In our work with patients, we usually use the approach to this evidence-based treatment that is described in Oxford University’s Treatments that Work workbook – Reclaiming Your Life From a Traumatic Experience.
This therapy works by helping you approach trauma-related thoughts, feelings, and situations that you have been avoiding due to the distress they cause. Repeated exposure to these thoughts, feelings, and situations helps reduce the power they have to cause distress.
Prolonged Exposure (PE) is one exposure therapy that works for many people who have experienced trauma. It has four main parts:
- Education. PE starts with education about the treatment. You will learn as well about common trauma reactions and PTSD. Education allows you to learn more about your symptoms. It also helps you understand the goals of the treatment. This education provides the basis for the next sessions.
- You will want to read the Introduction (Chapter 1) and Is This Treatment Right for You (Chapter 2) in your workbook before getting started.
- Session 1 is discussed in Chapter 3 in the workbook and you should review that before and after the first session.
- Your clinician will also do a structured assessment of the nature of the trauma (s) you experienced and their consequences using the Trauma History Form.
- Breathing. Breathing retraining is a skill that helps you relax. When people become anxious or scared, their breathing often changes. Learning how to control your breathing can help in the short-term to manage immediate distress. This skill is also covered in the first session.
- This is a link to a video demonstration of breathing retraining.
- After the first session you will do breath retraining for ten minutes three times a day.
- Real world practice. Exposure practice with real-world situations is called in vivo exposure. You practice approaching situations that are safe, but which you may have been avoiding because they are related to the trauma. An example would be a Veteran who avoids driving since he experienced a roadside bomb while deployed. In the same way, a sexual trauma survivor may avoid getting close to others. This type of exposure practice helps your trauma-related distress to lessen over time. When distress goes down, you can gain more control over your life.
- In the session 2 you will begin to work on in vivo exposure. Before the session you will be asked to fill out two surveys to measure symptoms of PTSD and symptoms of depression. You will do these from time to time throughout the course of treatment.
- Your therapist will also talk about common reactions to trauma and this handout from the workbook talks about Common Reactions to Trauma.
- This video also discusses the topic of common reactions or symptoms.
- You will also get introduced to the Subjective Units of Distress (SUDS) scale that will be used throughout treatment. You will talk with your therapist about the List of Typically Avoided Situations and you will create an In Vivo Exposure Hierarchy.
- After the session you will begin doing In Vivo Exposure as homework.
- Talking through the trauma. Talking about your trauma memory over and over with your therapist is called imaginal exposure. Talking through the trauma will help you get more control of your thoughts and feelings about the trauma. You will learn that you do not have to be afraid of your memories. This may be hard at first and it might seem strange to think about stressful things on purpose. Many people feel better over time, though, as they do this. Talking through the trauma helps you make sense of what happened and have fewer negative thoughts about the trauma.
- In session 3 you will get information about imaginal exposure from your therapist.
- This video talks about the topic of imaginal exposure.
- Your therapist will conduct an imaginal exposure exercise andwill keep a record of each exercise using the Therapist Imaginal Record.
- You will do your own homework and will use this form to record it: Imaginal Exposure Homework.