Exposure therapy has been found to effectively address the symptoms of post-traumatic stress disorder (PTSD), as well as symptoms of other anxiety disorders. With this roundup of different forms of exposure therapy, find out which treatment is right for you.
Overview of Exposure Therapy for PTSD
Exposure therapy is considered a behavioral treatment for PTSD. This is because exposure therapy targets learned behaviors that people engage in (most often the avoidance) in response to situations or thoughts and memories that are viewed as frightening or anxiety-provoking. For example, a rape survivor may begin to avoid relationships or going out on dates for fear that she will be attacked again.
It is important to recognize that this learned avoidance serves a purpose. When a person experiences a traumatic event, he may begin to act in ways to avoid threatening situations with the goal of trying to prevent that traumatic experience from happening again.
Avoidance is a safety-seeking or protective response. However, as this avoidance behavior becomes more extreme, a person’s quality of life may lessen.
He may lose touch with family or experience difficulties at work or in relationships.
In addition, avoidance can make PTSD symptoms stick around longer or even intensify. That is because a person is avoiding certain situations, thoughts, or emotions, he doesn’t have the opportunity to learn that these situations may not be quite as threatening as they seem. In addition, by avoiding thoughts, memories, and emotions, a person doesn’t let himself fully process those experiences.
The goal of exposure therapy then is to help reduce a person’s fear and anxiety, with the ultimate goal of eliminating avoidance behavior and increasing quality of life. This is done by actively confronting the things that a person fears. By confronting feared situations, thoughts, and emotions, a person can learn that anxiety and fear will lessen on its own.
So, how does a person actively confront feared situations, thoughts, and emotions during exposure therapy? A number of methods may be used by a therapist. These are described below.
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Methods of Exposure Therapy
In Vivo Exposure
In vivo exposure refers to the direct confrontation of feared objects, activities or situations by a person under the guidance of a therapist. For example, a woman with PTSD who fears the location where she was assaulted may be assisted by her therapist in going to that location and directly confronting those fears (as long as it is safe to do so).
Likewise, a person with social anxiety disorder who fears public speaking may be instructed to directly confront those fears by giving a speech.
Imaginal Exposure
In imaginal exposure, a client is asked to imagine feared images or situations. Imaginal exposure can help a person directly confront feared thoughts and memories.
Imaginal exposure also may be used when it is not possible or safe for a person to directly confront a feared situation.
For example, it would not be safe to have a combat veteran with PTSD to directly confront a combat situation again. Therefore, he may be asked to imagine a feared combat situation that he experienced.
Interoceptive Exposure
Interoceptive exposure was originally designed to treat panic disorder. However, there is evidence that interoceptive exposure may be successful in the treatment of PTSD as well. It is designed to help people directly confront feared bodily symptoms often associated with anxiety, such as an increased heart rate and shortness of breath. The therapist may assist this by having a person (in a controlled and safe manner) hyperventilate for a brief period of time, exercise, breathe through a straw or hold his breath.
Prolonged Exposure
Prolonged exposure therapy is a combination of the above three methods. Prolonged exposure has been found to be very effective for PTSD sufferers. It involves an average of 8 to 15 sessions for about 90 minutes per session.
Prolonged exposure therapy consists of education about trauma and what you will be doing, learning how to control your breathing (interoceptive exposure), practicing in the real world (in vivo exposure), and talking about your trauma (imaginal exposure).
Finding a Therapist for PTSD
Exposure therapy has been found to be a very effective treatment for PTSD. In addition, methods for delivering exposure therapy to people is continuing to advance. In particular, some therapists are beginning to use virtual reality technology to help people confront the things they fear most.
Yet, it is important to recognize that some people are hesitant to go through exposure therapy because it might sound scary to confront fears. Exposure therapy is like any other treatment for PTSD. It requires a tremendous commitment and can be difficult at times. A major part of most treatments for PTSD is confronting and connecting with feared situations, thoughts, and feelings. The way in which this is done in each treatment simply differ.
Therefore, it is very important to find the right therapist and treatment for you. You can find out more information about treatment providers in your area who might offer exposure therapy through the Anxiety Disorder Association of America.
When we hear the words “exposure therapy,” some extreme images might come to mind, such as people’s 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.
What Is PTSD?
