{"id":825548,"date":"2026-05-27T12:57:38","date_gmt":"2026-05-27T12:57:38","guid":{"rendered":"https:\/\/www.europesays.com\/us\/825548\/"},"modified":"2026-05-27T12:57:38","modified_gmt":"2026-05-27T12:57:38","slug":"can-any-fear-be-conquered-the-truth-about-exposure-therapy","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/825548\/","title":{"rendered":"Can Any Fear Be Conquered? The Truth about Exposure Therapy"},"content":{"rendered":"

<\/p>\n

\n Illustration: Olivier Heiligers\n <\/p>\n<\/p>\n

Not everyone with a phobia<\/a> can pinpoint the moment theirs began, but for Kelly, 36, the origin is clear: At age six, she came home from school to find her pet bird had escaped its cage. Kelly had one of those Barbie<\/a> heads with hair you could style, which she kept in its original packing. In her bedroom, she found that the bird had gotten into the plastic box and was so badly entangled in the doll\u2019s hair it couldn\u2019t free itself, despite its frantic flapping. Kelly tried to intervene but was too late; she watched her strangled pet convulse and die.<\/p>\n

She\u2019s spent much of her life since avoiding bird-laden places: the beach, outdoor cafes, city sidewalks. \u201cIt\u2019s embarrassing,\u201d she says, \u201cespecially in front of a client or on a date. When there\u2019s just a little bird on the curb and I stop and wait for someone to shoo it away, or I have to walk to the other side of the street, that\u2019s awkward.\u201d In her twenties, Kelly underwent a three-day exposure program with a therapist<\/a>, \u201cgoing over my childhood, the background of everything I\u2019d felt about birds over the years,\u201d she says. It became clear that wings flapping was what really terrified her, echoing her bird\u2019s dying spasms. On day three, the therapist took her to a parrot sanctuary where Kelly held and touched the birds, even allowing one to sit on her shoulder. It felt like a win.<\/p>\n

Many clinics and providers offer similarly speedy exposure therapy programs: a weeklong workshop or a one-session intensive. You\u2019ve likely seen ads for them on social media, among hundreds of reels and TikToks documenting self-led exposures: riding the tube on an empty stomach to address a fear of fainting, or doing the robot at a street performance to face social anxiety. And there\u2019s plenty of clickbait about Nicole Kidman\u2019s fear of butterflies, which she tried to treat herself by visiting the Museum of Natural History\u2019s butterfly vivarium.<\/p>\n

When undertaken with the help of a clinician, ET\u2019s success rate is well-known to be high\u2014estimated at up to 90 percent. But \u201csuccess\u201d in this context means feeling a reduction in fear upon completion of the program, a definition that belies a difficult and underpublicized reality of ET: Its positive effects frequently wane with time. \u201cReturn of fear,\u201d the clinical term for when phobia patients backslide, occurs in as many as 62 percent of ET patients. Though few therapists lead with this truth, many patients chip away at their phobia for years, not days or weeks, and return to treatment on and off for the rest of their lives. Some are so disheartened that they give up on ET altogether.<\/p>\n

Return of fear eventually came for Kelly. For a while after her triumphant trip to the parrot sanctuary, she passed pigeons on the sidewalk without concern. But she soon felt the old fears welling up, and within a matter of a few months, she was back where she started. She was a twentysomething in a new city, she says, and couldn\u2019t afford a second round of therapy. The frustration and disappointment were immense, and she still avoids birds in her daily life.<\/p>\n

A phobia is, in a sense, a set of expectations layered over a fear\u2014not just the feared thing itself, but also fear of the way it will make the patient feel. A person with a phobia of dogs might think, If I see a dog, I\u2019ll panic and I won\u2019t be okay. \u201cWe call this affect forecasting,\u201d says Matthew Free<\/a>, co-founder of the Columbus OCD and Anxiety Clinic in Ohio.<\/p>\n

The popular understanding of ET is that a patient can habituate to their phobic triggers via repeated encounters with it. But growing desensitized to what scares you isn\u2019t actually the goal, says Kevin Chapman<\/a>, Ph.D., founder of the Kentucky Center for Anxiety and Related Disorders in Louisville. Exposures are meant to show the patient that even if they do panic, they will survive it and return to feeling normal. \u201cYou want them to be anxious so their brain can learn that even if they\u2019re uncomfortable, they can tolerate it, and their feared outcome does not happen,\u201d says Chapman. The patient sees the dog, gets nervous, sees that nervousness isn\u2019t the end of the world, and then their anxiety abates. Rinse and repeat. This is the \u201cinhibitory learning model,\u201d in which the patient eventually learns the safety of the trigger so thoroughly that it inhibits their fear.<\/p>\n

