How is Exposure Used to Treat Phobias?

How is Exposure Used to Treat Phobias
Dr. Roseann Capanna-Hodge

Dr. Roseann Capanna-Hodge

Phobias are intense and persistent fears of specific objects, activities, or situations that are not dangerous. Common phobias include fears of heights, spiders, enclosed spaces, flying, and public speaking. Exposure and Response Prevention therapy (ERP) can treat phobias and is very effective. It is also relatively brief than other forms of treatment.

ERP is a cognitive-behavioral therapy that aims to help individuals confront and overcome their fears by gradually exposing them to the feared situation or object in a controlled and supportive environment.

I recall working with an adorable 5-year-old named Autumn with red curly hair who had a phobia of bugs. Her phobia seemed to amplify quickly, and they didn’t know how to manage it before they came to me for exposure therapy and neurofeedback.  We started with pictures of bugs and then bug toys and gradually exposed her to walking on the grass without her shoes. Over time with a calm brain from neurofeedback and exposure therapy, we were able to give Autumn the tools to control her phobia.

Can Debilitating Anxiety be Cured?

While anxiety disorders can be chronic and persistent, they are highly treatable. Many effective treatments are available for anxiety disorders. But we'll focus on natural remedies, such as ERP therapy combined with neurofeedback, PEMF, nutrition supplementation, and lifestyle changes.

Treatment can significantly reduce the severity of symptoms of anxiety disorders and improve quality of life. Managing anxiety symptoms have helped people with this disorder lead fulfilling lives through proper treatment.

How is Anxiety Treated?

Anxiety disorders can be managed in different ways. However, the use of natural methods is recommended for a developing child. Medications have many side effects that could affect the brain. Some helpful ways to treat anxiety naturally are:

1. Cognitive Behavioral Therapy 

CBT is the most effective therapy for anxiety disorders. It involves working with a therapist to identify and challenge negative thought patterns while learning relaxation techniques and developing coping strategies to manage anxiety. Exposure and Response Prevention therapy combines CBT with exposures that are particularly effective for treating specific phobias and obsessive-compulsive disorders (OCD).

2. Neurofeedback

The concept of neurofeedback centers around training the brain to regulate itself. Dysregulation of the central nervous system can lead to various symptoms, including anxiety, depression, memory loss, inability to focus, and impulse control problems. Through neurofeedback, one can learn self-regulation, leading to a significant reduction in anxiety symptoms.

Neurofeedback operates at the subconscious level, which controls most of our behaviors. By measuring brainwave activity and providing reinforcement, an individual can learn to regulate their brainwave activity. 

Using computers reinforces positive brainwave changes subconsciously, resulting in a calm nervous system and the reduction or elimination of symptoms. Almost any brain, regardless of its level of function, can be trained to function better. Furthermore, studies indicate that the long-term effects of neurofeedback are stable over time (Russo et al., 2022).


When someone is experiencing clinical mental health disorders like anxiety, depression, or OCD, their brain and body can get stuck in a state of stress where the sympathetic nervous system is dominant. It can cause problems such as racing thoughts, negative thinking, muscle tension, physical pain, sleep disturbances, and digestive issues.

PEMF (Pulsed Electromagnetic Field) therapy can calm the brain, allowing individuals to focus and take action. CALM PEMF™ is an effective treatment option for anxiety, as it helps the body relax and reduces uncomfortable physical sensations.

Brain waves are more stable when the nervous system is parasympathetic and excitatory neurotransmitters decrease. As a result, it increases healthy brain chemicals like serotonin, GABA, and endorphins, which can benefit those with mental health conditions, such as anxiety and mood disorders.

One study aimed to investigate the effects of PEMF treatment on a 68-year-old female with moderate anxiety, small vessel ischemia, chronic low back pain, and neck pain. Sixteen one-hour PEMF sessions were administered over six weeks using a PEMF device.

The patient's outcome assessments showed improvements in the Brief Pain Index (BPI) scores, Patient Health Questionnaire (PHQ-9), and anxiety scores. The BPI scores decreased by 19%, the PHQ-9 scores improved by 73%, and the anxiety scores decreased by 60%. 

Additionally, the patient reported a more profound and restful sleep, reduced tinnitus, and increased alertness. The study suggests that PEMF therapy could benefit patients with similar conditions (Borges & Esposito, 2019).

4. Magnesium Supplementation

The body needs magnesium to produce energy and facilitate glucose breakdown for energy production, which is known as glycolysis, a mitochondrial function. In addition, the metabolic process of the brain, particularly concerning anxiety and social behavior, is closely tied to the availability of cerebral energy.

Magnesium synthesizes DNA, RNA, and the antioxidant glutathione, supporting the body's detoxification and immune system. Conversely, anxiety and mental illnesses are linked to oxidative stress and poor detoxification.

These properties of magnesium help soothe the brain and alleviate symptoms associated with any mental health condition, such as anxiety, mood disorders, obsessive-compulsive disorder, and attention-deficit hyperactivity disorder.