Post-traumatic stress disorder, or PTSD, is a psychiatric condition that occurs in people who have experienced or witnessed traumatic events. According to the American Psychiatric Association (APA), the condition has existed for a long time, with records of combat veterans coming from deployment with “shell shock” or “combat fatigue.”
Although this history has made PTSD closely associated with wartime experiences, PTSD can come from anything that is perceived as especially traumatic or emotionally damaging to a person. This includes witnessing or being the victim of an assault or other crime, an especially violent event, a natural disaster or another very serious event.
How Does PTSD Manifest in Those Who Suffer From It?
It should be understood that traumatic experiences have the tendency to have after effects that may resemble PTSD immediately after they occur. To be PTSD, however, the following symptoms need to be present months or years after the event in question:
- Involuntary thoughts and memories: People with PTSD often have intrusive thoughts, including distressing dreams and unprompted flashbacks to their trauma.
- Low self-esteem: Often people with PTSD internalize their condition and the connection with the trauma that brought it on, feeling that they’re somehow inferior to others because of their condition or at fault for the initial event.
- Angry feelings and outbursts: People who have been affected by past trauma often have emotional control and temper issues, leading to severe outbursts and an inability to communicate with others at times.
- Avoidance of “triggers”: Because they know that certain exposure will trigger the negative effects of their condition, people with PTSD often become reclusive and go out of their way to avoid environments where these triggers may arise.
What Is the Need for PTSD Treatment?
So why do we need to find effective treatments for PTSD? Because the above symptoms can be barriers to a high quality of life. There are also many other conditions that can be brought on in conjunction:
For example, the number of military veterans who are homeless is continuing to rise, and according to one study, two-thirds suffer from PTSD.
Other common conditions that accompany/correlate with PTSD include:
- Depression, anxiety and suicidal thoughts
- Acute and chronic stress
- Alcoholism and addiction
PTSD is one of the most common co-occurring disorders with addiction, making it uniquely difficult to treat effectively.
For people with PTSD, life can be much harder than for those without. The symptoms mentioned above can make it difficult to maintain healthy relationships, find and hold a job and simply live a normal life.
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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 we’ll 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 (fear of crowds and public spaces) and social anxiety would involve gradually exposing someone to these situations in a controlled environment.
Dispelling The Myths About Exposure Therapy
Exposure therapy is subject to a few prominent misconceptions that may hurt the efficacy of the treatment. Here are a few.
Myth #1 Exposure therapy only treats phobias. While thoughts of exposure therapy may bring to mind images of people being forced to confront their worst fears, this is far from the complete picture of the treatment. It has a broad range of applications, including treatment for treat panic disorder, social anxiety disorder, OCD and, of course, PTSD.
Myth #2 You can undergo exposure therapy on your own. This is a dangerous misconception because exposure therapy is more than simply “exposing yourself” to something you fear or something that produces a negative response. If you try to self-treat PTSD incorrectly and outside of a controlled environment, exposure therapy can worsen the conditions it is being used to treat.
In Vivo vs. Imaginal Exposure Therapy
There are two types of exposure therapy: in vivo (live) and imaginal (virtual reality or based on images). In vivo exposure therapy is considered to be the most effective, but for some patients, it can be too intense.
Imaginal exposure is the treatment of choice in modern mental health rehab because it can be better controlled by mental health professionals in charge.
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. They’ll explore the ways in which your condition manifests and try to identify the triggers.
When the actual exposure therapy begins, you’ll 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.
Is Exposure Therapy Effective?
Exposure therapy can be very effective, especially treating something with well-defined triggers, like PTSD. A range of clinical studies back up claims that imaginal exposure and exposure therapy, in general, are effective in reducing the effect of PTSD.
So, Why Doesn’t Exposure Therapy Always Work?
When carried out using treatment best practices, exposure therapy will lessen the impact and effects of a range of conditions. The theory is that when someone becomes more comfortable with something causing them anxiety, the anxiety is diminished and that trigger becomes easier to face.
This involves a high level of participation on the part of the patient and the willingness to become more comfortable. When patients aren’t bought into the process of imaginal exposure, it’s not likely to work.
Is Imaginal Exposure Right for You?
If you’re suffering from a condition with distinct triggers, such as phobias, or anxiety about specific events, exposure therapy may be right for you. Contact FHE Health to learn more about the mental health conditions we treat and the therapy options available to you in our facility.
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