Guiding a patient through ET in order to net this result requires vigilance and nuance, and Chapman posits that in many cases, return of fear is a result of poor clinical technique. For example, Kelly believes that because the parrot on her shoulder during her exposure therapy wasn\u2019t flapping its wings, the experience didn\u2019t address her phobia directly. Patients also need to be steered away from \u201csafety behaviors\u201d (actions that let them avoid their triggers) during their exposure. And these behaviors can be subtle. In an exposure, it might look like closing one\u2019s eyes, hiding, or seeking reassurance. Outside of an exposure, it might involve avoiding thinking about the trigger (if they\u2019re afraid to fly, they may try not to dwell on an upcoming trip) or avoiding things that make them feel similar to how they feel when confronted with that trigger (they get jittery on flights and coffee makes them jittery, so they avoid coffee). They do lots of checking (Googling \u201chow safe is flying\u201d six times before a trip), carry \u201csafety aids\u201d (a lucky charm in one\u2019s carry-on), or engage in rituals to prevent disaster (\u201cI ordered a ginger ale on my last flight and was okay, so I have to order ginger ale again\u201d). They numb out with alcohol or Xanax or distract themselves with a book or music. Such maneuvers may bring immediate relief, but long-term, they increase the chances of entrenching a phobia more deeply, confirming to the patient that the trigger is worth fearing and that the safety behaviors were what forestalled disaster.<\/p>\n

A prerequisite for effective ET is that the patient must collaborate on the nature of their exposures. Holly, 47, underwent a one-session intensive exposure session for her arachnophobia and found it unhelpful. \u201cIt was at a wildlife park,\u201d Holly says, \u201cand there was tarantula handling, and I got as far as allowing one to set a toe on my fingertip. But I wasn\u2019t brave enough to let it walk onto my hand. It was too much too soon.\u201d Varying the type of exposures is key, says Chapman. \u201cGraduated exposure, where you come up with a fear hierarchy and you start confronting each item on the hierarchy step by step, is what most clinicians do,\u201d he explains. If a patient is afraid of takeoff, they might first watch videos of planes ascending (imaginal exposure), then try virtual reality to experience it more directly (simulated exposure), then graduate to seeing planes take off at the airport before ultimately getting on a flight (in vivo exposure). Being pushed to take on too much\u2014hopping onto a puddle jumper in a windstorm, for example\u2014may cause a patient to shut down.<\/p>\n

Another predictor of return of fear is how hectic the patient\u2019s life is, says Martin Antony<\/a>, professor and chair of the psychology department at Toronto Metropolitan University. He says that when people experience a stressful life event, like a big change in location or their job or a death in the family, it can trigger a sudden return of fear. Phobias are also roughly twice as common in women as they are in men, and some research suggests that return of fear is also more common in women.<\/p>\n

One thing that isn\u2019t as predictive of return to fear as you might think is length of treatment. It\u2019s natural to assume that quick-turnaround therapies\u2014the weeklong course, the one-day workshop\u2014are less likely to provide durable results. But that\u2019s not necessarily the case. Free describes a study centered on a single-day exposure for people afraid of public speaking, in which researchers \u201clooked at what kind of changes occurred that would make it less likely that a month later people would have a return of fear,\u201d he says. They had a theory: If the patients could alter their thinking about public speaking entirely, not just learn to tolerate it, they would see long-lasting relief. \u201cThat\u2019s exactly what they found,\u201d Free says. \u201cIt wasn\u2019t just about overriding or gritting your teeth and bearing down but actually letting your mind be changed about public speaking itself.\u201d<\/p>\n

That\u2019s why the nature of the phobia matters. A speech can go well, helping the phobic person to see public speaking differently, \u201cbut it\u2019s hard to imagine people who are afraid of spiders or vomit going from a negative attitude about those things to a positive one,\u201d says Free. Spiders will always be creepy, because they creep; vomit will always be gross. With disgust-based triggers\u2014germs, blood, disease-carrying animals\u2014the phobia is double-layered, with disgust at the core and the fear of encountering it laid over top of that disgust. \u201cResearch shows that when phobias are closely related to disgust, they can take longer to treat,\u201d says Free. They\u2019re also more prone to return of fear.<\/p>\n

