Exposure therapy is a key component of cognitive behavior therapy (CBT) for anxiety and related disorders. Research suggests that adherence to exposure, both in-session and between-session (i.e., via homework) is associated with improved outcomes in CBTs for anxiety disorders. This chapter provides a comprehensive framework for adhering to exposure therapy by integrating key principles from Emotional Processing Theory (EPT) and Inhibitory Learning Theory (ILT) to guide clinicians on how to conceptualize exposure therapy cases, develop treatment plans, and ultimately promote treatment engagement and optimize treatment efficacy. Readiness for change, safety behavior elimination, experiential avoidance, distress tolerance, and comorbidity are also discussed as they relate to potential barriers for adhering to an exposure therapy treatment plan. Evidence-based clinical strategies are also presented to provide a cohesive guide for clinicians to promote engagement in and maximize the effectiveness of exposure therapy for anxiety disorders and related conditions.