing the unhelpful responses (called compulsions) that you usually perform. You will learn more about how ERP works in the first few sessions of treatment.
  • What Can I Expect When I Commit To Exposure and Response Prevention Therapy for OCD?
    The process for OCD treatment is the same as described above, with the caveat that a thorough evaluation will likely require additional sessions at each stage described above. With OCD, in contrast to a single phobia, there are often many feared situations or “content areas.” For example, a person with OCD may be fearful of germs, of having violent thoughts, and of their physical environment being altered by others. In a case like this, we would need to assess each of these content areas and the treatment plan would be designed to treat all of them.
The Therepeutic Process for Exposure Therapy (and ERP Therapy)

Initial Evaluation for Exposure Therapy

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Sessions 1 - 3

The first few sessions will focus on education and assessment. During this period I will ask about the details of your specific phobia(s) or in order to help you identify the thoughts, physiological sensations, emotions, and behaviors that are reinforcing the cycle of fear. You will learn about your brain’s fear response (commonly called Fight or Flight) and how Exposure Therapy works to retrain your brain. The frequency of sessions during this phase of treatment ranges from 1-2 times per week, depending on availability and how quickly you want to move on to treatment planning.

 

Sessions 3 - 5

The next several sessions will focus on creating a treatment plan. The length of this phase of treatment depends on several factors including the number of phobias you want to address, your personal history and the complexity of how your phobia(s) are impacting your life, and whether other mental health issues need to be addressed prior to beginning exposure therapy. The frequency of sessions during this phase of treatment ranges from 1-2 times per week depending on availability and how quickly you want to move on to exposure sessions.


Additional Sessions of Exposure Therapy

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After the initial phase of education, assessment, and treatment planning, we will then shift to doing the exposure sessions. We will first do exposure tasks together in session so that I can guide you and give you feedback in real time. Once you have the hang of it, you will also do exposure tasks on your own for homework between sessions. The frequency of sessions during this phase of treatment ranges from 1-3 times per week, depending on the level of support you would like when doing exposure tasks (although we will gradually work towards you doing them independently).

 

Sessions during this phase of treatment are often longer than a usual 50 minute therapy session because we will meet to do exposures "in-vivo" (e.g., driving together on freeways or bridges, visiting the airport etc.). This phase of treatment can last anywhere from 4 sessions to 16 sessions (on average) depending on the issues you want to address, your motivation, and availability.

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