Have you tried Prolonged Exposure Therapy?

My T has suggested we try prolonged exposure therapy. I have read lots of information about it...both positive and negative...but haven't found anything written from the client about their experience..

I would love to hear from people who have tried it...hear about your experience ...whether you found it helpful or not.

I'm NOT looking to hear opinions from people who haven't tried it nor to have this turn into a debate of this type of therapy.

Yes, I did it. It worked. Then something happened that re-traumatized me and the symptoms came roaring back and I did it again and it worked again.

I really wanted to get rid of the symptoms I found dysfunctional, so I didn't resist, even in the beginning when it felt really really really bad. I had researched it and believed it would help if I had the gumption to do it.

I would recommend that you first learn about how it works, learn some relaxation techniques and then do in vivo exposure/desensitization with a person you trust by your side. Then talk about. And keep doing the in vivo (real life) exposure until you feel comfortable in the situation.

I did the in vivo in baby steps at first, but it didn't take long to make giant leaps, maybe a week of daily practice. But at first, I was shaking. I think that's fairly normal.

I'll never like the situation I had not been able to face, but I can now face it, conquer it and move forward with a certain amount of ease.

I could have done talk therapy for years and not made as much progress as I did in a few weeks of exposure therapy. Medication did not help. Exposure therapy worked when nothing else did. I highly recommend it on one condition ... the patient really has to be willing and has to have made the personal decision to not resist when the T pushes you to take one more step beyond what you think your limits are. It truly has to be a partnership where you've agreed in advance about the parameters of how far and how fast the T will urge you forward.

I wish you the best.

Snake Charmer... Thanks for sharing your experience.. My T is very experienced in doing this type of therapy so I would definitely have confidence in her... I was wondering if your trauma was from recent years or from your childhood? Also, did you have full memories of the trauma or more bits and pieces?

I'm somewhat ambivalent about doing this type of therapy.

The original trauma happened when I was 11-12 years old. I developed some very deep fears and depression and other problems related to PTSD. I remembered everything. I've always remembered every thing.

Several other things happened, that by themselves probably wouldn't have been much, but they deepened the fears tremendously. My family ... being depressed or afraid was not allowed. I was not allowed to talk about anything that happened and I didn't see a therapist until I was 19 and had moved away from home. Then, after a few visits that really seemed to help, my therapist suddenly died.

He'd given me some workbooks and homework assignments and I decided to do that on my own. I did self-help for years, but it didn't help the intense fears. It definitely helped the depression and anger.

After hiding my fears for another 20 years, I did the exposure therapy and it worked. It did not generalize to anything else. It worked on the specific fears that interfered most with my life and prevented me from doing things I wanted to do.

I felt cured. Then I was involved in an accident that made me feel powerless and the fears came back. More exposure therapy. It worked again. It worked fast. But I kept at it, thinking that maybe my fears were so deeply embedded that I needed to work on it for a longer time in order to prevent me from regressing back to that powerless 11 year old. So I kept at it.

Then the next time something Really Bad happened, something that everyone agreed was truly traumatic, I came through it okay. Compared to other people involved. I was grief stricken and horrified and terrified for about 5 days. When I thought about the exposure therapy and imagined myself doing something to combat the terror, the fear left me. Just by imagining myself doing exposure therapy. Other people were afraid to leave the house and I was okay. I was shaky, but I could close my eyes for a few minutes and imagine myself facing my fears and it worked.

Naturally, it didn't get rid of the grief in short order. That took several years to process and in all honesty I still suffer exaggerated symptoms of grief around anything related to death. Especially violent death. Can't even watch it in movies if it's portrayed realistically. By applying mental imagery on the subject I have improved tremendously, but it's still a problem. But I came out okay, considering how awful and bizarre the trauma was.

Somehow the technique had generalized and truly saved me. I should be a much bigger basket case and I'm not. I function at a high level and I'm fairly content.

