Post-traumatic stress disorder (PTSD) is acknowledged as a natural response to actual or threatened death, serious injury, or threat to the physical integrity of self or others (DSM-IV-TR). Treatment approaches for PTSD vary, but my aim for this sharepost is to focus on a form of therapy involving exposure techniques.
The basic idea informing exposure therapy is that by accessing and processing memories and their associated emotions, the person affected will reach a point of reconciliation. Various studies have concluded that exposure therapy is superior to supportive counseling, relaxation therapy or no intervention at all. Although the idea of deliberately exposing someone to the images, sounds and memories that helped cause the initial distress sounds dubious, if properly conducted and supervised, dropout rates will be minimal and the treatment will work.
A process of graded exposure is generally undertaken as a way to minimize distress during the early stages of exposure therapy. Here, the person affected talks about the situation or event at a level comfortable to them. This may take several sessions but the aim is to encourage a certain level of disclosure to a point where overt anxiety is not seen. During this stage of treatment the therapist avoids introducing questions that might trigger deeper and more disturbing memories.
After a few sessions the client is likely to feel both reassured and confident by the approach to therapy. At this point the therapist will encourage the client to reactivate memories to the point where they will describe them in greater detail along with the thoughts and emotions they felt at that time. As the process is more likely to trigger anxiety and other emotional responses the therapist is likely to have equipped the client with some basic techniques, such as relaxation, as a way to help cope with the arousal they will feel. Cognitive techniques might also be used as a way to reframe thinking. For example, ‘I new I was going to die', might be recast in terms of ‘I thought I might die, but actually I was in a panic'.
Research into this form of therapy suggests that fewer intrusive memories occur when compared to interventions, such as counseling, three months after treatment finishes. An important component of exposure therapy is self-instructional training and this may account for its relative superiority when compared to other techniques. Self-instructional training involves encouraging the client to replace restricting dysfunctional thoughts by self-talk. The point of self-talk is for the individual to think aloud and to replace negative thinking with more functional thoughts. This provides and alternative way of thinking which guides the client towards better ways of coping and controlling situations they find difficult and stressful. As clients learn to use the technique they praise themselves for anything that shapes towards the desired direction. Ultimately this provides the scaffolding against which self-esteem and confidence is restored.
Published On: April 29, 2010