What Exposure Therapy Reveals About The Mind-Body Connection

Exposure therapy, including VR-aided therapy, is now used to treat everything from back pain to irritable bowel syndrome.


Show, don’t tell. It’s the first rule of good creative writing. If you want readers to believe that your grizzled detective is volatile, you don’t tell them “Detective Jack Loosecannon is volatile,” you show him punching the police commissioner.

Exposure therapy operates on a similar principle. “You can talk with a patient for years about how spiders are harmless, but if that person’s brain associates spiders with terror, all that talk probably won’t make much difference,” says Arash Javanbakht, MD, a psychiatrist and director of the Stress, Trauma, and Anxiety Research Clinic at Wayne State University in Detroit. “The best way to counteract that association is to expose the brain to the feared situation.”

In Javanbakht’s lab, he and his colleagues use augmented reality to safely expose people to situations that cause them fear or anxiety, whether it’s a large social gathering or an encounter with a creepy creature. “With augmented reality, I can put a tarantula in your environment, and within an hour — 38 minutes on average — you’ll actually be able to touch a real tarantula,” he says.

Exposure therapy pokes holes in the unhelpful stories our brains have bought into.

If you want to see an example of exposure therapy in practice, watch this documentary video shot at the Boston University Center for Anxiety and Related Disorders. At first, when her therapist enters the room holding a snake, the woman in the video is so terrified that she literally cowers in her chair. Curled up in the fetal position, she trembles and sobs, unable to look at the snake without wincing. By the end of the session, she’s able to smile while the snake is draped around her neck.

“If we gradually expose the brain to the feared situation and nothing bad happens, the fear response in the brain reduces,” Javanbakht explains.

Exposure therapy is a mainstay of cognitive behavioral therapy (CBT), and it has long been used to treat phobias, anxiety disorders, PTSD, and other psychological problems that are grounded in worry or fear. But newer work has shown that exposure may help treat a much wider range of health problems — everything from chronic pain conditions to gut disorders.

A 2019 study in Behaviour Research and Therapy examined the usefulness of exposure therapy for the treatment of fibromyalgia, a medical condition that causes widespread pain, fatigue, and other debilitating symptoms “Patients with chronic pain tend to avoid activities associated with pain and distress, which has been shown to contribute to the maintenance of pain and disability,” the authors of that study wrote.

They showed that if people with fibromyalgia engaged in physical activity in a carefully controlled way (that is, with appropriate help and coaching from a clinician), they could effectively counteract these associations and reduce their symptoms. Similar studies have shown that exposure therapy can help treat chronic low-back painirritable bowel syndrome, and other medical conditions via the same mechanisms.

One of the overarching takeaways from this body of work is that much of what we feel is fueled by belief and expectation. Irving Kirsch, PhD, a psychologist and lecturer in medicine at Harvard Medical School, once put it to me this way: “What we experience — second to second, moment to moment — is an interaction of what’s coming in from the outside but also top-down processes from the cortex of the brain.”

Exposure therapy is so broadly effective because it goes to work on those top-down processes. It pokes holes in the unhelpful stories our brains have bought into, rendering those stories less (or un-) believable.

What you perceive is a simulation of the world your brain creates.

One of the most fascinating examples of this I’ve found comes from the research on phantom limb pain among people who have lost an appendage. (For example, a man who has lost an arm may feel excruciating pain in his missing hand, as though it’s being twisted or bent back.)

For years, doctors tried to treat phantom limb pain with drugs and other conventional pain remedies, often without much success. Then came mirror therapy. For the treatment, a mirror is positioned against a person’s body so that, when the patient looks down, the mirror creates the illusion of two intact limbs. By moving or manipulating the healthy appendage — for example, by clenching and then opening the hand — the person’s phantom limb pain often diminishes or resolves completely. Research has shown that, during mirror therapy, activity in the patient’s brain actually shifts, as though its pain circuits are being rewired. In this case, seeing really is believing, and that belief changes everything.

For a piece I wrote last year on the science of pain, the Dartmouth neuroscientist Tor Wager told me that, “What you perceive is always a gestalt — it’s a model or a simulation of the world that your brain creates.”

Exposure therapy, in all its forms, may be one of the most effective ways to challenge and change our unhelpful mental models. We’re only scratching the surface of how best to put it to use.

Reprinted with permission of the author from Medium.com.

Markham Heid is a long-time contributor at TIME and other media outlets, who writes mostly about health. Markham grew up in Michigan, but these days lives in southwest Germany.

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