Exposure Therapy for Post-Traumatic Stress Disorder (PTSD)

When most people hear of post-traumatic stress disorder (PTSD), they imagine combat veterans who have seen the worst of war. While PTSD may affect such individuals, it can also affect others who have suffered from trauma. It can be a very debilitating disorder that can affect one’s quality of life.

Exposure therapy for PTSD is a common therapeutic technique that is used to treat this mental health condition. It aims to address victims of trauma who experience increased levels of stress, even years after the occurrence of the initial traumatic event.

Read on to learn more about exposure therapy for PTSD.

What is Exposure Therapy?

Exposure therapy is a form of cognitive behavioral therapy that allows you to overcome things, activities, or situations that may cause fear and anxiety. It can involve live, virtual, and other types of exposure.

When you fear something, you usually avoid the objects, activities, or situations related to it. This may help you manage your fear in the short term. However, avoidance can actually worsen your fear in the long term and even interfere with your quality of life.

Exposure therapy is all about empowering you to be capable of confronting your fears, including those linked to the experience of PTSD.

How Can Exposure Therapy Help Treat PTSD?

Traditional forms of psychotherapy tend to focus on talking through negative thoughts and feelings associated with PTSD. Exposure therapy, on the other hand, helps individuals confront difficult triggers for their condition in real time. This method delivers faster results when compared with more traditional trauma-focused therapies, which use techniques such as visualizing, talking, or thinking about traumatic memories.

For many people, exposure therapy is better at breaking the fear and avoidance cycles that are associated with PTSD. Patients are exposed to their fears or memories of their trauma in safe, controlled environments, which allow them to process irrational or unrealistic beliefs associated with the stressor.

Is Exposure Therapy Effective for PTSD?

Exposure therapy is quite effective, especially when treating PTSD with well-defined triggers. It is generally a safe and effective form of therapy for this condition, especially when applied as directed by experienced clinicians [*].

Imaginal exposure and prolonged exposure (PE), in particular, are effective in reducing the symptoms of PTSD. Prolonged exposure is often considered the first line of treatment for PTSD in veterans and military personnel, regardless of the type of trauma [*].

Exposure Therapy Methods for PTSD

How do psychotherapists implement exposure therapy for PTSD? There are various ways to deliver exposure methods for this condition, including:

In Vivo Exposure

In vivo exposure means directly confronting feared objects, activities, and situations in real life with the guidance of an experienced therapist. For instance, a veteran with PTSD may fear the sound of fireworks as it reminds them of firearms and artillery. Their therapist may help by accompanying them to celebrations with similar loud noises, directly confronting the fear (as long as it is safe).

Imaginal Exposure

In imaginal exposure, clients are asked to imagine feared situations or images. This can help a person directly confront the thoughts and memories they fear. For example, it would not be safe to have a sexual assault survivor directly confront the perpetrator. Instead, they might be asked to imagine the feared situation that they experienced. This may be especially helpful in treating PTSD in children or PTSD in teens.

Interoceptive Exposure

Interoceptive exposure was initially designed to treat panic disorder but has been shown to be successful in the treatment of PTSD [*]. It works by helping people directly confront the feared bodily symptoms linked to anxiety, such as shortness of breath and increased heart rate. For example, a therapist may allow their client to hyperventilate in a safe and controlled manner for a brief period and then help them with breathing techniques.

Prolonged Exposure

Prolonged exposure therapy is a combination of the three methods mentioned above. It has been found to be the most effective type of exposure therapy for those with PTSD [*].

How Long Does Exposure Therapy for PTSD Take?

Exposure therapy is usually brief, usually no more than 15 sessions. However, the treatment length depends on various factors, such as the intensity of the symptoms, whether a concurrent disorder is present, the type of exposure technique used, and any complications that may arise during treatment.

That said, exposure therapy usually lasts for 6 to 12 sessions, which may last up to 50 minutes or more, depending on the severity of the patient’s psychological condition. Prolonged exposure therapy, for instance, averages 90 minutes per session.

Are There Risks Associated with Exposure Therapy?

Exposure therapy does not cause harm. However, as with all treatments, therapists can take steps to minimize the risk and maximize the benefits.

The greatest risk that one may encounter with exposure therapy is the worsening of symptoms during treatment. This may happen for various reasons, such as following the incorrect approach for the client’s needs or the client not allowing the therapeutic procedure to go on for long enough to take effect. Some have reported cases in which exposure therapy increased suicidal thoughts, depression, and violence [*].

Can Exposure Therapy Be Combined with Other Treatments?

Yes, exposure therapy can be very effectively combined with other treatments, especially for anxiety disorders and PTSD. Here are some of the most common complementary treatments:

• Cognitive behavioral therapy (CBT). CBT helps you identify and challenge negative thoughts and beliefs that contribute to your anxiety or fear. Exposure therapy helps you change your emotional response to feared stimuli, while CBT helps you change your thinking patterns about them.
• Medication. In some cases, medication may help reduce anxiety symptoms, making exposure therapy more tolerable and effective. Antidepressants and anti-anxiety medications are sometimes prescribed. However, it is important to discuss this with a mental health professional, as medication should not be a replacement for therapy.
• Relaxation techniques. Learning relaxation techniques such as deep breathing, progressive muscle relaxation, and mindfulness meditation can help you manage anxiety symptoms during exposure therapy sessions.

By combining exposure therapy with other treatments, you can create a more comprehensive treatment plan that addresses all aspects of your anxiety or fear.

Related Handouts: Benefits of Belly Breathing, Progressive Muscle Relaxation, and Meditation Benefits

When is Exposure Therapy Not Recommended for PTSD?

Exposure therapy may not be recommended when individuals are experiencing suicidal thoughts or going through psychotic disorders and dissociations.

The Bottom Line

Exposure therapy can help you overcome your fear, and research has found it to be effective at treating various anxiety disorders, including PTSD and phobias. Whether you are treating PTSD in teens or adults, it is essential to consult a licensed professional for this type of treatment. They may give you tools such as trauma worksheets and techniques to overcome your fears, which you can practice from the comfort of your home or out in the real world. It can also help to educate yourself on the difference between trauma vs. PTSD to determine if you need exposure therapy for yourself or a loved one.

References:

1. Rothbaum B & Schwartz A. Exposure therapy for posttraumatic stress disorder. 2002.
2. Rauch S, Eftekhari A, Ruzek J. Review of exposure therapy: a gold standard for PTSD treatment. 2012.
3. Boswell J, Farchione T, Sauer-Zavala S, et al. Anxiety Sensitivity and Interoceptive Exposure: A Transdiagnostic Construct and Change Strategy. September 2013.
4. American Psychological Association. Prolonged Exposure (PE). 31 July 2017.
5. Morris D. Trauma Post Trauma. 21 July 2015.