Matthew D. Jacofsky, Psy.D., Melanie T. Santos, Psy.D., Sony Khemlani-Patel, Ph.D. & Fugen Neziroglu, Ph.D. of the Bio Behavioral Institute, edited by C.E. Zupanick, Psy.D. and Mark Dombeck, Ph.D.
It was demonstrated that phobias could be learned through paired association, and reinforced through avoidance and escape. Scientists hypothesized that what could be learned could potentially be un-learned using these same principles. A common type of behavioral therapy is called exposure and response prevention therapy. It was developed as a direct result of the classical and operant conditioning research. For some disorders, the two components (exposure and response prevention) are most effective when used together. For other disorders, they may be applied separately, or together.
Exposure simply means facing or confronting one's fears repeatedly until the fear subsides. This occurs because of habituation (explained below). Response prevention means refraining from engaging in typical avoidance or escape behaviors when faced with a feared situation. This is necessary so that these maladaptive behaviors are no longer reinforced (See also operant conditioning and avoidance learning.)
The effectiveness of exposure therapy relies upon a behavioral concept called habituation. Habituation is the process by which a person's behavioral and sensory response diminishes over time after repeated exposure to a particular stimulus. We've all experienced habituation. Have you ever visited friends who lived nearby an airport, busy highway, or a train station? You wonder, how can they possibly concentrate or sleep with all that noise? Your friends may have felt the same way when they first moved in. However, after living there for a while, their sensory neurons just stopped reacting to the noise. They will probably tell you that they are so accustomed to the noise they no longer even hear it anymore. They've become habituated to it. Similarly, have you ever jumped into an ice-cold swimming pool only to feel comfortable after a few minutes? That's habituation at work.
Exposure therapy may be conducted using in vivo exposure (meaning real live exposure to the feared stimulus). It can also be conducted using imagination, or both. The use of imagination is particularly useful in cases of trauma, or other occasions when in vivo exposure is not practical. When imagination is used, the therapy is most effective when all five senses are included in the guided therapeutic exercises. Whether in vivo exposure or imaginal exposure, individuals are encouraged to repeatedly face the anxiety-producing stimulus until habituation occurs. In this way, they no longer experience the same degree of anxious distress.
Once habituation occurs, the fearful behavior will eventually be extinguished. This concept is based on the classical conditioning. Evidence suggests that individuals learn to become afraid of neutral stimuli (needles, doorknobs, rats, etc.) as a result of the paired association between a neutral, conditioned stimulus (CS) and fear-inducing stimuli (UCS). A behavior will be extinguished, (i.e., the fear is eliminated) simply by reversing that process. In other words, the fear can be eliminated by unlearning, or un-pairing, the association between the CS and UCS. For example, a person with social anxiety (social phobia) may associate parties with the dread of excruciating embarrassment. By repeatedly facing social situations, the person can learn that nothing terrible happened. Then, the fear will be extinguished.
Causing people to remain in the presence of fearful situations is called exposure therapy. It is a highly effective and efficient way to treat anxiety. However, as you might imagine, it is difficult to get people to agree to this method. A variant form of exposure therapy is called systematic desensitization. This technique avoids overwhelming anxious people. First, they are taught age-appropriate relaxation methods. This helps them learn to relax in the presence of fearful situations. After relaxation has been mastered, they are gradually exposed to progressively more intense experiences of the situations they fear. This may include both imaginal and actual exposure. For instance, suppose someone is afraid of elevators. First, they might be asked to practice their relaxation techniques while looking a picture of an elevator. Next, they might be asked to relax while imagining getting into an elevator. Next, they practice relaxation as they step on and off a real elevator. Next, they might step on, allow the door to close and reopen, and then get off. Finally, they might ride one up one story, etc. This gradual, systematic approach enables them to become desensitized to the fearful situation. This occurs because of habituation.
A component frequently coupled with exposure therapy is called "response prevention." As the name implies, response prevention means to discontinue maladaptive coping responses such as avoidance and escape.
Exposure and response prevention is an extremely effective treatment for anxiety disorders. Its effectiveness rests on scientific principles tested in laboratory research (Deacon & Abramowitz, 2004; Norton & Price, 2007; Stewart & Chamblass, 2009). More specific examples of these treatment methods can be found in the Treatment of Anxiety Disorders Section.
Very recently, emerging research has forced researchers to rethink the classical learning theory model to accommodate new insights into how memory functions. It was once believed that once a memory was established, that memory was more or less permanent. It turns out that memories are not very permanent structures at all. Rather, memories are structures that can be edited and changed under certain circumstances. This process of editing previously established memories has been termed "memory reconsolidation." This term derives from the concept that when a memory is first established, that process of establishment is known as "consolidation." Research has increased our understanding of how to manipulate the reconsolidation process. This led to development of experimental forms of memory reconsolidation therapy. These promising therapies appear to be able to effectively and quickly delete emotional memories including those associated with certain anxiety disorders. More information on these experimental therapies is provided here.