How Does Exposure Therapy Work For Ptsd
When we hear the words exposure therapy, some extreme images might come to mind, such as peoples eyes being held open as they are forced to watch unsettling imagery or being compelled to sit in a room with something they fear. The reality of exposure therapy is quite different and, as a result, significantly less intimidating.
How can exposure to something that triggers a negative emotional response be leveraged to help a patient get over that response in a safe, healthy way? As it turns out, various forms of exposure therapy can be effective in treating PTSD, as well as phobias, OCD and other conditions. Here is an overview of what PTSD is and how exposure therapy is carried out as a treatment for it in a rehab setting.
Next Step For Ptsd Support
Psychiatrists, psychologists, and therapists may provide exposure therapy, and this, and the other various forms of cognitive behavioural therapy used to address PTSD are part of their toolbox. Following diagnostic interviews, the best ones can be combined to match the needs of each individual, so its best to speak to your therapist or GP about whether Prolonged Exposure Therapy is right for you, and they can guide you from there.
Its important to note, that while choosing your PTSD recovery path you need to address both the symptoms and the underlying condition. NICE guidance updated in 2018 recommends the use of trauma focused psychological treatments for Post Traumatic Stress Disorder in adults, specifically the use of Eye Movement Desensitisation Reprocessing and trauma focused cognitive behavioural therapy .
Please remember, these arent meant to be medical recommendations, but theyre tactics that have worked for others and might work for you, too. Be sure to work with a professional to find the best methods for you.
What Can Exposure Therapy Treat
Overall, it seems that disorders that create high stress and worry, like most anxiety disorders, respond well to exposure therapy. Studies have demonstrated it to be helpful as the sole treatment or as a component of a larger treatment plan with additional interventions.
Some of the specific conditions effectively treated with exposure therapy include:2
While exposure therapy is a wonderful tool for these diagnosed mental health disorders, its principles can be applied to many situations as well as symptoms that do not yet meet the criteria for a full diagnosis. Because of this, exposure is a useful tool for a variety of mental health concerns.
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What Is Exposure Therapy
Exposure therapy involves repeated interaction with triggers, including images, sounds and other stimuli, as a way to desensitize a person from their trauma. This can be carried out through a number of different ways, which well cover below.
Exposure therapy is an intense form of therapy for people with phobias and anxiety related to certain situations. For example, exposure therapy for agoraphobia and social anxiety would involve gradually exposing someone to these situations in a controlled environment.
Alternative And Augmented Therapeutic Methods
An extremely important area of interest for context encoding is the hippocampus, which is essential in the consolidation of new contextual memories . Hippocampal lesions cause a deficit in conditioned freezing behavior during re-exposure to the fear conditioned context . This effect is greater when the hippocampus is lesioned soon after conditioning, suggesting that the hippocampus is important during the consolidation of contextual memory . Once sufficient time is given for consolidation, the contextual memory is no longer hippocampus dependent . Postlesion conditioned freezing can be rescued if the animals are pre-exposed to the context and given ample time to consolidate the representation , though not if the hippocampus is inactivated during the pre-exposure session . Taken together, there is strong evidence that the hippocampus is necessary for context encoding, and that the contextUS association cannot form if this encoding is prevented. The hippocampus also plays a major role in context fear conditioning and extinction by creating a context representation that the basolateral amygdala associates with the negative valence of the aversive US .
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Prolonged Exposure Therapy For Ptsd And Trauma
PTSD can hijack the lives of those who suffer from it. Fortunately, there are trauma treatments that work. Prolonged exposure therapy is one of the best such established treatments.
Post-traumatic stress disorder, or PTSD, is a serious mental health condition that can happen following a traumatic event. These events can involve combat experiences, motor vehicle accidents, terrorist attacks, assaults, sexual assaults, and other experiences that typically involve harm or the threat of harm.
PTSD can dominate the lives of people who have it, either in obvious or subtle ways. Fortunately, there are several effective treatments. Most of them are specific types of psychotherapy.
Perhaps the best known of these therapies is prolonged exposure therapy. PE therapy should be administered by a mental health professional who has been trained in PE. The therapy typically involves weekly therapy sessions for a period of several months.
Can Exposure Therapy For Ptsd Help
Yes! Although there are no guarantees, exposure therapy can help with reducing and even eliminating PTSD symptoms. Perhaps the greatest reason for this is that the process creates closure and allows your brain to realize that it is no longer in danger.
Also, as part of the exposure therapy process, you learn tools to better stay in control when you begin to feel the anxiety and stress of PTSD affect you.
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How Does Prolonged Exposure Therapy Work
PE works by addressing one important trauma-related response: avoidance.
When people experience fear, it is natural to want to run from the thing causing it. Often when people struggle with PTSD, they avoid certain people, places, or things. In the moment, this helps lower anxiety. But avoiding fears or reminders of painful past experiences can actually make anxiety worse over time.
