Exposure Therapy

I used to post fairly regularly on the forum, but took a break for a few years. I was on and off of medication and spent a bit of time in the hospital. After getting out this last time, I decided I wanted to come off of all medication and did really, really well for awhile.

My therapist decided that, since I was stable, we should start working on my lifeline, so I could live a full life and not avoid my past. We started with the easier things and ages, but are now working on the harder times (abuse). She says that the more I talk about what happened, the easier it will get. I am not allowed to write anything down or to use any coping techniques which could be considered avoidance. It's really hard. Lately, my anxiety has been really high. I'm worried that everyone I care about will die or get sick, myself included and even my pets. I have to check on them to make sure they're okay. It feels like I can't get a good breath in, I'm overwhelmed and always tearing up.

She says that, for this to go away, I have to continue the exposure therapy and now she wants me to record myself talking about a memory of abuse and replay it to myself over and over throughout the week. I'm angry at her for starting this with me and ruining my stability. I don't think I can keep doing this or continue day-to-day with this level of anxiety. I feel like I'm going to have a heart attack.

Has anyone else gone through exposure therapy? Can you share your experience? Does it really get better?

I don't know anything about exposure therapy,but if what she wants you to do is causing this level of anxiety, you should talk to her about that. I did my "homework" a long time ago by myself,and yes talking about it helps, but I don't know how replaying it over and over helps.

I talked to her about it last night and told her how anxious I was feeling. She believes that the only way to reduce the anxiety is to continue exposing myself to what I've been avoiding. She doesn't want me to avoid the anxiety, but to feel all the feelings instead. I told her I needed something and she offered paced breathing.

She said that my anxiety over death is associated with my anxiety about the abuse and my "mortal fear" of it. I guess her thinking is that I'm replaying the fear I felt as a child, as an adult, but instead of applying it to the abuse, it's showing up as this. Or something like that....

I have been really honest with her about how it's affecting me.

Trauma work requires breaks. It can be retraumatizing if it is done poorly or too much at once. I'm going thru something similar with my therapist and he said we should take a break. Can you ask tour T to slow down?

I asked and she said she is worried that it will just make the anxiety worse, because it would be left unfinished.

Prolonged exposure is only one of many treatment modalities for dealing with past abuse. There's no one 'right way' to do this. If it were me, I'd ask my T why she thinks this is the way to do this; why some other way won't work.

I would not do prolonged exposure for trauma. I've found exposure useful for other things, but not this. It sounds like hell. I really hope you find some relief soon.

I would talk to your T as well. I've been going through trauma related therapy for the last couple of years, but the one thing my T always says is that 'exposure' or 'flooding' can be really quite harmful precisely because it exposes you to all those emotions of huge anxiety and fear. I'm not an expert by any means and I only really know what I've been taught through my own experiences, but I would definitely talk to your T, explain how you're feeling, and ask if you can either have a break or ask her to really talk you through how this is going to help you, and if so what you can do in the meantime to cope with the anxiety it's bringing you.

Are you allowed to use ANY coping techniques?? Like grounding/mindfulness - anything that will allow you to have a breathing space to calm yourself and get back to the present moment? That's the one tool that helps me enormously when I feel overwhelmed and 'overloaded'.

I did this during cbt but it was written and I had to read through the trauma narrative every night. First few times I would rush through it skipping the harder bits but gradually during the week it got easier and in the end after about 2 weeks I could read it ok but I think by then I was just reading it with feeling any emotion and I knew it off by head so wasn't concentrating. I was doing cbt online so everything was written and I find it easier writing stuff. I'm now doing proper counselling and although I like and trust my t although there are issues from the last session I don't think I'll ever be able to actually say everything to her in detail like I did in cbt

This is your therapy; she's not the boss. Nor can she feel what you're feeling, so she may not get how destabilizing or hellish this is. If she has arguments for why exposure therapy would be best in your case, she can present those and you might agree with her or disagree. I think this sounds like way too much too fast. I wouldn't do the recording and playing back if I were you. Just giving you my personal feeling here, but this sounds like retraumatization. Exposure therapy is probably great for fear of spiders. Seems like a potentially dangerous idea when applied to trauma.

Yeah, I'm familiar with exposure therapy for OCD, but didn't know it was used for trauma. I started doing a bit of it for my contamination fears with OCD, but we didn't get too far before some more pressing issues in my life cropped up, so we switched over to those. I can see how they can help with OCD or phobias, since they could help you get used to something you have to deal with in everyday life. I'm not clear on why it would be beneficial for trauma though.

