Exposure is a family of evidence-based therapies that help you face what you fear in a planned, compassionate and scientific way. Instead of avoiding, escaping or neutralising anxiety, we design safe encounters with feared situations, thoughts, memories or sensations so your brain can learn a new story about threat. I integrate exposure with Acceptance and Commitment Therapy, Compassion Focused Therapy and trauma-sensitive mindfulness, so the work is paced, values-led and humane.

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Fear understandably makes us want to avoid what has scared us.  Then the brain makes us even more fearful because we don't have any new information to know we are now safe in the here and now.

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What exposure is aiming to do

• Reduce avoidance and safety behaviours that keep fear going

• Create powerful learning that feared outcomes are less likely, less catastrophic, or more cope-able than your threat system predicts

• Build confidence, skills and freedom to live in line with your values

 

Under the hood, exposure uses inhibitory learning. We are not trying to erase old fear memories. We are building new learning that competes with fear: “I can handle this”, “the outcome is different than I expect”, “if anxiety rises it also falls”.

 

Core principles of effective exposure

• Assessment and formulation. We map triggers, feared outcomes, safety behaviours and what matters to you. Exposure is then tailored to your life, culture and nervous system.

• Informed choice and consent. You choose the pace. We collaborate, not push.

• Expectancy violation. Each exercise is designed to test a specific prediction your threat system makes.

• Sufficient dose. Stay with the exposure long enough for anxiety to peak and naturally decline, or for you to discover you can function with it present.

• Reduce safety behaviours. We fade or drop behaviours that prevent new learning, such as checking, reassurance, distraction or subtle neutralising.

• Variability. We mix up the order, locations and difficulty. Varied practice strengthens learning.

• Context and retrieval cues. We practise in different settings and use simple cues to help the new learning show up later.

• Attention to the feared stimulus. We keep attention on what is feared, not on self-soothing in ways that block learning.

• Compassion and values. Courage grows when the reason for doing this is clear and kind. We link every step to what matters to you.

• Review and refine. We measure what is changing and adjust promptly.

 

Types of exposure include in vivo (real-life), imaginal (in the mind), interoceptive (body sensations), and, when useful, virtual reality.

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Exposure therapy for specific phobias

Specific phobias are intense fears of particular objects or situations, for example flying, needles, vomiting, dogs or heights. Avoidance works short term but keeps the fear network strong. Exposure helps you approach gradually and safely.

 

How it works

1. Clear formulation of triggers, feared outcomes and safety behaviours

2. A personalised ladder of exposures from easier to harder items

3. Repeated, longer practice with coaching, until your confidence rises and avoidance drops

4. Generalise the gains to everyday life

 

Examples

• Flying. Watching take-off videos with sound, simulated boarding, seat practice, then real flights with reduced safety behaviours.

• Blood, injection, injury. Graduated exposure with applied tension to prevent fainting.

• Vomiting. Exposure to images, sounds, smells, then eating in public, travel and illness scenarios.

• Animals. Observing from a distance, approaching, touching and handling with guidance.

 

Typical length
Many specific phobias respond in a brief block, for example 4 to 8 sessions. Some can be treated in an intensive one-day format when appropriate.

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Exposure and Response Prevention (ERP) for OCD

OCD involves intrusive thoughts, images or urges and compulsions that temporarily reduce distress but strengthen the cycle. ERP is the gold-standard behavioural treatment. The logic is simple: approach the trigger and prevent the ritual so new learning can occur.

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How ERP works

• Identify obsessions, compulsions and reassurance patterns

• Build exercises that trigger the obsession, then refrain from rituals, checking and subtle mental neutralising

• Practise long enough to let discomfort rise and fall on its own, or to discover that feared outcomes do not happen or are handleable

• Repeat in varied ways and contexts, reducing safety behaviours

 

Examples

• Contamination OCD. Touch a “contaminated” surface and delay or skip washing. Prepare food after touching clean but feared items.

• Checking OCD. Intentionally leave the house without re-checking, photograph once, then close the album and go.

• Harm or sexual-orientation obsessions. Read or listen to scripts that state the feared thought, then carry on with chosen activity.

• Purely mental compulsions. Exposure with response prevention targets rumination, analysis, mental praying and covert reassurance.

 

What to expect

Discomfort is expected at first. With repetition, urges weaken, time lost to rituals shrinks and life expands. ERP is usually delivered over 12 to 20 sessions for moderate OCD, with daily home practice.