The main goal of PE is to address this avoidance. One of the first tasks of PE is to make a list with your therapist. This list will contain all the things you are avoiding out of fear. Then, you and your therapist will start working on addressing each item on the list using PE.
Typically, you and your therapist will start with the item on the list that scares you the least. Then slowly, you will work up to more and more challenging items. The list will help you practice exposure to trauma reminders that you avoid in your life.
Reminders are different for everyone, but they are usually:
Sensations in your body
During PE, you will practice exposure using real-life, visualization, or virtual reality to go over memories of the traumatic experience or reminders you fear with your therapist. Your therapist is there to help track your anxiety levels and make sure therapy moves at an appropriate pace.
Over time, repeated exposure helps to lower your PTSD symptoms. And by facing your fears in a safe environment, you may eventually be able to lessen them. PE can also help you:
How Exposure Therapy Helps Treat Ptsd
Whereas traditional forms of psychotherapy focus on talking through the negative feelings and thoughts associated with your PTSD, exposure therapy helps you confront difficult triggers in real-time. When possible, you might even face them head on, in real-life situations. These methods are proven to deliver faster results when compared to more traditional trauma-focused therapies, which may involve visualizing, talking, or thinking about traumatic memories.
In contrast, for many people, exposure therapy is bettersuited to breaking the fear and avoidance patterns that are associated with PTSD. As youre progressively exposed to your fear or faced with memories of your trauma , youll learn to process any irrational beliefs and unrealistic fears you have that are associated with the stressor.
Some research suggests that exposure therapy is successful in 75% of people who received this form of therapy to treat their PTSD.
Exposure therapy is a CBT technique which makes a person confront the things that they fear the most. It ultimately helps decrease the persons anxiety because they realize they can face their fears rather than avoid them.
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Exposure And Response Prevention
In the exposure and response prevention variation of exposure therapy, the resolution to refrain from the escape response is to be maintained at all times and not just during specific practice sessions. Thus, not only does the subject experience habituation to the feared stimulus, but they also practice a fear-incompatible behavioral response to the stimulus. The distinctive feature is that individuals confront their fears and discontinue their escape response. The American Psychiatric Association recommends ERP for the treatment of OCD, citing that ERP has the richest empirical support.
While this type of therapy typically causes some short-term anxiety, this facilitates long-term reduction in obsessive and compulsive symptoms.:103 Generally, ERP incorporates a relapse prevention plan toward the end of the course of therapy.
Imaginal Exposure Protocol For Ptsd: Processing Hot Spots In Trauma Memories
Barbara Rothbaum, Ph.D.
This presentation is an excerpt from the online course Prolonged Exposure for PTSD: A Comprehensive Guide for Clinicians.
- Focus on only 1 hot spot per session.
- Instruct the patient to recount that hot spot repeatedly.
- Ask probing questions.
- Work on hot spots until the final session.
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Who Can Help Me With Exposure Therapy
A trained therapist who is experienced in treating trauma victims can implement exposure therapy for PTSD. Having a knowledgeable guide through this process is very helpful. They can provide context for why you are experiencing symptoms and help you better understand what is happening. This is particularly comforting when you must once again face those memories or triggers which can be so debilitating.
Remember, your trauma does not have to be a burden that you carry for the rest of your life. By participating in exposure therapy for PTSD with a qualified therapist, you can address what happened and teach your mind that the danger is long past.
Questions, Concerns, Thoughts?
I invite you to call me for a free 15 minute phone consultation to discuss your specific needs and to answer any questions you have about anxiety, treatment and my practice. Please visit my website @ www.theanxietydocseattle.com or call me directly @ 745-4933.
Will I Talk In Detail About My Trauma
Yes, around your 3rd session, you will start talking in detail about your trauma. Your provider will guide you through it, keep track of your anxiety level as you talk, and make sure you take things at your own pace. You will listen to a recording of this part of your session at home between sessions.
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What Does Prolonged Exposure Therapy For Ptsd Involve
To address PTSD symptoms, this therapy is usually delivered in weekly sessions, over a period of three months. The therapist would use various techniques to give the individual a sense of safety and inclusion, especially breathing exercises to combat heightened anxiety.
Sessions involve exposure to both the source and effects of trauma, but this is managed carefully to ensure it doesnt become overwhelming or harmful.
It involves a combination of:
Imaginal exposure The individual imagines the event and experience, confronts their fears, and starts to process their responses. This is recorded, so further consideration and discussion can address the issue and reactions. They can even take the recording home, for self-managed reflection.
In vivo exposure This happens outside the therapy session. The individual and therapist agree on a series of challenges, often something the individual has been actively avoiding. The person with PTSD is tasked with facing that fear. Such as purposefully encountering a person or situation that triggers memories and emotions. The aim is to show that the individual can manage their reaction and stay in control.
