Psychologists have a knack for giving new names to old concepts. We generally do this after the old concept has been thoroughly researched and slightly tweaked for maximum usefulness… enter the term “exposure therapy” or “exposure work.” For a person coming into therapy for the first time, these terms can sound decidedly intimidating and unattractive! Whenever we go to therapy, it’s an anxiety-provoking experience in the beginning, and we definitely don’t want to feel more “exposed” than we already do! Rest assured, exposure therapy means little more than getting used to something that has previously made us uncomfortable or afraid. In therapy, this might mean getting used to certain thoughts, warded-off feelings, or activities we have stopped doing after an upsetting event.

All of us have things in life that we avoid doing. Sometimes we avoid things simply because they’re boring or mildly unpleasant, such as paying bills, housekeeping chores, or making tedious phone calls. Other times, we avoid certain activities because they make us anxious.. a little, or a LOT. Over many decades of research, behavior scientists have found that the fastest and most effective way to get over our anxieties, whether they are big or small, is to do the things that scare us. It turns out that our mothers were right: if you’re afraid of the ocean, learning to swim will help. If you’re afraid to ask someone on a date, learning to make small talk with people you find attractive will make it easier. Doing the things that frighten you, under supportive and controlled conditions where you take small steps forward, is usually the fastest way to decrease the fear.

So how does exposure therapy work with trauma? What if a person has grown up with violence, been sexually assaulted, witnessed a crime or accident, or seen horrific images in the line of duty? While these examples are a much taller order in terms of decreasing avoidance behavior, the basic principles are still the same. For example, a person with a history of sexual assault may avoid wearing certain clothes in the future because the clothing they were wearing at the time of the assault is now linked in memory and reasoning with the assault, e.g., “ I was wearing the pink shirt with the open neck. To stay safe, I’m never wearing that shirt again… or anything pink… or anything with an open neck.” As the person attempts to avoid risk of future assaults, and also avoid memories and feelings about the trauma, their world can become increasingly small because there are fewer and fewer things they are willing or able to do.

When a person has been through a traumatic event, powerful learning happens that can make it so the person will attempt to avoid anything associated with the trauma. Trauma learning can be so big that it affects things that would initially seem only randomly related to the traumatic event, such as the temperature or the weather that day, or a person’s internal sensations, like heart rate or sweating. Imagine someone who witnesses a terrible accident on an overcast day. They want to help render aid, but become frozen in place. Their heart begins to race, and they start to sweat profusely.

Going forward, this person finds that they now do not want to leave the house on cloudy days, and they have become acutely sensitive to increases in their heart rate or to perspiring even a little. As a result, they now avoid taking the stairs, have dropped out of an exercise class, and call out of work on overcast days. Television shows that cause their heart rate to speed up with excitement or anticipation are now turned off. Having dinner with friends outside on a patio no longer happens because it can result in mild perspiration on a summer night. For this person, the trauma learning has become too big; too many things that are random and harmless have gotten looped in. This person is now avoiding many parts of life that are not dangerous, but FEEL dangerous. Exposure therapy attempts to reverse this pattern so that people can get their everyday lives back.

In therapy, we have many techniques to work with the thoughts and feelings that surround prior traumatic learning. These techniques help people develop a right-sized view of how safe or unsafe the world is, return to behaviors that they previously found enjoyable and meaningful, and stop blaming themselves for things that happened to them or others around them.

Exposure therapy does involve some emotional discomfort and anxiety in the short-term, but tends to work relatively quickly, and can have a big impact after several weeks or months of effort. It is also the most researched and universally accepted form of treatment for people who have experienced traumatic events.

You CAN feel better. If you would like to talk about your readiness for exposure therapy and the suitability of this technique for you, please reach out to me with a text or voicemail at 402-650-0584 to discuss what it would be like to work together.