I was diagnosed with PTSD shortly after the last Bad thing. Mentally applying exposure therapy techniques worked on my symptoms. Just thinking about it. No anger outbursts, no flashbacks, no nightmares, no avoidance, no inability to talk about it, no substance abuse, no horrible or frightening thoughts. Those things responded to mental imagery of me doing exposure therapy on them. Weird, huh?

The only symptoms of PTSD that seem resistant to efforts are an exaggerated startle response, although it's much better than it was, and sleep issues, but no more nightmares.

So, as you can see, I'm really sold on it as a useful therapy for trauma.

Snake charmer....how much support did you receive from your t outside of sessions during that time?

Between session support was not part of the treatment plan. No calls, texts, e-mails or anything. The agreement was that such calls would be reserved for serious emergencies only.

Part of the treatment was learning relaxation and self-calming techniques in session and practicing it at home between-session. The idea was that if I felt upset, I was supposed to use the relaxation and self-calming techniques before calling for any help. All that took place before the in vivo exposure.

That worked for me. But each person is different and some traumas are worse than others and some behaviors are more embedded and more frightful, so I don't think it's possible to compare between two different people because we each have our own special needs.

I understand the in Vivo experience to be doing things that would trigger you...like showering with the door unlocked....but did you also do the part where you keep telling the story over and over again in session and then listen to the recording every day all week?

That is the part that frightens me...it's more of a performance anxiety... I can't talk with emotions or show emotions in front of anyone and I think that is part of the "experience"...and so I worry that my T will take it as conscious resistance and be angry with me... Because I can't do it right.

The in Vivo experience doesn't sound too hard for me.... I would need to pay someone to yell at me over and over again because that what triggers me and/or I would need to be in a small room with a creepy old guy so I feel trapped.

ReadytoStop, I don't have trouble talking about emotional things and I don't have performance anxiety. I did when I was young, but I actually did a sort of self version of exposure therapy in high school, making myself do public speaking until I could do it without fear. When I started, I was shaking so hard I thought I'd wet my pants. Just doing it over and over again and not dying from it helped me improve.

If you tell your therapist now hard it is to talk about it, your T will know what to do. Talking about it is part of the process. The T sees where you choke up and where you shake and panic or shut down. Slowly, the T will help you get through it. It's part of the exposure. Don't worry about doing it right. Your T will understand that it's all part of the deep emotional wound and talking about it in baby steps is part of the exposure.

This kind of therapy is different than what most posters here talk about. The T will push you further than you want to go. You'll say, "I can't." And T will, say, "Yes, you can. A few more words. You can do it."

Maybe the most important thing is that you and T talk about it beforehand, that you understand the process and that you give permission for T to push you one step further than you want to go. You may get angry, you may cry and scream, you may panic. Your T will say, "C'mon, I'm here. It'll be okay. Now, one more step."

A T who does this kind of therapy will expect resistance when you're facing the dreaded thing. If talking about it is hard, then talking is the first step in facing it.

T will help you create safe situations with trusted people to practice in vivo.

I'm pretty sure that if you tell T that talking about it over and over and listening to the recording is frightening for you that T will know what to do.

I appreciate your willingness to answer. It's not that talking about it is hard. It's talking about it with emotions is hard. I can tell it like a news reporter. But the other fear is that I don't have full memory of it and I don't want to feel the need to "fill in the blanks" because the T is pushing me?... Lots of things to talk about with her.

It's my pleasure to talk about exposure therapy because I do believe that if it's done right it can effectively address fearfulness and panic in ways other therapies don't even touch.

It might be a good idea to talk to your T a little bit more about the process and how it works. If you can talk like a news reporter without emotion, that could be a place to start. Then, let your T guide you.

Many therapies are non-directive. The T does not direct the patient in overt ways. Exposure therapy is highly directive. The therapist may say things like, "Stop! Go! Breathe! Now!"

That's why it's important to agree ahead of time about what will and will not happen and to give your T permission to direct you.