One study discusses the role of magnesium in brain function and its potential as a treatment for various neurological and psychiatric disorders, including anxiety, depression, and schizophrenia. 

Results show that magnesium in the brain affects neurotransmitter release and neuronal activity. Evidence also supports that magnesium supplements help treat anxiety disorders, as magnesium is crucial to brain function (Sartori et al., 2012).

5. Lifestyle Changes

Lifestyle changes, such as regular exercise, healthy eating, avoiding caffeine and alcohol, and stress management techniques can also help manage anxiety symptoms. Making lifestyle changes can have a positive impact on anxiety levels.

Improving physical health through regular exercise and healthy eating can help reduce anxiety symptoms. For example, exercising for 20 minutes helps release endorphins, improve mood, and decrease stress levels. In addition, a healthy diet of fruits and vegetables can reduce anxiety symptoms.

Another way to reduce anxiety is by managing stress. Stress management techniques like deep breathing, meditation, and yoga can effectively reduce stress levels, a common trigger for anxiety. Improving sleep is also essential for overall health and can help to reduce anxiety symptoms. Getting adequate sleep helps the body to restore itself and improve mental health.

Increasing social support is another way to reduce anxiety. A robust social support network can reduce feelings of anxiety and isolation while improving one's sense of belonging, which can help manage anxiety. Higher self-confidence also helps reduce anxiety levels.  

Can Anxiety Treatment Options be Used for Phobia?

Some anxiety treatments can be effective for phobias, as phobias can also be considered anxiety disorders. However, the effectiveness of exposure therapy may depend on the type of disorder and individual differences.

Cognitive-behavioral therapy is one of the most effective treatments for anxiety disorders and social phobias. CBT involves identifying and altering negative thought patterns and behaviors contributing to anxiety and phobias. This treatment can be used for specific phobias, such as fear of flying, social phobia, and fear of spiders, as well as generalized anxiety disorder.

Exposure-based therapies are effective treatments for phobias, which involve gradually exposing the person to the feared object or situation until the anxiety decreases. This approach can be combined with cognitive therapy sessions to address negative thoughts and beliefs related to the phobia.

It is important to calm the brain and combine it with psychotherapy to address phobias because the nervous is too activated to process language in a therapy session. When one is in fight, flight, or freeze, such as when activated by a phobia, using tools such as PEMF can support a regulated nervous system, which makes therapy much more effective. 

What is Exposure Therapy? 

As previously discussed, ERP is an area of CBT that involves gradually exposing individuals to the objects, situations, or memories that cause them anxiety or fear in a controlled and safe environment. ERP aims to help individuals learn to manage their fear or anxiety and eventually become less afraid of the things that once caused them distress.

Exposure is a type of therapy based on habituation, which means that repeated exposure to a fear or anxiety-inducing stimulus can decrease the fear response over time. Through exposure, individuals can learn to confront their fears while developing coping strategies to manage their anxiety.

Exposure therapy can be conducted in various ways, such as imagining the feared object or situation, viewing pictures or videos, or directly confronting it in real life. Exposure therapy is often done graduated or systematically, starting with less anxiety-provoking situations and gradually progressing to more challenging ones.

Exposure therapy is an evidence-based treatment for various anxiety disorders. Aside from anxiety and phobias, it can also be used for obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). It is typically done in conjunction with other types of therapy, such as cognitive restructuring, which involves challenging negative thought patterns and developing coping strategies.

Why Doesn't Exposure Therapy Always Work?

There are instances when ERP may not work as a phobia treatment. Lack of motivation or engagement is a factor that can affect the success of the treatment. Most treatment plans won't succeed if the individual is not fully committed or engaged. 

Severe avoidance behavior is another factor that can make ERP inappropriate as a first-line treatment, primarily when the individual engages in extreme avoidance behaviors such as refusing to leave their home. 

In the same way, co-occurring disorders such as depression or substance abuse may need to be addressed before starting ERP. In addition, individuals with a history of trauma may require additional support to address the trauma before beginning ERP. Finally, other factors, such as medical conditions or medication side effects, can also impact the effectiveness of ERP and need to be addressed accordingly.

Examples of Exposure Therapy for Different Types of Phobias

Examples of Exposure Therapy for Different Types of Phobias

In the sample cases below, a person is gradually exposed to the feared situation or object, with the therapist providing support and guidance throughout the process. With repeated exposure, the person's anxiety levels should gradually decrease, allowing them to overcome their phobia.

1. Fear of Flying

A person with an intense fear of flying might start by looking at pictures of planes, then progress to watching videos of takeoffs and landings, and eventually go on short flights, gradually increasing the length of the flights over time.

2. Fear of Spiders

A person with spider phobia might start by looking at pictures of spiders, then progress to watching videos of spiders, and eventually work up to being in the same room as a spider.

3. Fear of Heights

A person who fears heights might start by looking at pictures of high places, then progress to standing on a low balcony, and eventually work up to an elevated balcony or even a rooftop.

4. Fear of Public Speaking

A person who fears public speaking might start by practicing their speech in front of a mirror or a small group of friends, then progress to speaking in front of larger groups, and eventually give a presentation in front of a large audience.

