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Imaginal exposures can also be useful for confronting fears of worst-case scenarios (eg, patients with obsessive-compulsive disorder [OCD] who imagine that they might contract a deadly illness, patients with social phobia who imagine that they are being ridiculed) to reduce the aversiveness of the thought.Exposure therapy is defined as any treatment that encourages the systematic confrontation of feared stimuli, with the aim of reducing a fearful reaction.For example, in the Harvard/Brown Anxiety Research Project, only 23% of treated patients reported receiving even occasional imaginal exposure and only 19% had received even occasional in vivo exposure.

For example, initial exposure to ocean water can be cold.

Because of the apparent importance of interoceptive exposure (ie, learning to tolerate uncomfortable physical sensations), relaxation exercises aimed at decreasing these sensations may actually attenuate the outcome of therapy, in much the same way as does the use of as-needed short-acting benzodiazepines.

examined the effects of single-session in vivo exposure (that lasts 1 to 3 hours) for patients with specific phobias.

At posttreatment follow-up (after an average of 4 years), 90% of these patients still had significant reduction in fear, avoidance, and overall level of impairment and 65% no longer had a specific phobia.

Barlow and colleagues investigated the effects of interoceptive exposure with components of cognitive restructuring (cognitive-behavioral therapy [CBT]), imipramine, and a combination of the two in patients with panic disorder.

At first, all treatments appeared equally efficacious; however, at 6 months’ follow-up, 32% of patients in the CBT group continued to maintain their treatment gains compared with 20% in the imipramine group and 24% in the combined-treatment group.