This is especially important if the trauma has anything to do with the patient being forced to do things against their will. It's even more important if the trauma was perpetrated by a person in a position of authority, which is something that often happens in childhood abuse.

Unless the patient and T have thoroughly discussed the process, agreed on what's going to happen, and the patient has given the T overt permission to proceed and to push the patient forward toward the Dreaded Thing, the whole thing can just feel horribly triggering and coercive.

My Dreaded Things were brought about by traumatic experiences, but the original experiences did not involve coercion by authoritative figures. The traumas were deepened by authorities behaving in insensitive, critical or judgmental ways, but the traumas were not brought about by coercion.

If coercion was part of the traumas you suffered, it's important to talk about that with your T and to develop a sense of trust that even though T might push you a little further each time, that you're being pushed in a direction that you're agreed you want to go.

I liken it to having a personal trainer at the gym, someone who's going to say, "One more rep," and who'll correct my form and tell me to stand a different way or hold my arms a certain way in order to better achieve my personal fitness goal. I give the trainer permission to push me beyond what I think my limits may be, to make sure I do it correctly and safely and to teach me along the way how to do this on my own without injury.

Personally, if I had not given advance permission and agreed on the direction I was going to go -- either to a trainer or a T-- if I was just pushed, it would not have worked for me. I would have fought it and refused and walked away. But I did agree and did give permission. Basically, I gave permission to scare me to death by making me do things I thought would be unbearable. One little step at a time. We started small. And I felt so good and strong and free after all the shaking and gasping and fear.

Snake charmer, I really appreciate your description and sharing your experiences.

I wonder if this type of therapy could help me grow a backbone and learn that the sky will not fall if I stand up for myself?

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Stressed, if you could find a therapist who was trained in the techniques, they could probably work with you to identify whatever beliefs or fears or bad experiences you've had in life that make it hard for you to stand up for yourself and then design a treatment plan with you to start addressing them.

It can work with something as specific as a simple phobia caused by a trauma or as generalized as combat-induced PTSD. It's designed to help patients process traumatic events by facing them rather than avoiding them. It's a form of behavior therapy or cognitive behavior therapy. Not all CBT Ts are trained in the technique. If prolonged exposure therapy isn't quite right for a person's specific problem there are related techniques that might work. Prolonged exposure therapy was designed to use with chronic PTSD.

Naturally, a lot depends on the skill of the therapist and willingness of the patient to give permission to the T to push them toward the Dreaded Things or the triggers for panic, rage, flashbacks and so on. There's a lot of homework involved. The patient becomes fully engaged in the process. I felt like my own co-therapist, which was empowering.

It's an intense experience. I found it to be worthwhile in a very big way.

Is there a difference between Prolonged exposure therapy and exposure therapy? (Sorry if it's a stupid question).

Scarlet, that's actually an excellent question.

Prolonged Exposure Therapy is a specific exposure therapy technique for PTSD.

Prolonged Exposure Therapy - PTSD: National Center for PTSD

Thank you

I was wondering because my T is doing exposure therapy with me for agoraphobia. My therapy for agoraphobia isn't that structured. It's similar though in relation to "in vivo", why I was wondering. And it makes sense why I can't do prolonged...my agoraphobia isn't really linked to a specific trauma. I had a lot of trauma that lead to me shutting out the world, but six years never stepping outside the house lead to my agoraphobia.

I decided to do the PE therapy. What do I have to lose? It will be 12 to 16 horrific weeks with the chance of symptoms of PTSD significantly diminished. If it doesn't work well at least I can say I tried everything. Things won't change until I start doing something different.

Challenging weeks. Challenging. Days on end of practice and more practice interspersed with moments of sheer terror. Then feeling mighty because you just did something you thought impossible. Then more practice and more until those unbearable things come with a certain amount of ease and comfort. You may never like them, but you can do them without symptoms.