Does Zoloft Help with Anxiety?

Zoloft (sertraline) is an antidepressant medication commonly prescribed to treat anxiety disorders, particularly generalized anxiety disorder, social anxiety disorder, panic attack disorder, and PTSD.

Zoloft works by increasing the serotonin levels of the brain, which is the neurotransmitter that helps regulate mood, reduce anxiety, and improve sleep. However, it usually takes several weeks for Zoloft to start working, and the dose may need to be adjusted over time to achieve the desired effect.

While Zoloft can be an effective treatment for anxiety, it is essential to note that it may not work for everyone, especially children, as it causes side effects like nausea, dizziness, headache, and insomnia, as well as more serious side effects.

How are Phobias Different from OCD?

Obsessive-compulsive disorder (OCD) and phobias are both clinical disorders, but they have significant differences in their symptoms.

The main difference between OCD and phobias is the nature of the anxiety-inducing object or situation. In OCD, anxiety is caused by intrusive thoughts or obsessions, which are repetitive and unwanted thoughts, images, or impulses that can be distressing and interfere with daily activities. These obsessions are often accompanied by compulsions, which are repetitive behaviors or mental acts performed to reduce the anxiety associated with the obsessions.

In contrast, phobias involve an intense and persistent fear of a specific object or situation that is not dangerous. The fear is often disproportionate to the threat posed by the object or situation. The person may experience panic attacks or avoidance behavior when exposed to the feared object or situation.

OCD vs. Phobias

OCD vs. Phobias:



Involves intrusive, unwanted, and repetitive thoughts or mental images

Involves intense, irrational fear or anxiety about specific objects, situations, or events

Results in compulsive, ritualistic behaviors or mental acts

Results in avoidance behavior or panic attacks when confronted with the phobic stimulus

Can cause significant distress and impairment in daily life

Can also cause significant distress and impairment in daily life

May involve multiple obsessions and compulsions, such as contamination fears and checking behaviors

Typically involves one specific fear or phobia, such as fear of spiders or heights

Often begins in childhood or adolescence

Can develop at any age, but more common in childhood

May be associated with comorbid conditions, such as depression or tic disorders

Less likely to be associated with comorbid conditions

Treated with ERP, cognitive-behavioral therapy (CBT) and medication, such as selective serotonin reuptake inhibitors (SSRIs)

Treated with exposure therapy and CBT, medication may be used in severe cases

Exposure and response prevention therapy (ERP) is a primary treatment

Gradual exposure to the phobic stimulus is the primary treatment

Family involvement in treatment is often essential

Family involvement in treatment may also be helpful

The goal of treatment is to reduce obsessions and compulsions, and improve daily functioning

The goal of treatment is to reduce fear and anxiety associated with the phobia and improve daily functioning

Why is Calming Anxiety the Key to Overcoming Phobias?

Calming anxiety is essential to overcoming phobias because anxiety is often the driving force behind a phobia.  As people with phobias are exposed to a feared object or situation, they may experience overwhelming anxiety, leading to avoidance behavior.

Exposure therapies help reduce anxiety and desensitize the person to fear. However, treating anxiety disorders and phobia may be ineffective if the person cannot remain calm during exposure. For that reason, calming anxiety becomes vital to overcoming phobias because it allows people to control their emotions and gradually confront and overcome their fear. 

It can involve learning relaxation techniques, such as deep breathing or progressive muscle relaxation, and developing coping skills to manage anxiety when it arises. With practice, the person can learn to tolerate the feared stimulus, object, or situation without experiencing intense anxiety or avoidance behavior, resolving the phobia.


Borges, B., & Esposito, S. (2019). Effects of PEMF (pulsed electromagnetic fields) treatment on a 68-year-old female with moderate anxiety, chronic neck and low back pain and small vessel ischemia. Frontiers in Neurology, 10.

Russo, G. M., Balkin, R. S., & Lenz, A. S. (2022). A meta‐analysis of neurofeedback for treating anxiety‐spectrum disorders. Journal of Counseling & Development.

Sartori, S. B., Whittle, N., Hetzenauer, A., & Singewald, N. (2012). Magnesium deficiency induces anxiety and HPA axis dysregulation: Modulation by therapeutic drug treatment. Neuropharmacology, 62(1), 304–312.

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Dr. Roseann is a Children’s Mental Health Expert and Therapist who has been featured in/on hundreds of  media outlets including, CBS, NBC, FOX News, PIX11 NYC, The New York Times, The Washington Post,, Business Insider, USA Today, CNET, Marth Stewart, and PARENTS. FORBES called her, “A thought leader in children’s mental health.” 

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She is the founder and director of The Global Institute of Children’s Mental Health and Dr. Roseann Capanna-Hodge. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Medicine Mental Health Provider (CMHIMP) and an Amen Clinic Certified Brain Health Coach.  She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America (ADAA) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF) International Society for Neurofeedback and Research (ISNR) and The Association of Applied Psychophysiology and Biofeedback (AAPB).

© Roseann-Capanna-Hodge, LLC 2023

Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.

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