Exposure therapy involves repeated, prolonged, and systematic confrontation with certain objects or situations that trigger anxiety or fear responses, and learning to tolerate the anxiety associated with these triggers without engaging in avoidance or safety behaviours (i.e., behaviours which reduce the anxiety) [728, 729]. The triggers that induce anxiety can be objects (e.g., food), situations (e.g., open spaces), cognitive (e.g., memories, intrusive thoughts), or physiological (e.g., dizziness) [730]. The nature of the exposure therapy can be in vivo (e.g., physically touching a light switch), in the imagination (e.g., confronting images of loved ones dying), or recalled (e.g., details of a specific memory). In cases where in vivo is not possible or feasible, due to either a lack of access to the situations associated with anxiety or safety concerns, exposure via virtual reality may be used [729].
There are different types of exposure therapy which have been tailored for the treatment of specific disorders, such as exposure response therapy (ERP) for OCD and prolonged exposure (PE) for PTSD [729]. Regardless of the type of exposure therapy, this technique concurrently weakens the association between triggers and anxiety arousal, and avoidance or safety behaviours and anxiety reduction (i.e., exposure therapy seeks to weaken the idea that anxiety will only reduce once avoidance or safety behaviours are performed [731–733]). Exposure therapy aims to help people tolerate the distress associated with triggers without engaging in avoidance or safety behaviours (e.g., AOD use; repetitive behaviours), and provides corrective feedback to challenge the fear response [730–732]. Common elements of exposure therapies include psychoeducation, building a stimulus or fear hierarchy (i.e., rating anxiety-provoking stimuli based on the amount of anxiety generated), and using this hierarchy to guide treatment intensity [730, 732].
Exposure therapy can be used to successfully treat OCD [731, 734], ED [735, 736], anxiety disorders (including those co-occurring with AOD use [737, 738]), and PTSD (including those co-occurring with AOD use [739–741]). Exposure therapy has also been used successfully to reduce relapse and cravings among people with alcohol dependence [742, 743], and reduce cravings among people who use cannabis [744], methamphetamines [745], and opiates [746]; however, this evidence is mixed and often limited by methodological factors (e.g., lack of active control groups [742, 743]). Clinicians wishing to deliver exposure therapies require specialised training before implementing.