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For example, in the Harvard/Brown Anxiety Research Project, only 23% of treated patients reported receiving even occasional imaginal exposure and only 19% had received even occasional in vivo exposure.

Another factor may be that many health care professionals do not understand the principles of exposure or may even hold (usually unfounded) negative beliefs about this form of treatment.

Using exposure to internal cues, a patient with panic disorder can run in place to experience physiological sensations (eg, heart palpitations) that elicit anxious reactions, a patient with generalized anxiety disorder (GAD) can purposefully induce worry thoughts, a patient with PTSD can revisit traumatic memories, and a patient with OCD can intention-ally evoke intrusive and aversive thoughts.

With or without relaxation One of the earliest variations of exposure therapy was systematic desensitization, in which patients engage in imaginal exposure to feared stimuli while simultaneously undergoing progressive muscle relaxation.

At first, all treatments appeared equally efficacious; however, at 6 months’ follow-up, 32% of patients in the CBT group continued to maintain their treatment gains compared with 20% in the imipramine group and 24% in the combined-treatment group.

Foa and colleagues randomized patients with OCD to receive in vivo exposure and response prevention, clomipramine, or a combination of both.

The available research literature suggests that exposure-based therapy should be considered the first-line treatment for a variety of anxiety disorders.

In clinical practice, exposure-based therapies for anxiety disorders are underutilized, which highlights the need for additional dissemination and training.

We hope the dissemination of the theoretical mechanisms, practical applications, and empirical support for exposure-based therapies in this article will encourage mental health practitioners to embrace this modality as a viable and easily accessible option in the treatment of anxiety disorders.

Internal vs external Exposures can target internal and/or external cues.

Exposures to external cues include a spider-phobic patient handling a spider, or a height-phobic patient systematically approaching increasing heights in a skyscraper.