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Webinar: Psychological Approaches to Creating Healthy Media Habits. 5/24 – 1 – 4 pm. 3 CE. Register Now!

Effective Use of Intensive Exposure Treatment for Phobias


By Gwilym Roddick, DSW, LCSW

Millions of people suffer from phobias such as fear of flying, claustrophobia (including avoidance of tunnels, elevators or subways), or intense fear of certain types of animals. These problems can significantly interfere with people’s lives, strain personal and familial relationships, and impede both financial and career growth.  It can be a painful burden to carry, and often comes with a sense of embarrassment, feelings of shame, or social isolation.

People with phobias relating to travel (which includes fear of flying, bridges, tunnels, or the subway) can have limitations on work and social activities. Career potential and relationships are often affected.  Fear of flying, one of the most common phobias, can lead to a variety of serious problems for those who suffer.  Those who suffer from fear of flying often miss important events such as weddings, funerals, or graduations, and cause problems for their own family members by limiting travel opportunities.

Phobias CAN be effectively treated. Decades of research supports the validity of Cognitive Behavioral Therapy (CBT) and Exposure based therapies as the most effective forms of treatment for these issues.  Treatment typically involves two components: imaginal work and what are called ‘in vivo exposures’.  The former is where the person activates their fear response by simply thinking about the distressing situation, using imagery with a therapist.  In vivo exposures involve the client and therapist leaving the office and going to the place that brings on the fear (e.g. subway, driving over a bridge, or watching a video of being on a plane), purposefully engaging in the triggering experience. Both types of exposure happen gradually, so as not to overwhelm a person.  The goal is to increase a person’s tolerance for distress and for their brain to learn that these situations are not threatening or dangerous.

Avoidance is a key factor in maintaining anxiety disorders and phobias.  If a person avoids one of their triggering experiences, they feel better temporarily, and then have taught themselves that their fear is real and that the experience should be avoided.  The temporary relief they feel is a short-term solution and actually makes the anxiety worse.

Exposures are done with the guidance of an experienced therapist who has special training in this kind of therapy.  By exposing oneself to a distressing situation, new learning and corrective experiences occur and therefore the anxiety a person experiences is reduced.  It is like getting acclimated to a swimming pool that’s cold; in time, the brain and body adjust to the situation without experiencing it as significantly distressing.

A significant amount of research also supports the idea of frequent and intensive sessions to treat phobias.  Intensive therapy involves longer and more frequent therapy sessions, and includes sessions in locations out of the therapy office where the anxiety is most often elicited. At The Ross Center, we have therapists who will help clients perform their “exposures” in the area they experience distress (i.e. subway, elevator, airplane) every day of the week if necessary, to speed up the process of new learning. The initial sessions are intended to educate the client about anxiety, teach them techniques to challenge their anxious thoughts, and provide strategies that will relieve anxiety.  Eventually the therapist will join the client in real life situations where anxiety is strongest. The goal is to have the client engage in the activities they had previously been avoiding within a matter of a few weeks from the start of therapy.

Intensive therapy for phobias teaches the client that they can be in situations that are uncomfortable and scary, regardless of how they feel or what they think.  Anxious thoughts and feelings can be greatly reduced.  This is empowering and can be life changing, leading clients to opportunities that they had been missing out on for years.  The treatment is extremely effective and can be delivered in a short amount of time, leading to lifelong change.

If you have any questions about our intensive treatment process and how we can help you or your loved one, please do reach out. You don’t have to suffer anymore.

>>> Learn more about Intensive Treatment at The Ross Center 

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