Exposure Therapy

Exposure therapy is based on the principle that we get used to things that are just annoying and not truly dangerous. This is called habituation, and it occurs naturally in over 95% of people. For example, if you visit a friend in a large city who lives in a second-floor apartment just beside an elevated railroad, it would be very annoying every time a train screeched by, shaking the building and rattling the windows to the point that conversation became difficult. One might even say to the friend, "How do you live in this din?" The friend might answer, "What din?" If we only visit, we leave with a belief that our friend lives in an impossible situation; if we stay in the apartment for a week or two, we are no longer annoyed by passing trains and may not even be aware of them.

Exposure therapy is based on the idea that this kind of habituation must occur in the person who has been traumatized if they are to overcome PTSD. Exposure therapy asks patients to confront, in a safe way, the very situations, objects, people and memories they have attached to the trauma (and are probably very consciously avoiding).

Exposure therapy is the opposite of the typical, self-prescribed avoidance approach. Because while avoidance may provide temporary relief, it just doesn't last. Facing these triggers is the key to reducing the frequency and severity of PTSD symptoms.

Exposure may be done in vivo (in real life) or in imagination. In vivo exposure is more effective than imaginal exposure. While anxiety or other discomfort may get worse in the first few minutes of in vivo exposure, it is important to continue exposure until the discomfort has diminished. Escaping discomfort only reinforces avoidance as a coping tactic, and produces all the limitations associated with avoidance—like avoiding safe places or situations that might be fun, beneficial or essential for a career and a full family life. It also increases the likelihood that the anxiety might spread, first to similar triggers and eventually to triggers that have little or nothing to do with the original anxiety. Examples of exposure in vivo are resuming driving after being in a traumatizing accident or returning to a now-safe site where an assault once occurred.

Exposure in imagination involves the person recounting traumatic memories until they lose their sting. This can be done by saying them aloud repeatedly, writing, reading and rewriting a biography of the events or recording them on a tape and playing them over and over until they are no longer distressing.

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