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This posts shares some information about a supportive, evidence based treatment for trauma and PTSD symptoms: Prolonged Exposure.

What is PTSD?

Post traumatic stress disorder is a common mental health problem following trauma. Individuals with PTSD often have difficulties with emotion regulation, managing symptoms of arousal, and other related symptoms. Co-occurring problems such as eating disorders, substance use disorders, depression, and self-injury are also common. You can read more about PTSD in my prior Chrysalis blog about PTSD.

What is prolonged exposure?

Prolonged exposure (PE) is a well established evidence based treatment for PTSD. It has been shown to yield long term improvement in PTSD symptoms.  PE can be applied with individuals who have co-occurring problems as part of a comprehensive treatment plan.

PE s a form of Cognitive-Behavioral Therapy (CBT) for PTSD, developed by Edna Foa, PhD. PE typically takes 8-12 sessions with at home practice in between sessions. Before working on traumatic memories, the PE therapist teaches the patient various safe techniques for relaxation from anxiety and arousal.  After the patient learns theses techniques, the PE therapist helps the client begin to work on traumatic memories. As part of this process, the trauma survivor intentionally recalls a traumatic memory that is contributing to PTSD symptoms. This is done through the use of verbal or written narratives while under the careful supervision of the PE therapist. These memories are recalled and then the safe relaxation techniques are employed. This is done long enough and often enough to experience a reduction in PTSD symptoms.

Working in this careful manner with a PE therapist, the patient learns new ways for the brain and body to respond to traumatic reminders. This allows the traumatic memories to lose their power to elicit PTSD symptoms. To be successful, PE needs to target the traumatic memories that are most related to PTSD symptoms. However, individuals can experience improvement  without discussing every trauma or all aspects of their trauma.

How does prolonged exposure work?

PTSD can be seen the inability of the brain to stop the fight-or-flight response. Reminders of the trauma trigger distressing thoughts, feelings, and harmful behaviors, even when there is no current danger. Escape and avoidance behaviors develop to provide temporary relief; unfortunately, over time they can lead to PTSD and co-occurring problems.

By intentionally approaching traumatic reminders safely under the therapeutic guidance of a PE trained therapist, new learning can happen to decrease PTSD symptoms. Over the course of PE, the brain starts to learn that traumatic memories and reminders are not dangerous, that anxiety does not last forever and that it is possible to have some power and control over traumatic memories.

What if I feel too afraid to start prolonged exposure?

It is natural to feel afraid at the start of PE. It is common not to feel quite to start PE or even feel afraid. All of that is totally okay. In fact, the first steps of PE address these concerns and give patients tools to decrease these anxious feelings, relax and regain control before working on traumatic memories.

PE should only be done in the context of a strong therapeutic relationship with a licensed clinician who has received formal training in PE. PE is a gradual process where the patient is in control and works collaboratively with the PE therapist. As part of this collaboration, fears about PE should be discussed about openly with your PE clinician throughout the process. This should help decrease initial fears and keep later fears manageable. It is okay to feel afraid and PE will help you gain strength and confidence.

What if I am ready to start prolonged exposure?

If you think you may have PTSD and that PE might be helpful, talk with your primary clinician or  contact Chrysalis to set up an initial evaluation. PE is compatible with ongoing therapy for other difficulties. PE can be added for 8-12 weeks in conjunction with your primary therapist in a collaborative approach to your treatment. At Chrysalis, we offer PE by a licensed psychologist who has been intensively trained in PE.  You can contact Chrysalis for more information about getting started. Recovery from PTSD is possible and within reach!

Dr. Kate Brody Nooner is a licensed clinical psychologist and associate professor of psychology at UNCW. She also holds an adjunct appointment at Duke University and is the principal investigator of NIH-funded grants aimed at reducing child and adolescent trauma and preventing alcoholism.



Image credit: dreamstime.com

What is traumatic stress?

