Exposure therapy is a deliberate method designed to expose the mind to intense emotional fear (your past trauma) in controlled doses, and teach your body that it now not need be disturbed by traumatic memories, as they are just memories, and that you do not any longer have to take seriously these unbidden memories of your past traumatic experience/s. Exposure therapy is a learning strategy simply designed to separate 'then' from 'now'.

Exposure therapy does not make up the entirety of Cognitive Behavioural Therapy (CBT), as many facets are required to complete the overall healing process, though exposure therapy is certainly a good portion of the trauma healing process.

Are You Suitable for Exposure Therapy?

The main criteria with any CBT method, is that you are not dependent upon alcohol or drug use (suppressants and depressants) which will negatively affect the therapy working for you, and in fact, may even work against you and make you worse if dependent. Please review more information on use, abuse and dependence before considering exposure therapy or CBT.

Why Exposure Therapy?

The reason is simple. You need to come to terms with the full reality of your trauma, and no longer continue that you have it under control with your current coping strategies, which are more often than not, non effective. Whilst many think they have their symptoms under control with alcohol usage, smoking a joint per day, dedicating yourself to working long hours or maintaining a busy lifestyle, each and every time, you end up back at the beginning, with your symptoms prevailing over you, and not you over them.

You need to accept that these types of strategies are not actually coping mechanisms at all, and merely delusional suppressants which are proven non-effective. If you're still having nightmares, still having flashbacks, and still suffering symptoms arising daily / weekly from PTSD, then your strategies are not working for you. You must push yourself from this point past your comfort zone, into an area you have avoided for so long, though an area which must be dealt with to move past the worst of PTSD itself.

If you think of your memories being attached to an elastic band, and the more you push those memories away, the more they spring back at you. This is what the usual suspects within personal coping strategies comprise. Ineffective methods which only tighten the elastic band, and make it pull back more each time you push it away from you. Memories are in concrete within the amygdala and hippocampus, they cannot be erased, nor are they going anywhere. Exposure therapy turns these painful, hurtful memories that you fear, into what they actually are, just memories of the bad times within your past. You will no longer ignore them, but accept them and come to terms with them being part of your past, but without the fear and pain associated to them.

So... Effective Strategies

Effective strategies for exposure therapy are:

• Writing about the trauma for at a set time for a couple of minutes.
• Typing something for a few minutes a day (the lesser stressful option).
• Talking with a confidant for a few minutes each day.
• Spending a few minutes daily talking and listening to a audio recording of yourself (not recommended for trauma from horror).
• Setting dares to extend you beyond your comfort levels.
• Writing about the trauma and its effects in a more documentary style.

This enables you to put the pieces of the jigsaw puzzle back together, and construct a complete picture of the trauma, and not just figmented or fragmented memories. More is detailed on the actual scope and process within the thread, getting started with exposure therapy, which outlines the actual writing process itself, and how to get the best results.

The Aftermath

During exposure therapy, expect to have an increase in negative mood, an increase in symptoms, and a definite impact from your increased mood on friends, family and partners, all of whom may discourage you continuing exposure therapy, as it will negatively impact them also, but a little pre-warning can get around this negative feedback from your support cell. This is short term pain, for long term gain. It is effective, it is proven, and it factually lessens the effect of trauma upon the mind and body, thus having a carry on effect to all other symptoms of PTSD, as the trauma is the ignition of all other symptoms.

Dares... The Art of Successful Recovery

Dares are the therapeutic antidote to the safety behaviours involving learning not so much at an intellectual but primarily at an experiential level, in the gut. Intellectual learning is very much hippocampal learning, where experiential is more at the amygdala based learning. Basically, if you look at how a young child can be taught to not be afraid of the water, they gradually increase the dares as such that are performed in learning to swim at the experiential level (doing) rather than the learning of physics principles, which is what then gives them the confidence to float at a basic level.

Dares are identified between closing the gap between current behaviours, opposed to pre-trauma behaviours. If you used to be capable to going to a crowed shopping centre, or standing in long waiting lines at the checkout, and now cannot, then these would facilitate the dares that you need to perform. These range across your entire behavioural patterns, and are not just limited to one or two of your symptomatic responses now. What must be stressed, is that experiential learning can only be accomplished by triggering the amygdala to the alarm position, which then the alarm rings and it will be quite uncomfortable to you, though afterwards the alarm will come back a notch. The payoff for the alarm coming back a notch is that you will begin to notice improved patterns, ie. sleep will improve with less need for sentry duty, concentration will improve with less effort focused upon your traumas, and the list carries on.

Dares must be timetabled, to prevent avoidance. For example, if you tell yourself your going to perform a dare by going into a crowded shopping centre at late night shopping, then something less trivial arises, you will talk yourself out of the dare. If you timetable yourself to meet someone, or have a coffee with your partner at a coffee shop within that crowded shopping centre at "x" time, you are then more likely to adhere to the appointment time, than talk yourself out of just going into a crowded shopping centre.

The intent of dares is not to be at ease afterwards, but instead disconfirm there expectations that you have created, and learn to tolerate rather than remove distressing emotions. Intentionally inducing the internal alarm to panic is so that the body and mind can see and learn that nothing terrible actually does happen. It is about beating your own thoughts and perceptions that you have now come to believe are reality, when in fact, they are just thoughts and perceptions, and not reality.

MOOD Management

MOOD is a mnemonic for helping people remember their mood altering framework. Construct a table with the following as headers:

• Monitor mood
• Observe thinking
• Objective thinking
• Decide what to do

The questions that assist you in documenting your mood (first column) for review are:

• What am I feeling?
• What mood am I in?
• What effect is my mood having on others?
• etc etc... think laterally.

The easiest question to ask yourself to fill in the second column (observe thinking) is, "what have I been saying to myself to feel the way I do?". Answer that honestly, and record your answer in the second column. This is generally the area of most concern as you may not be capable of identifying the actual appropriate thought, however; sometimes the thoughts that are causing the problem could be more at the edge of awareness, ie. a day dream, upcoming event, an anniversary of event, etc. These thoughts are just as relevant, though often harder to identify. If troubled, discuss this on the forum for feedback, as something someone else says might just identify the actual thought for you.

The third column is asking you to be objective in your thinking style, which in essence could be a problem, so you may require others opinions to help you with this. Appropriate questions could be:

• How true is it?
• How useful is this way of thinking?
• Would others be looking at this in a different way? (ask others)
• etc etc...

The fourth column is about you now putting into practice your more objective way of thinking.

Stuck? Use the forum chat areas to discuss your mood, or discuss this within the trauma diaries itself, to help assist you in identification of particular issues. That is what the forum is about; helping you to answer the questions you are often confused about yourself. We all suffer this self identification process, so you're not alone.