Exposure therapyPart of CBT

Exposure in vivo

Anxiety does not disappear through avoidance. Exposure in vivo lets you experience that in practice. Step by step you face what triggers your anxiety, and you discover it is more bearable than you thought.

What is exposure in vivo?

Exposure in vivo literally means exposure in real life ("in vivo" is Latin for "in life"). You practise in reality with the situations, triggers or objects that make you anxious. Not in your head, but for real.

The mechanism behind exposure is twofold. The classic model speaks of habituation: if you stay in an anxious situation without walking away, the anxiety comes down by itself. Contemporary research adds inhibitory learning to that (Craske et al., 2014): it is not only about anxiety coming down, but about building new safety memory. Your brain does not learn that the situation is safe because the anxiety drops, but because you gather new experiences that contradict the old expectation. That combined effect is what makes exposure so effective.

Scientific basis: exposure therapy is one of the most researched and most effective treatments for anxiety disorders worldwide. Meta-analyses show large effects for phobias (Öst, 1989; Norton & Price, 2007). Recognised by the WHO, NICE and the Dutch Trimbos Institute.

How does exposure in vivo work?

Drawing up an anxiety hierarchy

Together with your provider you make a list of situations that trigger anxiety, ranked from mild to very demanding.

Starting at the bottom

You start with the situation that triggers the least anxiety, and stay until the anxiety noticeably drops. No walking away.

Repeating until it settles

The exposure is repeated until the situation hardly triggers anxiety any more. Then you move a step up the hierarchy.

Building up at your pace

Step by step you work towards the situations that seemed most frightening at the start. That process goes faster than most people expect.

Which complaints does exposure in vivo work for?

Specific phobiasSocial anxiety disorderPanic disorder with agoraphobiaAgoraphobiaOCDGeneralised anxiety disorderFear of flyingFear of drivingFear of heights

Related complaints

Anxiety disorder Phobia Social anxiety disorder Agoraphobia Claustrophobia

Related treatments

Imaginal exposure EMDR CBT ACT

Frequently asked questions

Is exposure in vivo not too frightening?

Yes, it is nerve-racking. But the method is built so that you are never thrown in at the deep end. You help set the pace, together with your provider. The gain is enormous compared with the temporary discomfort.

How long does a course of treatment take?

For single phobias, 1 to 5 sessions are sometimes enough. With more complex anxiety patterns or several anxieties it can take longer, on average 8 to 15 sessions.

What is the difference with imaginal exposure?

With exposure in vivo you really enter the situation. With imaginal exposure you do it in your imagination. Both are effective and they are sometimes combined.

Ready to face your anxiety?

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Sources: Öst (1989), Behaviour Research and Therapy · Norton & Price (2007), Behavior Therapy · NICE Guidelines