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.