Exposure therapy is considered one of the most effective evidence-based treatments for phobias, panic disorder, and avoidance-related anxiety.

I offer two formats for Exposure Therapy: weekly outpatient therapy and intensive outpatient therapy. Both approaches are effective and I will be happy to help you determine which is the best fit for you during our consultation call. 1) Weekly Outpatient Therapy (virtual or in-person) I meet with Exposure Therapy clients a minimum of once per week. This cadence provides sufficient time for you to complete exposure homework between sessions while still being frequent enough to maintain motivation and make timely adjustments to the treatment plan based on your progress. Meeting more frequently (2x per week) can also be helpful in certain circumstances and I would be happy to discuss different options with you. This approach works best for clients who feel confident that they can do exposure homework on their own (with support to get you started) and who want to do therapy alongside other commitments in their life. 2) Intensive Outpatient Therapy (virtual or in-person) For clients who want to overcome their fears and anxiety within a shorter timeframe, I offer customized intensive therapy plans. These treatment plans are tailored to your specific needs and consist of multiple (3+) Exposure Therapy sessions per week to help you reach your goals sooner. For these treatment plans, sessions can be anywhere from a standard length (50 minute) up to a half or full day session. This approach works best for those who have flexibility in their schedule (or who are currently taking time off school/work) and can commit their time and resources to focusing on treatment. If you are interested in an accelerated treatment plan please reach out to learn more. Examples of Extended Sessions: - 75 minute or 90 minute session to practice riding BART, the bus, or the ferry together - 75 minute or 90 minute session to practice driving on freeways and bridges together - Half day session to practice going to the airport, checking in, going through security etc. together - Full day session completing a round trip flight to nearby destination (e.g. LAX, RNO) together

Exposure therapy can be practiced in different ways and at different paces. The approach I use, called graded exposure, involves us working together to construct a fear hierarchy. The hierarchy is a list of your specific feared situations ranked according to difficulty. We begin with mildly or moderately difficult exposures, then progress to harder ones. There are several variations of exposure therapy including: In Vivo Exposure: directly facing a feared situation in real life Imaginal Exposure: vividly imagining and describing a feared situation, sometimes using scripts to help make the experience feel more real Interoceptive Exposure: deliberately bringing on physical sensations that are harmless, yet feared, in order to learn that they are tolerable and safe Adapted from American Psychological Association Div. 12 (Society of Clinical Psychology)

Exposure therapy can be effective in several ways, including: Habituation: Over time, people find that their reactions to feared objects or situations decrease. Extinction: Exposure can help weaken your previously learned associations between feared objects, activities, or situations and bad outcomes. Self-efficacy: Exposure can help show you that you are capable of confronting your fears and can manage the feelings of anxiety. Emotional processing: During exposure, you can learn new, more realistic beliefs about feared objects, activities or situations, and can become more comfortable with the experience of fear. Adapted from American Psychological Association Div. 12 (Society of Clinical Psychology)

Initial Evaluation: During the initial evaluation (usually 1-2 sessions) I will take a history of the problem and do an assessment of how it is impacting you in the present. I will ask about the details of your specific phobia(s) to help you identify the thoughts, physiological sensations, emotions, and behaviors that are reinforcing the cycle of fear. You will learn about your brain’s fear response and how Exposure Therapy works to retrain your brain. The next sessions (usually 1-2) will focus on creating a treatment plan and an exposure hierarchy (a list of exposure tasks to help you overcome your fears). The length of this phase of treatment depends on several factors including the number of phobias you want to address, the degree to which your phobia(s) are impacting your life, and whether other mental health issues need to be addressed prior to beginning Exposure Therapy. ​Exposure Sessions: After the initial evaluation we will begin to work through your treatment plan and exposure hierarchy. We will first do exposure tasks together in session so that I can guide you and give you feedback in real time. Once you have the hang of it, you will also do exposure tasks on your own for homework between sessions. Sessions during this phase of treatment can be standard 50 minute sessions (virtual or in-person) or they may be extended if we choose to meet in-person for longer exposure tasks (e.g., driving together on freeways or bridges, going on the ferry, taking a flight). This phase of treatment can last anywhere from 4 sessions to 16 sessions (on average).

Exposure Therapy is a collaborative process. My goal as your therapist is to help you overcome your fear so that you can live your life more freely. In order to help you get there, I will encourage you to challenge yourself in therapy. However, I will never pressure you to do exposure tasks that you do not feel willing to do. This is important for two reasons: 1) Your trust in me is important and matters to me. 2) Exposure therapy is simply not effective if you are “white knuckling” your way through your exposure tasks. The brain does not learn anything new or useful from this kind of experience. In order for exposure to be effective, you must be able to stay present and mindful of what is happening during the exposure task. This is when new learning occurs.

ERP is a type of Exposure Therapy that is specifically used to treat Obsessive Compulsive Disorder. This difference between Exposure Therapy and ERP is that with ERP we are not only gradually exposing you to the feared situation, we are also intentionally reducing or preventing the unhelpful responses (called compulsions) that you usually perform. The process for OCD treatment is the same as described above, with the caveat that with OCD, in contrast to a single phobia, there are often many feared situations or “content areas.” For example, a person with OCD may be fearful of 1) germs, 2) having violent thoughts, 3) changes to their physical environment. In a case like this, we would need to adress each of these content areas and the treatment plan would be designed to treat all of them.

Yes. Depending on your goals, treatment may involve real-world in vivo exposures including driving, riding BART, airport practice, or a round trip flight.

That is extremely common. Treatment often includes interoceptive exposure as well as CBT and ACT strategies specifically designed for panic disorder and fear of bodily sensations.

Sessions can range from standard 50-minute appointments to extended sessions lasting several hours depending on treatment goals.

Yes. Extended sessions and full day intensives are available for transportation phobias, fear of flying, panic disorder, and related anxiety conditions.