Imagine you have a fear that keeps you awake at night—something that makes your heart race and your palms sweat at the mere thought. Now, picture being allergic to a common food, something that everyone around you eats without a second thought, but for you, it’s a ticking time bomb. Both situations seem worlds apart, but what if we told you that the way we conquer these fears, whether in our minds or our bodies, is strikingly similar?
This is the story of two seemingly different worlds: the realm of the mind, where anxiety and phobias dwell, and the world of the immune system, where food allergies can lurk, ready to pounce. Yet, in both, a shared hero emerges—exposure. Through controlled and careful exposure, both our minds and bodies can learn to cope with what once seemed unbearable. Let’s explore how this approach unites Cognitive Behavioural Therapy (CBT) and Oral Immunotherapy (OIT) in a powerful dance of resilience and adaptation.
The Mind’s Battle: Cognitive Behavioural Therapy and Exposure
Step into the office of a therapist practicing Cognitive Behavioural Therapy. The air is calm, the lighting soft, a safe space for someone to confront their deepest fears. Here, a person might be terrified of flying, of spiders, or perhaps of social situations. The therapist gently guides them, not into a confrontation, but into a gradual meeting of their fears.
This is exposure therapy. It’s about baby steps, about starting small and systematically desensitising the mind to the feared stimulus. If someone fears flying, they might start by looking at pictures of airplanes, then listening to the sounds of an airport. Slowly, they might visit an airport, sit in a plane on the ground, and one day, take a short flight. Each step is a victory, a teaching moment for the brain: “This is okay. I can handle this.”
This process is not just about getting used to the fear; it’s about building up coping skills and changing the way the brain reacts. Each exposure helps rewire the brain’s response, turning a trigger for panic into something ordinary, something manageable. It’s like teaching the brain a new story, one where the protagonist can confront dragons and come out stronger.
The Body’s Battle: Oral Immunotherapy and Exposure
Now, shift your scene to a doctor’s office, where a child with a dairy allergy sits, their parent by their side, nervous but hopeful. Today, they begin a journey that could change their life and will, if they persist, their destiny too. They are starting Oral Immunotherapy, a treatment where they will eat tiny, minuscule amounts of their allergen, under careful medical supervision.
Like the gradual steps in CBT, OIT starts small. Tiny particles of dairy, barely visible, mixed into a solution. Over weeks and months, the amount increases—slowly, cautiously, but steadily — always in a doctor’s office for a larger updosing amount. The body, once primed to overreact to even a trace of dairy, begins to learn. It’s as if the immune system is being re-educated, taught that dairy proteins are not the enemy. Each dose is a step closer to a normal life, one where an accidental bite of a sandwich doesn’t mean a trip to the emergency room.
The stakes are high, and the process is careful. Just as a therapist watches for signs of overwhelming anxiety, doctors and their teams monitor for allergic reactions. It’s a dance of exposure and safety, of pushing boundaries but knowing when to hold back. And as with CBT, this exposure transforms—turning a severe allergic response into tolerance. It’s a metamorphosis that can last for a lifetime as long as the maintenance is continued on a daily basis to start with.
The Bridge Between Mind and Body
So, what binds these two treatments together? It’s the principle that facing a fear or an allergy, in a controlled, gradual way, can bring about profound change. Both CBT and OIT use exposure to teach a new narrative—to the brain or the immune system.
Safety and Control: In both therapies, safety is paramount. Exposure is never about throwing someone into the deep end; it’s about wading into the water, one step at a time. Whether in a therapist’s office or a medical clinic, the environment is controlled, the risks managed. The goal is to build confidence and resilience, not to overwhelm.
Gradual Exposure: Both CBT and OIT rely on a step-by-step approach. In CBT, the fear is broken down into manageable steps—a picture, a sound, a place. In OIT, the allergen is introduced in tiny, safe amounts. This gradual exposure helps the mind or body adjust, reducing fear or allergic response over time.
Desensitization: The power of repeated exposure lies in its ability to desensitize. In CBT, the mind learns that the feared object or situation is not as dangerous as it once seemed. In OIT, the immune system learns not to overreact. It’s like rehearsing for a play—the more you practice, the less nervous you are, until the performance feels natural.
Long-Term Change: Both therapies recognize that change doesn’t happen overnight. Just as a phobia is not cured after one session, an allergy is not tamed after one dose. It’s about long-term commitment—continuing to challenge the mind or body, maintaining the new normal that has been achieved.
Further reading:
Jones et al., Age-Related Food Aversion and Anxiety Represent Primary Patient Barriers to Food Oral Immunotherapy, 2024.
Hawkins et al., Treating Food Allergies with Modern Medicine, 2022.
Written by Dr Elizabeth Hawkins (PhD, MPH), food allergy psychologist, parent and founder of Food Allergy Hive platform, and Dr Nina Markovic Khaze (PhD), food allergy researcher and parent.