I hope you will give us regular reports on how it's going. I wish you the best of good fortune while you face your traumas.

Had my first session of Prolonged Exposure Therapy... completed the interview form... Worked on current symptoms of PTSD. Once we get through assessments and education side of this treatment I can again decide if I want to continue.

Once I start I cannot stop. My T will only do this prescribed therapy...so if I want to stop I will have to quit I guess. She has never had someone quit. I told her I was sorry. She didn't ask why...but I am a quitter it's what I do. I have quit every therapist I've had well one moved away. I would hate to ruin her record so I will do my best not to quit.

I will have no out of session contact at all (I don't have any now...she doesn't respond to scheduling texts even...unless of course she initiated it) and we will not spend time talking about any of my current day problems or stressors. She says it can seem like she is a bully at times.

I'm completely numb anyway so I'm not feeling anything one way of another about it.

Wow. Sounds intense! Is it a lengthy process?

According to the site that Snake Charmer linked above:

A round of PE therapy most often involves meeting alone with a therapist for about 8 to 15 sessions. Most therapy sessions last 90 minutes

My sessions will only be 60 minutes so I don't know if that will lengthen the process any... I don't really think so but I guess its possible.

I really think it will work for you. Of course it sounds like it will be hell but you will come out stronger on the other side. I'm proud of you!!

ReadyToStop, you've made a courageous decision! Please come back and tell us how it progresses for you. It is intense, but there are so many small successes and triumphs along the way -- real, visible progress -- that the desire to quit is overcome by all the positive reinforcement.

My sessions were usually about an hour, too. I don't know if 90 minutes would have improved things or not. I don't know.

I wish you the best with this. And please don't worry about quitting. Getting through any part of it is important. It's one step at a time and if it's a baby step, that's okay. Each little step is a move forward.

Thanks. I'm doing this for 2 main reasons...

1. I don't know exactly what happened at the end of the traumatic event we are dealing with...i fear an even greater trauma occurred...she said if this doesn't bring such memories back then she would say nothing additional happened

2. She doesn't think I will require therapy after doing this...even for things I consider core beliefs and negative self talk....not PTSD related.

I couldn't find anything in the prolonged exposure therapy book for therapists that I read related to this though....hope it's true?

Feel like I'm going nuts and a week is to long.. At one point I'm resolved to do this and then a few days later I'm determined to not do this.... I wish I could just get it over with instead of weeks of sessions about assessments and education.

Ready, I'm sorry you're having a hard time with this. The process isn't anything at all like regular talk therapy or the types of interactions other posters talk about here with their Ts. It's not ... I was going to say it's not supportive, but that's not right. It is supportive, but our panic and feelings of inadequacy and being overwhelmed do not get either positive reinforcement or punishment or too much sympathy.

Ts who are good at this have great empathy and compassion, but they've been trained to listen to us, not to our fears, panic and neuroses. They don't see us as broken, just a little cracked around the edges. They won't validate the idea that we're permanently wrecked. They'll validate that it's hard and scary and rough, but not that we're too weak to move forward. I found this empowering.

The education and assessment portion is important. If the patient doesn't understand the process in advance and doesn't give informed consent before the really stressful stuff starts, it could feel abusive and it could be more traumatizing. As your T said, there may be times you see them as a bully. I saw my T as a drill instructor, probably an old fashioned Marine training up a raw recruit, preparing me for battle. If I had not given consent in advance, I would have said FU and walked away. Stormed away. It would not have been pretty!

Understanding how the process works and buying into the idea of allowing your T to push you to face your fears when you want to run and hide is an important part of making it work.

The T also has to have an accurate picture of the patient's stamina. The goal is exposure to the Dreaded Things in a completely safe way. Anxiety attacks may happen. They have to make sure they push just hard enough to get us to face our fears, but not so hard that safety is jeopardized.

The breathing and calming exercises are vital, too. I still use them whenever I feel myself getting upset about something.

Hang in there! It'll be okay.