White paper

Bia and Guided Exposure

William Schaller, Founder • willy@biajourney.com

https://biajourney.com/whitepaper

v1.1 July 2026

For questions or research partnerships, please reach out to willy@biajourney.com

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Purpose

Bia is a tool for digitally guided exposure for anxiety disorders like specific phobias, OCD, panic, and social anxiety. Rooted in evidence-based approaches, Bia implements a novel process we call guided exposure, a real-time adaptive algorithm that titrates exposure difficulty and prompts CBT/ACT and other evidence based tools, improving exposure adherence and efficacy. This paper establishes the motivation and methodology behind guided exposure.

Our first program-evaluation manuscript reviewing two years of anonymized self-guided results written in partnership with the University of Utah is pending review. We have presented at NASP, ADAA, and WCCBT in 2026.

Lack of Access to Effective Exposure Therapy

Exposure therapy, while having significant scientific evidence of its effectiveness, is misunderstood and underutilized. Forty five percent of providers report their reasons against using exposure as lack of training and/or fear of risk of harm, fear of damaging the therapeutic relationship, and high risk of client dropout (Kline et al., 2021). One of the primary reasons that exposure is underutilized is clinician negative beliefs about exposure, and often this is due to anxiety related to facilitating exposure (Frank et al., 2025). As a result, there is a lack of trained and willing exposure therapists, and access to exposure therapists is limited for clients who need it. Additionally, improperly delivering exposure therapy impacts its effectiveness. For example, exposure therapy can be less effective when the continued use of safety behaviors prevents crucial corrective learning. Exposure also loses effectiveness when exposure tasks are insufficiently challenging or excessively difficult, or when learning is not generalized across contexts. When delivered using evidence-based principles, however, exposure therapy is a straightforward, safe, and highly effective treatment for anxiety disorders (Craske et al., 2014) Modern day exposure therapy is done with a mix of in-session exposures and exposure homework the client is intended to do in between sessions. Research strongly shows the more exposure is completed the more effective the results. Homework exposure suffers from several issues. Anxiety negatively impacts critical reasoning and executive functioning skills, the exact skills required to execute exposure correctly (e.g without safety behaviors, avoidance, or over exposure). Lack of accountability, visibility into the process, and fear of next steps contribute to high drop out rates and low treatment success.

Prevalence and Impact of Specific Phobias

Specific Phobias are a form of anxiety disorder impacting up to 12% of the population. Phobias cause substantial chronic distress. Specific Phobias can cause substantial distress including hypervigilance, panic attacks, behavioral avoidance, eating rituals, avoidance, and more. Specific Phobia has a large impact on life decisions like work, travel, social engagements, avoiding pregnancy, and avoiding medical treatment (Veale, D. and Lambrou, C., 2006) Sufferers of phobia often don't seek treatment and have higher dropout rates than similar disorders, particularly due to fear of what is involved in treatment. In addition, therapists report not utilizing exposure in treatment of phobia despite understanding its role in recovery. Individuals with phobia report challenges accessing affordable care. Phobia is a substantial problem in need of improved treatment methods.

Research into effective treatment for phobia is challenging due to high levels of comorbidity, dropout, and small sample sizes. (van Hout & Bouman, 2012; Veale & Lambrou, 2006). Clients with phobia have much higher dropout rates, in part because of the clients' strong reaction toward what is involved in treatment (Boschen, 2007). Case studies show ERP (Ahlen, Edberg, Di, Schiena, & Bergström, 2015; de Jongh, 2012; Graziano, Callueng, & Geffken, 2010; Hunter & Antony, 2009; Maack, Deacon, & Zhao, 2013; Paulus & Norton, 2016), acceptance and commitment therapy (ACT) (Bogusch, L. M., Moeller, M. T., & O'Brien, W. H. ,2018), and cognitive behavioral therapy (CBT) can be effective treatments for phobia. However, for clients, finding a therapist they trust is challenging and takes significant time and money.

Bia

Bia is a website and app that provides lessons and exercises to learn and practice exposure techniques. Pre-built hierarchies of curated exposure content (images, videos, text, sounds, and more, tagged and filterable based on specific users needs) are easily personalized and adapted to user needs. Intended as a supplement to traditional therapy, Bia is a tool designed to lower treatment barriers and drop out rates by providing a safe, self driven, and progress oriented experience.

Gamification elements like reminders, achievements, practice streaks, and availability on mobile devices aim to lower the barrier to starting treatment and improve treatment adherence.

Guided Exposure

Bia's Guided Exposure is a novel algorithm that adapts exposure sessions based on users' subjective unit of distress (SUD) scores. Guided exposure emulates the adaptive actions a therapist might make during a therapy session, but is now made available to users at any time on their phone or computer. Guided Exposure is a technology innovation that adjusts exposure flow based on user discomfort to ensure proper ERP practice and improve recovery outcomes. An algorithm and dynamic content presentation aims to achieve the ideal SUDs curve to facilitate habituation and inhibitory learning.