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Prolonged Exposure for trauma-related difficulties

Prolonged Exposure (PE) is an evidence-based treatment for post-traumatic stress difficulties. People naturally avoid reminders of trauma and parts of the memory. This makes sense in the short term, but it blocks processing and keeps the alarm stuck on high. PE helps you reclaim your life by approaching what has been avoided in a planned, supported way.

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Key components

• Psychoeducation and breathing retraining. Understand how trauma memories work and how anxiety rises and falls.

• In vivo exposure. Gradual approach to safe reminders you currently avoid, for example routes, sounds, places or activities.

• Imaginal exposure. Revisiting the trauma memory in session, aloud, in detail and in present tense, followed by processing. Sessions are recorded so you can listen between appointments.

• Values and reconnection. We link the work to the life you want after trauma, and build actions that reflect this.

 

Safety and readiness

PE is collaborative. We stabilise first if dissociation, self-harm, substance dependence or severe instability are present. Where needed, we integrate skills from ACT, CFT and DBT to support grounding, emotion regulation and compassion. You set the pace and keep consent throughout.

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Typical length
Often 8 to 15 sessions, usually weekly, with structured home practice.

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Interoceptive exposure for panic and health anxiety

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If bodily sensations are feared, we deliberately and safely recreate them so your brain can learn they are tolerable and time-limited.

• Spinning to produce dizziness

• Breathing through a straw to produce breathlessness

• Stair sprints to raise heart rate

• Holding a warm drink to notice flushing

 

We then practise staying with the sensations without escape, testing catastrophic predictions and fading safety behaviours.

 

Combining exposure with ACT, CFT and mindfulness

• ACT. We clarify values and use acceptance and defusion to unhook from anxious thoughts so you can take chosen action during exposure.

• CFT. We strengthen the soothing system, use compassionate imagery and reduce shame so you can face fears with warmth, not attack.

• Mindfulness. Present-moment skills help you notice urges, stay with the task and let waves of feeling rise and fall.

 

This integration makes exposure kinder and more sustainable, without diluting its effectiveness.

 

Common worries and helpful answers

• “What if my anxiety never comes down”. Sometimes it does not drop much during a single practice, yet you still build powerful learning by staying engaged without rituals.

• “Is distraction allowed”. We avoid strategies that prevent learning. If you must use a support initially, we fade it out as fast as is sensible.

• “What if an exposure is too much”. We step back, adjust the task and continue. Setbacks are data, not failure.

• “Will this erase my fear completely”. The aim is flexibility and freedom, not perfection. Fluctuations are normal. You will learn how to get back on track.

• “Is exposure cruel”. Done well, exposure is compassionate. You choose the goals, pace and steps. My job is to help you feel safe enough to be brave.

 

What sessions with me are like

• Clear formulation and a written plan

• Weekly practice with between-session tasks that fit your routine

• Measurement of progress that matters to you, for example time saved from rituals, places you can go, activities reclaimed, reductions in safety behaviours

• Sensitive adaptations for neurodiversity, health conditions and complex presentations

• Collaboration with your GP or psychiatrist when medication is part of your care

 

Who exposure can help

• Specific phobias

• Obsessive Compulsive Disorder

• Panic disorder and agoraphobia

• Social anxiety

• Health anxiety

• Post-traumatic stress difficulties

• Generalised anxiety where avoidance and reassurance are central

 

Preparing for exposure

• Sleep, nutrition and basic routines help your nervous system learn

• Identify a few supportive people who understand the plan and will avoid giving reassurance

• Schedule practice times and protect them like appointments

• Expect discomfort and plan self-care that does not block learning, for example gentle movement, time in nature, balanced activity

 

Short FAQ – Exposure based Therapies
 Is exposure safe?
Yes—done collaboratively with consent, pacing and clear goals. You are never pushed into anything
you have not agreed to try.
 

How long does it take?
Specific phobias often improve in 4–8 sessions; OCD and trauma protocols typically run 8–20 sessions
depending on severity.
 

Will I have homework?
Yes. Brief, structured practices between sessions build momentum and solidify learning.
 

What if I have a setback?
We treat setbacks as data, refine the plan and continue. Flexibility beats perfection.
 

Can this be done online?
Yes. Exposure, ERP and PE adapt well to video with clear planning and support

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Next steps

If exposure-based therapy sounds right for you, we can start with a careful assessment and design a first small task that is both meaningful and manageable. From there, we build momentum step by step, always linked to what matters to you.