Exposure therapyPTSD- 30% of people had a childhood sexual abuse and suffered no symptoms
1st category- intrusive thoughts. It pops in times they do not want it to.
“how often do you have thoughts about …” “when you think about it does it just kind of shove
its way in” “how often do you have these thoughts?” “how does it feel? Physically and
emotionally” “sleep state”
Does it impair functioning or daily life?
Physiological:
Sleep state? Nightmares?
Flashbacks? It is very rare. In a dissociative state, not in the present moment. The think about
the trauma happening again. “are there ever times where it feels like you’re at the event again”
Do not use the word flashback.
2nd category- Avoidance
Do you allow yourself to think about it, do you do anything to make yourself ignore it?
Are there are any people places or things that they do that you will not do? “what’s most
distressing about ….”
Can be difficult to assess.
3rd category - alterations in cognition and mood
Cannot remember all the things about the event. As a trauma response. Exaggerated negative
beliefs about themselves or others.
Distorted cognitions about what happened. “this happened because I was drinking”
“why do you think that happened to you?” “how do you understand the reason that this
happened? Do you believe it is your fault?” “do you have a sense of guilt?”
“since this went has you view of the world changed” “have you had negative events that
effected your life”. Include domestic violence. Irritability, feeling on edge, lack of emotions, not
connected to others. “How often are you able to feel a sense of positivity”
Category 4: increased anxiety and arousal
Mixing medication, sexually riskier, lack of concentration “how often do you find yourself
feeling distracted” “how often do you find people getting frustrated about that?”
Hyperpigmented “do you find that when you’re in public, you have to watch your back” “are
you always trying to be prepared for something to happen” one of the most
symptoms.
Exaggerated startle response “are their times you react strongly when started or surprised.
Issues with sleep.
After doing their intake:
Tell them about their diagnosis of PTSD
Ask about Coping skills
Explaining theory
Give them the discussion of trauma handout
PECoach an app to download
Discuss the trauma handout
Give them the avoided situations list.
Check in with them on their coping skills.
Nest Session:
After reviewing homework of avoided situations
How does it feel knowing you have PTSD?
Wants a SUDs, a 30 or below. So that they can function.
“In vivo exposer systematically expose yourself to things you have avoided over time”
Speaking of avoidance, lets list some of the things that you avoid. List them on the sheet, only
the ones we can recreate. Exposure has to last for 45 min.
Someone we choose to share our stuff with might not be equipped to handle the conversation.
Prep client for this reaction or possibility for their work.
Homework, I want you to do some of these exposures. Be very specific. Pick the two lowest or
lowest.
Give them the in VIVO recording form. Go over the rules.
Rules:
1. Stay in exposure for 30-45 min OR if your SUDS have dropped in half.
2. Engage in that activity like you did before your trauma or like other people do. Be
mindful of body and what you’re doing. It will signal fear.
3. Don’t avoid during the exposure. Do not engage in coping skills. We NEED to activate
the fear. Once done do into a coping skill and what is needed to regulate.
Always send them home with this homework.
Check in on the numbers. Ask about their body, and time frame. What they were thinking. Any
cognitive distortions.
Next Session:
You’re already thinking about it. You’re already playing it back in your mind. It seems like you
have associated talking about it as reliving the process. Old literature used to believe this too.
There is research that says that this is not true.
“Safety behaviors” having a friend go. Taking a gun or knife.
Second branch of therapy called
Imaginary exposure:
Telling the story does not mean you will reencounter it. Habituate it, so exposure over and
over. File away in the brain so that it does not make decisions for you.
“ what event stands out to you the most”.
Anchor points:
When did you know something was wrong? When did you start to become distressed?
When did you know you were safe? When was this all over for you? When did you know the
event was ending?
Rules:
1.
2.
3.
4.
5.
6.
Use present tense
Have their eyes closed (we are activating the trauma)
Tell the story in as much detail as possible, using all 5 senses
Every few minutes ask for their SUDS (in present moment)
Observe their reaction to the story
Record the exposure
I will be jumping in during the story more than I ever would. I might correct their language as
they speak correcting the tense. Ask questions that increase their senses about their senses.
What are you smelling? What are you feeling? What are you thinking?
Story should be told for about 30-45 min.
In sessions AFTER, if their story did not last, tell the story again.
Give them feedback pertaining to MY observation. Where does your body feel that trauma?
If after telling the story they are dysregulated, we are going to use a coping skill together until
they become regulated. Then do the processing (recorder).
Identifying distortions after session and give feedback and observations.
Record to the session. Send it to them. Have them listen to the recordings weekly. Have them
listen to my processing once a week. Record every session after and follow the same rules.
Hotspots: a spot that they cannot process fully. Change the imaginal exposure around the
hotspot. Create anchor points for the hot spot. Move on to the next hot spot once habituated.
IF a new trauma occurs. Do not do trauma work within a month of the trauma occurring,