Academic journal article American Journal of Psychotherapy

Exposure Therapy for Posttraumatic Stress Disorder

Academic journal article American Journal of Psychotherapy

Exposure Therapy for Posttraumatic Stress Disorder

Article excerpt

RESEARCH

Exposure therapy is a well-established treatment for Posttraumatic Stress Disorder (PTSD) that requires the patient to focus on and describe the details of a traumatic experience. Exposure methods include confrontation with frightening, yet realistically safe, stimuli that continues until anxiety is reduced. A review of the literature on exposure therapy indicates strong support from well-controlled studies applied across trauma populations. However, there are many misconceptions about exposure therapy that may interfere with its widespread use. These myths and clinical guidelines are addressed. It is concluded that exposure therapy is a safe and effective treatment for PTSD when applied as directed by experienced therapists.

Exposure therapy, also referred to as flooding, imaginal, in vivo, prolonged, or directed exposure, is a well-established treatment for Posttraumatic Stress Disorder (PTSD) that requires the patient to focus on and describe the details of a traumatic experience in a therapeutic manner. Exposure methods share the common feature of confrontation with frightening, yet realistically safe, stimuli that continues until the anxiety is reduced. The rationale for exposure therapy is that by continuing to expose oneself to a safe, yet frightening, stimulus, anxiety diminishes, leading to a decrease in escape and avoidance behavior that was maintained via negative reinforcement (1).

In this article, we will first discuss the theory of Cognitive Behavioral Treatments (CBT), specifically exposure therapy, for PTSD. Next, we will demonstrate the efficacy of exposure therapy for PTSD by reviewing the relevant research findings and clinical conclusions. Important clinical guidelines that increase the likelihood of successful exposure therapy will be discussed. Finally, a number of common misbeliefs regarding exposure therapy that may contribute to the clinician's reluctance to use this treatment will be addressed.

THEORY

Emotional-processing theory holds that PTSD emerges due to the development of a fear network in memory that elicits escape and avoidance behavior (2, 3). Mental fear structures include stimuli, responses, and meaning elements. Any information associated with the trauma is likely to activate the fear structure. The fear structure in people with PTSD is thought to include a particularly large number of stimuli and, therefore, is easily accessed. Attempts to avoid this activation result in the avoidance and numbing symptoms of PTSD. Emotional-processing theory proposes that successful therapy involves correcting the pathological elements of the fear structure, and that this corrective process is the essence of emotional processing. Two conditions have been proposed to be required for fear reduction. First, the fear structure must be activated. Second, new information must be provided that includes elements incompatible with the existing pathological elements so they can be corrected. Exposure procedures consist of confronting the patient with trauma-related information, thus activating the trauma memory. This activation constitutes an opportunity for corrective information to be integrated, and thus modify the pathological elements of the trauma memory. Of particular relevance to PTSD is a study demonstrating that fear activation during treatment promotes successful outcome (4).

Several mechanisms are thought to be involved in the specific changes relevant to improvement of PTSD. First, repeated imaginal reliving of the trauma is thought to promote habituation and thus reduce anxiety previously associated with the trauma memory, and correct the erroneous idea that anxiety stays forever unless avoidance or escape is realized. Second, the process of deliberately confronting the feared memory blocks negative reinforcement connected with the fear reduction following cognitive avoidance of trauma-related thoughts and feelings. Third, reliving of the trauma in a therapeutic, supportive setting incorporates safety information into the trauma memory, thereby helping the patient to realize that remembering the trauma is not dangerous. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.