Is Psychedelic-Assisted Therapy the Same as Exposure Therapy?

Trauma healing can take many forms, but two approaches that often spark curiosity and discussion are exposure therapy and psychedelic-assisted therapy. While both methods aim to help individuals process trauma, they are fundamentally different. Understanding how they work and where they intersect is essential for clinicians and clients seeking the most effective approach to healing.

What Is Exposure Therapy?

Exposure therapy is a well-established, evidence-based approach that is particularly effective for treating PTSD. It involves a structured, often manualized process where clients confront feared stimuli in a controlled and repeated manner. The goal is to reduce anxiety through habituation, desensitization, and cognitive restructuring.

Key elements of exposure therapy include:

• Repeated confrontation with trauma-related stimuli

• A focus on reducing avoidance behavior

• Building tolerance and mastery through graded tasks

  
  

Exposure therapy is top-down, meaning it engages the cognitive aspects of the brain to help clients process and restructure their trauma through predictable, structured tasks.

What About Psychedelic-Assisted Therapy?

Psychedelic-assisted therapy is not designed around exposure principles. Instead, it focuses on emotional and somatic experiences that are often spontaneous and deeply felt by the patient.

Key elements of psychedelic-assisted therapy include:

• Non-linear, emotionally driven sessions

• Somatic experiences of trauma and healing

• Client-directed rather than therapist-directed exploration

  
  

Rather than pushing clients to confront trauma head-on, psychedelics tend to soften psychological defenses, creating conditions where trauma may surface unexpectedly, often symbolically, archetypically, or viscerally. This approach fosters a deeper, experiential form of healing, where trauma is not merely revisited but felt in a way that calls for witness and integration.

Where Exposure Therapy and Psychedelic-Assisted Therapy Intersect

While exposure therapy and psychedelic-assisted therapy differ in structure and approach, they do share some overlapping benefits, particularly when it comes to trauma healing. In psychedelic-assisted therapy, clients may encounter trauma-related material, but this is not a structured confrontation. Instead, the re-engagement with trauma is often unexpected, emotionally immersive, and deeply embodied.

How they intersect:

• Both therapies can help reduce avoidance behaviors

• Both improve affect tolerance — the ability to stay present with difficult emotions

• Both can facilitate deeper emotional processing, though the mechanisms differ

  
  

Where exposure therapy achieves this through structured repetition, psychedelic therapy unlocks internal resources and emotional safety, allowing for spontaneous healing experiences. This approach, although non-linear, can result in similar outcomes, like a renewed capacity to sit with challenging emotions and memories.

A Polyvagal Lens

From a polyvagal perspective, exposure therapy often asks a system that’s already dysregulated (in fight/flight or freeze) to confront the threat again, with the hope of achieving safety through the threat. In psychedelic-assisted therapy, the medicine's state-shifting capacity helps clients enter ventral vagal safety, a "sweet zone" of social connection and receptivity, even as they revisit traumatic material.

Key differences from a polyvagal perspective:

• Trauma doesn’t get resolved in sympathetic arousal or dorsal shutdown. It heals when the system can hold both activation and connection. Psychedelics often create a physiological bridge to that “dual awareness.”

• Rather than pushing through resistance, psychedelic states invite co-regulation with the self, often via imagery, inner wisdom, or a felt sense of something greater.

  
  

In this sense, psychedelic-assisted therapy is polyvagal-informed by default. It's not about healing by tolerating more stress, but about finding safety to process what was once overwhelming.

A Somatic Lens

One of the most significant differences between exposure therapy and psychedelic-assisted therapy is the somatic experience. While exposure therapy often focuses on cognitive processing, asking clients to recount trauma and analyze it, psychedelic-assisted therapy invites a more physical experience.

Somatic differences:

• In exposure therapy, clients may recount traumatic events but rarely engage with the physical sensations stored in the body.

• In psychedelic-assisted therapy, trauma is often felt viscerally. Clients experience physical sensations like shaking, tightness, heat, or tears as the body processes what was once locked away.

  
  

Psychedelic therapy facilitates "bottom-up" processing, meaning it engages the body’s inherent wisdom to help release and process trauma without conscious effort. This approach often allows for the completion of "thwarted" stress responses, such as unexpressed screams or unprocessed physical reactions to past trauma.

Where exposure might say, “Describe the trauma,” somatic psychedelic work asks, “What is your body telling you now?”

Final Takeaway

At its core, psychedelic-assisted therapy is not exposure therapy. It doesn’t focus on forcing confrontation or desensitizing individuals to trauma. Instead, it creates conditions where trauma can emerge organically, in a safe and spacious environment, allowing the body and mind to process what they’ve been avoiding.

Where exposure therapy seeks to habituate the individual to their trauma, psychedelic-assisted therapy aims for liberation of what has long been held in the body and mind. 

When the body feels safe enough, it will often reveal what it’s been carrying, not so that you can tolerate it, but so you can finally release it. This is when true healing and transformation take place. 

Kate Schroeder, LPC, LMHC, NCC is a trauma-informed psychotherapist specializing in psychedelic-assisted therapy and integration. She writes about the intersections of trauma, consciousness, and transformation.