This is the one everyone is scared of – fear not! I’ve got your back. We can tackle this together in therapy, and you can take charge of your life again. It’s not your fault – and there is a way to beat it. Let’s discuss…
Trauma. Definitely a buzzword in our current milieu. Big T, little t? How do we define it? How do we “catch” it? Most of all, how do we beat it?
What is PTSD? The American Psychiatric Association (2022) outlines the diagnostic criteria for PTSD:
- First: There needs to have been exposure to actual or threatened death, serious injury, or sexual violence by directly experiencing it, witnessing it happen to others (in person), learning that it happened to someone close, or experiencing repeated or extreme exposure to aversive details of it.
- Second: PTSD includes symptoms from 4 categories – intrusion, avoidance, alterations in cognition and mood, and alterations in arousal and reactivity.
- Third: The disturbance and impairment have to have lasted for more than 1 month.
There are additional nuances involved in assessing for and diagnosing PTSD, but that’s enough of a gist for our purposes here.
Re-experiencing (i.e., flashbacks – feeling like we are “there” again) and avoidance (i.e., places, people, memories, even sleep – things that remind and trigger us, in terms of the trauma) are hallmark indicators of PTSD. Chronic PTSD is driven by persistent avoidance. So, we need to avoid avoiding. Why is this? It is only by inoculating ourselves (via exposure, which leads to habituation) to the trauma that we can take charge of our lives again.
In our trauma narratives (the stories we tell ourselves about ourselves, the trauma(s), and the world), there are usually themes of danger (i.e., erroneous thinking patterns) and incompetence (i.e., perceived weakness).
In Prolonged Exposure, we engage in repeated confrontation to the feared (but actually safe) stimuli. This can be accomplished via imaginal and/or in vivo exposure. Lots of psychoeducation accompanies PE treatment. Generally speaking, somewhere between 8-15 sessions (60-90 minutes each) is the recommended treatment plan, though this is flexible, depending on client response and progress.
What do we do in imaginal exposure? We identify the index event (the worst trauma – this helps the PE to generalize downward, effectively knocking off any less-intense/impactful traumas). Then we recount it repeatedly in the present tense – from the “oh sh*t” moment until the immediate threat has passed. And go again. And again. Usually 3 times per session. We need to digest the trauma in order to be symptom-free.
What do we do in in vivo exposure? We avoid avoiding the things that trigger us. Planning for this requires some finesse – there are certain things we would obviously not expose ourselves to on purpose, just for the sake of exposure. However, if we are avoiding the grocery store because the fluorescent lights trigger us – we can make a plan to push back against this barrier to functioning.
We accept non-zero risks all the time in life. In PE, we are able to gain new perspectives regarding the trauma, ourselves, and the world – we ultimately shift unrealistic beliefs in order to promote better functioning. Let’s get our lives back.
For more information, please visit : https://www.apa.org/ptsd-guideline/treatments/prolonged-exposure
American Psychiatric Association (2022). Diagnostic and statistical manual of mental health disorders, Fifth Edition, text revision. American Psychiatric Publishing: Washington, DC.