A therapist who tells someone not to use their coping skills? This is damaging. She doesn't know what she's doing. I don't know how else to put it.

Agreed, and I would not do it for myself. Just reading what is being demanded of you was more than I can handle and I have already found relief from past trauma.

This is your process, not hers ... She's not the one having to live with all the difficult emotions it opens up, you are ... It is okay to put the brakes on before it breaks you ... I have a therapist that allows me to come and go at my pace and comfort ... We're currently on our third extended break ... She "Gets" It ... If yours can't, doesn't or won't, then I'd start looking for one that does ... It's WRONG for anyone to push us to go faster or further than we are ready to proceed ... Where do they get off on rewounding us like this?

Sincerely,
Pfrog!

I have felt that my process has been similar to exposure therapy, in the sense that I've had to push myself to talk about our relationship (t and mine). Talking to someone directly about something that is bothering me, something I don't like, or making a request of them is panic inducing to the point that I don't build relationships. The first time I did this, I tried to melt into the furniture and totally disassociated. It has gotten easier through the exposures. Each exposure has been my doing and by my pushing - regardless if I was really ready for it.

I can't imagine being pushed like you described and not getting angry at her and being somewhat belligerent towards her. I echo many of the previous suggestions. It is your journey and if she has good reasons that exposure therapy might work for you, it should still be at your pace and I believe that part of the process is learning how to give yourself the needed self-care and compassion to get through it. I have heard the "let your self just experience the feeling" concept before - at some point I've got to self-sooth or else my anxiety leads to a plummeted level in depression.

Like Pfrog said.. "It is okay to put the breaks on before it breaks you". As far as I know, there is nothing that says how frequent the exposure has to be to work.

- E

Do you know what type of exposure therapy you are doing? Have you done any research on the effects and effectiveness of this type of exposure therapy? I only did a quick search of e.t. in general, but it all sounds like a very painful process, though apparently fruitful for many especially for PTSD. One thing that I did notice is that there aren't a whole lot of therapists with the required specialized training in exposure therapy. You might consider asking your t the extent of exposure therapy training she does have if you haven't already. Knowing what type of e.t. your t is using could also help you better search out the answers you are looking for. You might even want to consult with a specialized trained exposure therapist on this also to make sure you are in good hands with your current t and that she is doing things right. You are incredibly brave for going through the exposure therapy process.

I have had exposure therapy for fears and phobias. What your t is doing sounds like "emotional flooding" which is a controversial way of dealing with a phobia. It means you force your way though overwhelming anxiety and supposedly you end up on the other side of it. My long term t though that flooding was just asking for retraumatization Most of my t's have worked with me via gradual exposure or as one t put it stress inoculation. All gradual. If t asked me to do homework and it was too much then next time he would break it down into more manageable parts. How experienced is your t anyways?

I would not be able to do what your t is requiring. I require stability, and none of my ts think that should be challenged. Would you consider switching ts? If you want to stay with the one you have, how can we support you?

She is telling me not to use coping skills as a way to avoid the feelings or the anxiety. She did offer up paced breathing and temperature change as a way to combat high levels of distress. My go-to coping mechanisms can be considered avoiding (like counting things or distracting myself).

I do see the reason for it. She wants me to feel the emotions that I've been avoiding for so many years. It's just really hard.

It seems like she's following what I read here: Can exposure therapy help rape victims? | Al Jazeera America. You are right, though. It wouldn't hurt for me to ask her what process she's following. I'd like to learn more and maybe it would make it easier to connect with others who have gone through it.

I have a second counselor, who I have seen for 5+ years for a very specific issue, who thinks that the work she's doing with me will be beneficial. I DO trust her and her thinking that this is a good idea is part of what is making me continue.

She has had me rate things so we start at less distressing topics first and work our way to the most distressing. I ranked times in my life and types of abuse based on how remembering it and talking about it made me feel. We started at the 'not very distressing' and have worked through to the 'very distressing'. It's been going on a few months, but what we worked on before was easier.

In a way, we have gradually exposed me to distressing memories. Now that I'm at the high-ranked memories, though, I'm just feeling overwhelmed.

Intellectually, I understand what she's trying to do and I see the purpose in it. That's why, I think, I keep going back. I don't want to be terrified by my past and I do see how this would work. When I drop the intellectual part, though, I'm just left with how I feel and that's what I'm struggling through now. It's hard to keep my eye on the 'prize', so to speak, when I feel so awful by the process.