There are also therapists who also use the following:
Will I Have Homework
Yes, you will practice doing some of the things you have avoided since your trauma. You will start with activities that are manageable for you, and you will work up to activities that are more challenging. You will also listen to a recording of your therapy sessions, including your imaginal exposure recording. Practicing these skills between sessions helps you get the most out of PE.
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Prolonged Exposure For Ptsd
The best treatments for PTSD are trauma-focused talk therapies. These treatments help you processor work throughyour traumatic experience. Learn about Prolonged Exposure , which teaches you not to be afraid of the memory of your trauma or other trauma reminders.
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Prolonged Exposure Therapy And Ptsd
One of the most robust ways to address the symptoms of PTSD is to engage in various types of exposure-focused cognitive behaviour therapy. Though its always vital this is done with the support of a trained professional in the technique.
Exposure therapy aims to tackle avoidance, and instead encourages the individual to change their learned behaviours and manage emotional responses. They are designed to explore traumatic events and experiences, as well as their reaction to them.
Behavioural therapy involving prolonged exposure helps the person to achieve these goals over a period of time, in a place of safety. This gradually reduces the power that traumatic memories and cues have. Ultimately taking the individual to a state of acceptance and making them more comfortable with reminders.
This article will answer questions such as How does prolonged exposure work? and will show its relevance to addressing the symptoms of post-traumatic stress disorder.
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Key Questions To Ask A Therapist When Considering Exposure Therapy
Entering into a new therapeutic agreement with a mental health professional can feel uncertain and unnerving, so people should always come prepared with questions about the therapists experience and process.
Key questions to ask an exposure therapist include:
- Is exposure therapy a suitable treatment for my symptoms?
- How long have you been providing exposure therapy?
- Are you currently receiving consultation or supervision from an expert?
- Will the exposure use graded or flooding techniques?
- Will I use in vivo, imagined, virtual reality, or a combined exposure technique?
- How long will the course of treatment last?
- Will I learn relaxation techniques along the way to manage my stress?
- Will exposures only take place during sessions, or will I be expected to engage in exposures in between sessions?
- How will we establish my goals?
- Will my fears return after my course of treatment is over?
Defining Exposure Therapy For Ptsd
Before understanding how exposure therapy works, its important to understand what PTSD is. Post Traumatic Stress Disorder, popular by its acronym PTSD, is a type of anxiety disorder that can develop after someone experiences a traumatic event. This can include events like combat, natural disasters, car accidents, or sexual assault. symptoms of PTSD can include nightmares, flashbacks, panic attacks, and avoidance of anything that might trigger memories of the trauma. For many people, these symptoms can be debilitating and make it difficult to live a normal life.
While there are many different treatment options for PTSD, exposure therapy has been shown to be one of the most effective.
Exposure therapy is a type of cognitive-behavioral therapy that focuses on helping patients confront their fears. The goal is to help patients see that their fears are not as dangerous as they seem, and that they can cope with them. This type of therapy usually involves gradually exposing patients to the things they fear most in a safe and controlled environment. There are many various types of exposures. However, they all share the common goal of helping individuals face their fears.
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Benefits Of Exposure Therapy
While exposure therapy may be uncomfortable at first, it can be beneficial in reducing avoidance and anxiety symptoms.
The potential benefits of exposure therapy include:
- Milder reactions: By being exposed to your fear gradually and repeatedly, the intensity of your reaction will likely decrease and become more manageable.
- Eliminated symptoms: Sometimes, exposure therapy can entirely eliminate certain symptoms of fear and anxiety.
- Improved emotional regulation: Exposure therapy aims to teach people how to interrupt their emotional response to their fear and regulate it both mentally and physically.
Increased sense of agency: Many people who experience exposure therapy report an increased sense of self-confidence and self-esteem, knowing that they can successfully survive and even thrive in situations that once caused them fear.
What Is An Exposure Therapy Session Like
It should be noted that exposure therapy varies at different facilities and in different applications. Some facilities use classical exposure therapy, using images and sensory stimuli. Others use more technologically advanced forms of VR exposure therapy.
When you undergo imaginal exposure therapy for PTSD, your therapist will first conduct sessions to pinpoint the sources of your trauma and anxieties. Theyll explore the ways in which your condition manifests and try to identify the triggers.
When the actual exposure therapy begins, youll be exposed to very small amounts of the stimulus in question for a very short duration of time in the beginning. Your therapist will discuss how you felt during each exposure and gradually build up to a longer and more vivid exposure each time.
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What Are The Risks
The risks of doing PE are mild to moderate discomfort when engaging in new activities and when talking about trauma related memories. These feelings are usually brief and people tend to feel better as they keep doing PE. There is also a slight risk that someone could listen to a therapy session without your permission if the recording was not secure. You and your provider can discuss ways to secure your personal information related to this program. Most people who complete PE find that the benefits outweigh any initial discomfort.