Traumatic stress and posttraumatic stress disorder (PTSD) are unique mental health problems in that they have a known cause – a traumatic event. Life is filled with stressors. There are typical daily stressors such as a car breaking down or a large bill to pay. There are also bigger stressors such as getting divorced, losing your job, or the death of a grandparent. Even positive events can be stressful including buying a home or getting married. However, none of these positive or negative daily stressors are considered traumatic events.

Traumatic events are different in that they are events in which someone believes that their life or the life of others is being threatened. Traumatic events can be witnessed, such as watching a friend get mugged, or experienced directly, such as being sexually assaulted, fighting in a war, experiencing a serious accident or natural disaster, or being abused as a child. These are the types of traumatic events that can lead to PTSD.

How common are traumatic events?

Unfortunately, traumatic events are common. Statistics from the National Center for PTSD show that more than 60% of men and 50% of women have had at least one traumatic event in their lives. This means that most people have experienced a traumatic event at some point. However, among the people who have experienced a traumatic event, most do not develop PTSD. While about 7% of people develop PTSD in their lifetime, this is actually a substantial number, representing 1 out of every 15 people. So, it is likely that your or someone you know may have experienced PTSD at some point.

What happens after a traumatic event?

After people experience a traumatic event, it is useful to have a strong reaction. Remembering what was dangerous and staying away from that can help you stay safe after a traumatic event. However, once that threat has been removed, it is healthiest for our brains and bodies, if our strong reactions decrease to pre-trauma levels. For most people, this happens within about a month after a traumatic event. But, for people with traumatic stress and PTSD, these strong reactions do not disappear and they start negatively impacting daily life. In fact, if the traumatic stress or PTSD symptoms do not return to pre-trauma levels within a year, it is highly unlikely that they will go away without evidence-based treatment from a professional.

How do I know if I have PTSD?

If you have experienced a traumatic event and are having difficulty in areas of your life or find that you are coping with behaviors that are unhealthy, such has drinking heavily or drug use, self-injury, significant changes in eating or sleeping, or other high-risk activities, you may have PTSD.

To diagnose PTSD, individuals need to consult with a licensed mental health professional who specializes in PTSD. Symptoms of PTSD include experiencing a traumatic event and having specific symptoms that cause significant distress or impairment for more than one month including:

1) intrusion of traumatic memories or uncontrollable reminders of traumatic events

2) avoidance of safe people, places, activities, or behaviors that are in some way associated with the traumatic event

3) negative changes in thinking or mood

4) alterations in arousal or reactivity, which include feeling numb, also called dissociation, or feeling on edge, also called hyperarousal

What should I do if I think I have traumatic stress or PTSD?

It is not a good idea to “self-diagnose” if you think you have PTSD. Self-diagnosis can lead to increase in trauma symptoms and other problematic behaviors. The best course of action if you think you may have PTSD is to seek an evaluation from a licensed mental health professional who specializes in treating traumatic stress and PTSD.

How can I get help for traumatic stress or PTSD?

The Chrysalis Center for Counseling offers compressive treatment for traumatic stress, PTSD, and many co-occurring problems. At Chrysalis we have licensed professionals, who used evidence-based treatments to decrease trauma symptoms and help people live their best lives following trauma.

Future blog posts will describe the specific evidence-based traumatic stress and PTSD treatments offered at Chrysalis. However, you can call at any time to hear about these treatments and to schedule a time to talk with one of our licensed professionals.

You can also find out more about evidence-based treatment for PTSD at the National Center for PTSD: www.ptsd.va.gov. This site has useful posts and videos on PTSD treatment, including many of the treatments we offer at Chrysalis.

Dr. Kate Brody Nooner is a licensed clinical psychologist and associate professor of psychology at UNCW. She also holds an adjunct appointment at Duke University and is the principal investigator of NIH-funded grants aimed at reducing child and adolescent trauma and preventing alcoholism.


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