A typical exposure hierarchy is a linear set of content and activities completed in order, however, order often changes during exposure or additional items are added as needed. Guided Exposure applied automatic 'difficulty' scaling. For example, viewing an image can be easier by making is smaller, blurry, and black and white. It can be made harder by asking the user to describe the image from memory after viewing or having the user click in the image where they are most uncomfortable.

A guided exposure session begins with easy content, progressing until the user reaches a discomfort of 6 or higher. Then, the triggering content is repeated but easier, varied, and revisited, until the user fully conquers it. Bia's guided exposure adapts to a users' reported subjective units of distress score (SUDs), adjusting flow through the hierarchy, repeating content, breaking content into incremental steps, and pausing exposure when needed, increasing the likelihood of successful habituation and inhibitory learning. Interactive and engaging activities are designed to keep the user focused on exposure including journaling, games, selecting, describing, reading, listening, watching, and more.

Key Concepts

Bia uses a journey, a set of chapters made up of lessons and exercises tracking users progress against a customizable hierarchy. Lessons teach users anxiety, OCD, and phobia concepts. Interactive exercises expose users to letters, words, images, sounds, videos, activities, in a dynamic environment automatically adjusting content based on discomfort level.

During exercises, users report their subjective units of distress (SUD) scores on a scale of 0-10. Bia's guided exposure algorithm then automatically adjusts by changing exposure content, prompting specific tools, among other dynamic responses.

Providers are able to connect to clients through our provider portal where they can personalize their hierarchy, assign homework, monitor SUDs and exercise activity.

Bia will help therapists deliver exposure treatments confidently.

Exposure is a scary and challenging treatment for both clients and therapists. Bia has lowered the client barriers with our self-guided, incremental exposure app as evidenced by our two years of anonymized results. Now, we aim to solve the therapist barriers with our provider portal. Bia offers a few key value adds to therapists.

We reduce drop outs. We provide pre-built curated hierarchies that start low and slow, delivered in guided exposure that prevent over exposure and the resulting drop outs.

We improve outcomes. Guided exposure provides guide rails that enforce clinical best practices of exposure both in session and during homework. Homework monitoring provides accountability that increases client follow through inbetween sessions.

We provide empirical evidence. SUDs data combined with bi-weekly symptom severity measures empowers providers with powerful insights. Per-session reports and Remote Therapeutic Monitoring (RTM) reports support both clinicians and organizations in their documentation process. We analyze exposure data from 80,000+ exercises to tweak and improve hierarchy order and structure.

Measuring Success

Bia measures users phobia severity using the APA Severity Measure For Specific Phobia at the start and at each milestone of the exposure hierarchy We use this as our primary measure of impact on users.

Users consistently report a reduction in anxiety symptoms after 2 weeks with continued improvements throughout the program with an average decrease of 13.6 out of 40 on the phobia severity scale.

SMSP-A Severity Over Time with Bia ● SMSP-A (0 to 40)

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Aggregate SMSP-A severity across Bia clients over the program (30.4 down to 10.0 on the 0 to 40 SMSP-A scale). Average peak SUDS on a client's first Bia exposure (5.11) vs their twelfth (3.01), 0 to 10 scale. Not a controlled trial; individual results vary.

Impact

Bia is designed to:

• Significantly lower the barrier to starting phobia treatment by placing the user in control of exposure from the comfort of their own phone or computer.
• Reduce dropout rates by gamifying exposure through visual progress, short activities, and mechanisms for daily practice.
• Improve outcomes for clients in exposure therapy by improving on traditional homework.

Research Status

Our first manuscript, a program evaluation paper reviewing the first two years of self-guided user data written in partnership with The University of Utah is current pending review. We are excited to share these results, and have several other projects in progress. If you are interested in partnering on exposure research, please reach out at willy@biajourney.com.

Data Privacy

Bia never shares or sells any user data to 3rd parties.

Bia users can delete their data (exercise/lesson input, entire account) at any time, and the data is permanently removed from the service. Historical reporting data (impact and frequency survey data) is anonymized and cannot be linked back to a user or email address. Bia users can export all of the data the service has linked to their email at any time.

Safety

Bia is not a replacement for therapy. Bia is a self-guided tool for learning about and practicing exposure that can be used with or without the aide of a therapist. We encourage clients to find and work with a therapist during their recovery and support this through our provider directory and therapist search features.

Bia employs crisis monitoring. If terms of harm or self-harm are detected, users and their providers may be alerted and crisis resources are provided in real time. To learn more, please visit https://biajourney.com/crisisMonitoring

References