According to the American Psychological Association (APA), there are four main types of exposure therapy, which include in vivo exposure, imaginal exposure, virtual reality exposure, and interoceptive exposure.
In vivo exposure is defined as directly facing a feared object, situation or activity in real life.
Imaginal exposure entails vividly imagining the feared object, situation, or activity.
Virtual reality exposure can include something as robust as being immersed in a simulation of the thing feared or simply looking at a photo depicting your fear.
And lastly, interoceptive exposure involves deliberately bringing on physical sensations that are harmless yet feared.
In vivo exposure
For much of my adult life, I have used in vivo exposure. Although there are many benefits to glean from this form of exposure, it can sometimes be extremely painful and even overwhelming at times, especially if you expose yourself to more than you are ready to handle.
Depending on how resilient you will be at conquering your fears, as well as the severity of your anxiety, in vivo exposure may be something that you’ll only want to practice down the road after you’ve mastered other, less painful forms of exposure therapy, such as imaginal, virtual reality, and interoceptive exposure.
These less intrusive forms of exposure therapy are great for people suffering from intense anxiety and who are extremely resistant to facing their fears. A lot of mental conditioning, skill acquisition, resiliency, and confidence must be acquired before we can realistically expect someone with Cynophobia to actively seek out dogs at the park to pet or someone with Aerophobia to jump on a flight across the country.
As enticing as it may be for some, this isn’t the place for hubris as exposing yourself to too much too soon can have horrible consequences, such as worsening your symptoms of anxiety, as opposed to improving them. With this being said, it may be best for you to start off slowly.
Depending on how adept you are at coping with your anxiety, as well as how severe your anxiety is to begin with, you may find some of the other forms of exposure to be superfluous. Nevertheless, for the sake of ensuring that your options are not limited, it’s important that you at least be aware of the existence of these other forms of exposure.
This form of exposure is a great alternative for people whose anxiety is far too severe for them to realistically engage in in vivo exposure. Just as the name implies, with imaginal exposure, you’ll use your imagination to “expose” yourself to that which you fear.
To practice this form of exposure you should first try and find a quiet place where you will be undisturbed. Then, you can sit down in a comfortable chair, close your eyes, and think. Think of something you’re highly afraid of, something that you think you would be unable to face in real life.
This may be something as simple as having a phone conversation with someone you’re unfamiliar with or giving a speech in front of thousands of people. You may be surprised as to how just thinking of your fears will make your heart rate rise, your rate of breathing increase, and your muscles tense up, but it shouldn’t as these are normal responses to fear.
The real magic happens after you have practiced imaginal exposure consistently for some time and begin to notice your anxiety dissipating overtime when exposed to the same thought(s). It is in these moments when it may be time for you to graduate to in vivo exposure.
Virtual reality exposure
The APA provides us with a perfect example of how virtual reality exposure can be implemented: Someone with a fear of flying might take a virtual flight in the psychologist’s office, using equipment that provides the sights, sounds, and smells of an airplane.
Although such resources are not to be expected among the pantheon of psychologists working in the US due to the parsimonious nature of our mental healthcare system, it is not implausible to conceive of it occurring in some facilities. This is especially true given the exponential advancement of technology, especially with virtual reality (VR).
In lieu of advanced VR helmets, one can procure similar benefits by watching videos of their fear or even by observing a photograph. For example, if you are absolutely terrified of public speaking, then perhaps you can “expose” yourself to your fear of public speaking by observing photographs of people giving speeches in front of large crowds.
Once your anxiety subsides and becomes manageable, then you can graduate by watching a video of someone giving a speech. Just as you would do with imaginal exposure, you can think of virtual reality exposure as your “training wheels” before you engage in in vivo exposure.
This form of exposure is much different than the previous three as it helps you to expose yourself not to that which you fear, but rather to the physiological symptoms of arousal you will inevitably experience when in a state of panic, such as having an increased heart rate, an increased rate of breathing, perspiration, muscle tension, and fatigue.
An example of interoceptive exposure in action, according to the APA, is someone with panic disorder being instructed to run in place in order to make his heart speed up, and therefore learn that this sensation is not dangerous or that it is not intimation that danger is nearby.
When we look closely, we find that there is absolutely no difference at all – physiologically speaking – with someone who is experiencing a full-blown panic attack and someone who is running a marathon. Both people are fatigued, sweating, experiencing muscle tension, have raised body temperatures, are breathing heavily, have higher blood pressure than they would have if they were at rest, have cotton mouth, and have a heart that appears to be pounding out of their chests.
The quintessential difference between these two individuals is that one person is dwelling on fear thoughts, while the other one isn’t. Anxiety exists in the mind only and is nothing more than a cluster of thoughts and subconscious beliefs, which in turn arouses our bodies to either fight, freeze, or flee.
The moment we understand this fact about anxiety, the sooner we will be able to unveil the illusoriness of this paralytic emotion. One of the best ways to practice interoceptive exposure is to exercise, especially by doing aerobic exercise like jogging or biking.
Excessive sweating, increased body temperature, and muscle tension are all byproducts of a panic attack and inducing these physiological changes in your body while in a safe environment and in a mental space of equanimity can train your mind to not react reflexively whenever such physiological responses manifest during times of high stress. The only meaning your racing heartbeat has or your cotton mouth has is that which you give it.