Carrie, 48, experienced the difficulty of treating disgust-based phobias firsthand. \u201cI\u2019ve had it as long as I can remember,\u201d she says of her emetophobia, or fear of vomit. \u201cOne time my stepdad was vomiting and I had a panic attack. We were pulled over on the side of the road, and I was down in the area of the car where your feet go, crouched in a ball, covering my ears.\u201d<\/p>\n

It was during college\u2014a time of high vomit potential, with its bars, parties, and Spring Break revelry\u2014that she sought help. But Carrie only made it through one session of exposure therapy, in which the therapist told her to watch the worst vomit scene in a movie that she could think of. \u201cShe gave me no tools,\u201d Carrie says. Carrie now has four kids, and when they get a stomach bug, she sleeps in a guest room, terrified one of them will enter her bedroom to say they\u2019ve thrown up.<\/p>\n

Experts in exposure therapy say that despite the pervasiveness of return of fear, it shouldn\u2019t stop phobia patients from trying the treatment. Free says the 90 percent effectiveness stat exists because any progress, albeit temporary, is important: It shows the patient that they have the power to move the needle. Free also says that going back to therapy after a return of fear is less demoralizing than you might think. \u201cWhen people experience a return of fear a year or two years or five years later, we almost never have to start at the beginning,\u201d says Free. \u201cWe call them booster sessions. Usually, subsequent episodes of care are shorter because the patient has a good understanding of the condition, they\u2019ve just forgotten how to apply the skills or don\u2019t know how to apply them to a new situation.\u201d<\/p>\n

Several years ago, Ava successfully treated needle phobia, and now undergoes blood draws without incident. Though she does not recall being told she might experience a return of fear, it took her three tries to fully address the phobia. \u201cI\u2019d do a period of sessions,\u201d she says, \u201cand it would get better, but I didn\u2019t feel like I got all the way there. A few years later, I would return and have another course of sessions.\u201d The exposures were gradual, patient-informed, and well-suited to the aspect of needles that most triggered Ava: the moment the needle enters the vein.\u00a0 \u201cWe went from talking about blood tests, to looking at paraphernalia, to watching videos online,\u201d she says. \u201cAnd then the final, final thing was to go to the hospital to watch somebody get a blood test and have one done myself.\u201d When she arrived, a stern but kind nurse made Ava draw blood from the nurse\u2019s own arm. The pair still keep in touch. \u201cIt was a mix of her being this soft, motherly figure, but also being a strong woman and empowering me,\u201d Ava says. She also now makes sure to get regular blood draw\u2014a step she hadn\u2019t taken after the first several rounds of ET.<\/p>\n

That\u2019s the key, says Free, who cautions that it\u2019s not just the clinician who has to put in careful work to prevent return of fear. \u201cPeople who practice the skills do a lot better,\u201d he says. In other words, get the treatment, then continue taking flights and donating blood and holding spiders. Therapy is a beginning. It\u2019s what follows\u2014the living you do\u2014that makes the difference between freedom and fear.<\/p>\n

Stay in touch.<\/p>\n

Get the Cut newsletter delivered daily<\/p>\n

Vox Media, LLC Terms and Privacy Notice<\/p>\n

By submitting your email, you agree to our Terms<\/a> and Privacy Notice<\/a> and to receive email correspondence from us.<\/p>\n


\n See All<\/p>\n

<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Illustration: Olivier Heiligers Not everyone with a phobia can pinpoint the moment theirs began, but for Kelly, 36,…\n","protected":false},"author":3,"featured_media":825549,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","_share_on_mastodon":"0"},"categories":[36],"tags":[197809,4637,339089,153592,339090,210,1184,517,1800,32821,2192,67,132,68,3149,139029],"class_list":["post-825548","post","type-post","status-publish","format-standard","has-post-thumbnail","category-mental-health","tag-audio-article","tag-body","tag-emetophobia","tag-exposure-therapy","tag-germophobes","tag-health","tag-medicine","tag-mental-health","tag-pain","tag-phobias","tag-self","tag-united-states","tag-unitedstates","tag-us","tag-wellness","tag-where-does-it-hurt"],"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/116646659061709303","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/825548","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=825548"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/825548\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/825549"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=825548"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=825548"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=825548"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}