Exposure Therapy For PTSD

Exposure therapy is a form of mental health treatment designed to help people face, manage, and overcome their fears. Exposure therapy for PTSD (post-traumatic stress disorder) or anxiety disorders like OCD (obsessive-compulsive disorder) can be highly effective.  To treat PTSD, prolonged exposure therapy or consists of several sub-types, including in vivo exposure, imaginal exposure, interoceptive exposure, and directly confronting feared situations. If you believe you would benefit from cognitive behavioral therapy, specifically exposure therapy for PTSD, an online therapy platform may help you get started.

According to the National Center for PTSD, this disorder's primary symptoms can include:

• Intrusive or disturbing thoughts
• Visual, auditory, or emotional flashbacks of a traumatic experience, often involving feared images
• Nightmares and trouble sleeping
• Increased heart rate
• Frequent negative feelings, such as anger and rage
• Avoidance of places and topics that revive trauma-related memories, leading to a feared situation

Exposure therapy for PTSD

Depending on the client’s condition and the severity of anxiety, a trained professional may use different kinds of exposure therapy methods, resources, and training. A person with intermittent flashbacks and nightmares may not yet be ready to handle direct contact. They may need to try a different technique that gradually introduces what they're afraid to confront. These various methods can range from being intense, where the individual faces their fear head-on, to more prolonged or gradual presentation to their fear. According to the Department of Veteran Affairs, exposure therapy takes around three months to complete, however, the length of time needed may depend on individual factors. Four types of exposure therapy are commonly used: in vivo, imaginal, interoceptive, and prolonged.

In vivo exposure refers to a direct confrontation of the person's fear. For example, a person who has had a traumatic episode on a train may directly confront their fear by going to the train station and riding the train. A person with social anxiety might be afraid to do public speaking. Using the in vivo method, they may overcome their fear by delivering a speech in front of a small group. They may have a high level of anxiety when they first stand up in front of a room full of people. However, when they realize that nothing terrible is going to happen, the anxiety may decrease. 

In vivo exposure therapy, conducted in the present tense, can be an intense endeavor but can also be instrumental in treating anxiety. It can be empowering when people realize they can conquer their fear. Exposure therapy may improve their quality of life, and they may discover that they're in control of their emotions.

Imaginal exposure therapy is a form of exposure therapy in which a person tries to imagine feared images of the thing they're afraid of during a therapy session. The imaginal exposure occurs during visualization exercises of the disturbing memories or of a fear-inducing situation. A person may envision something they're afraid of and work through the trauma mentally with the guidance of a therapist.

For example, a person may have survived an accident on a dirt road and could now be scared to travel on country roads. They could work with a trained professional and start by imagining walking down the road. When they start to feel distressed, the therapist could help them work through their emotions using breathing techniques and positive self-talk. In exposure therapy, they might imagine that they are driving on a country road and they are in control of their vehicle. It may be best to do this kind of exercise with a trained professional because it can trigger anxiety or panic attacks. It’s generally not recommended to attempt this type of treatment on your own.

Interoceptive exposure is usually used for panic disorder but can also treat post-traumatic stress disorder (PTSD). It is a form of exposure therapy that can help people confront physical symptoms. Whether you're feeling heart palpitations, shortness of breath, sweating, or shaking, anxiety can create uncomfortable sensations in your body. These uncomfortable physical symptoms may then lead to more anxiety and continue on in a vicious cycle.

In interoceptive exposure therapy, the therapist usually works with a client's physical anxiety symptoms during weekly individual sessions to help calm them down, perhaps by using a breathing technique. This may help the person manage their anxious symptoms and can calm down their body. Interoceptive treatment often teaches people to be aware of how their bodies react when they feel panicked.

Prolonged exposure therapy is usually a combination of in vivo, imaginal, and prolonged treatments to form an integrated approach. For those with PTSD, prolonged exposure therapy is a form of psychotherapy that helps them confront their trauma-related memories, thoughts, and feelings. People with PTSD usually complete eight to 15 sessions of this treatment for 90 minutes a session. The client may not have to face their deepest fear during each session, but they may instead practice different techniques during each meeting with their therapist.

Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences - Therapist Guide, published by Oxford University Press, is a comprehensive manual that provides therapists with a step-by-step guide to implementing prolonged exposure therapy.

Exposure Therapy for Anxiety: Principles and Practice, published by Guilford Press, is a comprehensive resource that offers guidance for therapists who want to implement this kind of treatment for clients struggling with anxiety disorders. This book covers the theoretical underpinnings of exposure therapy, its evidence-based practices, and the latest research on its effectiveness.

Exposure therapy is often recommended for those experiencing fear stemming from OCD, PTSD, and other mental health conditions that include anxiety as a symptom. However, finding a local therapist that practices this treatment can sometimes be challenging. However, you might consider trying online exposure therapy, which research has shown to be effective. One study looked at the efficacy of online therapy for flying phobia and found that it can be very effective. Although it did not investigate the use of online exposure therapy for other types of fears, the study’s authors noted, “Internet-based treatments appear to be a promising way to enhance the in-vivo exposure approach, specifically in terms of acceptability and approach to treatment.”