Live exposure. direct confrontation of feared situations

In vivo exposure is one of the most fundamental and effective techniques within exposure therapy for anxiety disorders.

It consists of the person directly, gradually, and systematically confronting the situations, objects, or activities that they fear and avoid in real life, with the goal of reducing anxiety and disconfirming catastrophic beliefs.

Principle of Direct Coping

The basis of in vivo exposure is the direct confrontation with the phobic stimulus or anxiety-provoking situation in a safe and controlled environment, rather than resorting to imagination or symbolic representations.

The goal is for the person to experience the situation as it would occur in their everyday life.

For example, if a person has a fear of dogs, in vivo exposure would involve being in the presence of real dogs, perhaps starting with a small, calm dog at a distance, and gradually progressing to closer interactions or with larger dogs.

Graduality and Hierarchy

In vivo exposure is carried out following the previously developed hierarchy of feared situations.

It begins with items in the hierarchy that provoke a low or moderate level of anxiety, and only advances to more difficult items when anxiety at the lower levels has significantly decreased through habituation.

This gradual progression is crucial for the person to feel capable of facing the exercises and to avoid an overwhelming experience that could be counterproductive.

Duration and Repetition

For in vivo exposure to be effective, each exposure session must be long enough to allow anxiety to decrease noticeably (within-set habituation).

Leaving the situation when anxiety is at its peak reinforces avoidance.

Furthermore, exposures must be repeated frequently (inter-set habituation) until the feared situation no longer provokes a significant anxiety response or this is manageable.

Regular practice is essential.

Avoidance Response Prevention

During in vivo exposure, it is essential that the person refrain from engaging in subtle avoidance or safety-seeking behaviors, as these prevent the person from learning that the situation is safe or manageable on its own.

The therapist helps identify and eliminate these behaviors.

In vivo exposure, although it can generate anxiety in the short term, is one of the most powerful tools for overcoming fears in the long term,It allows the person to learn through direct experience that they can face what they fear and that their catastrophic predictions do not come true.