Exposure therapy as the antidote to trauma symptoms

Today we do a deep-dive into exposure strategies, and how we can use exposure to treat trauma symptoms.

Transcript

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Welcome to the Inner Solutions Podcast. We are your hosts, Donna Hughes and Jessica Heil. We own and operate Inner Solutions, a private practice clinic located in Calgary, Canada. We seek to understand and help our clients by providing empirically supported treatments and evidence-based practices with compassion and expertise. This podcast will provide you with information regarding complex psychological conditions as well as treatments that are available. And today I'm going to be talking about exposure therapy as the antidote to treating trauma symptoms. When we talk about trauma, trauma for us refers to any situation that has occurred that has impacted an individual in such a way that they're left with having a series of symptoms because of the event that they had undergone. Trauma symptoms can be things like having heightened emotions after experiencing something that was considered a traumatic episode to the person. It's certainly having heightened emotions whenever they're facing something that reminds them of that traumatic event. It includes things like avoidance of things that remind them of that event. It could be flashbacks where all of a sudden they just feel like they're reliving the event, intrusive thoughts, like they just can't get the event out of their minds. And it could be changes to how we think about ourselves and the world as a result of having gone through this traumatic incident. When we're living with trauma symptoms, they can be quite debilitating. They can cause us so much suffering. They can stop us from being able to live our lives the way that we want to live them. And it's really important to be able to get this treated so that we can go back to living just a high quality life and living in a way that's very aligned with our values and making sure that we can move forward from the event that we had suffered from. Exposure is a strategy that is used in many, many different psychotherapies, not just therapies that treat trauma. There's many different therapies that will have an underpinning of using exposure to be able to get the results that they're looking for. And essentially exposure therapy is getting a person to approach things that they don't really want to approach, things that make them feel uncomfortable with the purpose of when we do these things, then generally speaking, we're actually going to end up feeling better after the fact. So, for example, this would be something that's used when treating anxiety, that most people who have anxiety, they tend to avoid the things that make them feel anxious, but then it keeps them stuck in a pattern where they're perpetually having to avoid things in their lives and they end up missing really important things in their life because they can't get themselves to do things because of how they feel. When we start to expose to anxiety and we do the thing we don't really want to do and we tolerate the anxiety, what we end up learning is that while the anxiety was uncomfortable, it is tolerable and we can get through it. And as a result, the more that we go and expose to the things that create anxiety for us, over time the anxiety actually starts to get less and less and less. We call this process habituation, where we are habituating to the emotions that over time the emotions will start to decrease in intensity. Exposure therapy is the underpinning to most of the different trauma treatments that are out there and are certainly the underpinning to the trauma treatments that we use here at Inner Solutions. Exposure strategies are based on a theory called classical conditioning, which is a theory that helps us understand a type of automatic learning where variables get paired in our brains with other variables to create associations. Many of us have heard of the researcher who discovered classical conditioning and his experiments that he used with dogs. His name was Ivan Pavlov, and he researched dogs and whether he was able to get the dogs to have a specific response to food. So, in specifics, what he did is he paired the sound of a bell with the naturally occurring reflex of a dog salivating in response to food. And what he found was that over time, when he kept on ringing the bell at the same time as providing these dogs food, over time the dogs learned to associate the sound of the bell with the food. And he could start to play the sound of the bell alone without giving the dogs food at all. And the dogs would salivate even though the food was not present. Okay, so that's the theory of classical conditioning, that when we pair certain stimuli together, over time it'll create an association. The same process of classical conditioning is at play with trauma. What happens with trauma is that neutral stimuli. So things that never created an emotional experience for us before end up getting paired with these natural responses, such as having really intense emotions, right? So emotions are natural, they are a response that we have, but usually they're not happening in the face of a natural stimulus. They're typically happening from things that would create big emotions. But because there are kind of these like neutral things that were around us or happening with us at the time of trauma, our brain ends up pairing that neutral stimuli with having these big, big, big emotions. So what happens after the fact, after a trauma event has occurred, is the brain will make that association and assume that when it's in the face of these neutral stimuli, it makes the assumption that we must be in danger, that the trauma is about to occur again because that's what happened during the traumatic episode. It doesn't realize that the trauma has passed, it assumes that we're in danger again. So perhaps something traumatic occurred in a certain environment. That environment then becomes associated with the traumatic event. And then in the future, every time that a person is in a similar environment, they might get triggered with emotions related to the traumatic event. So an example of this might be that if a traumatic event occurred at a concert, then every time a person goes to a concert, they may find themselves feeling triggered, even though nothing dangerous is happening at that present concert. Often we try to avoid the things that remind us of our trauma because of course it causes distress to be reminded and who wants to be feeling distress. However, the problem then is that if we are consistently avoiding the things that remind us about those traumatic events, we never get the opportunity to unlearn the associations that we originally learned from the trauma. So we get stuck in feeling like these neutral events, whatever was around us at the time of the trauma, they feel dangerous to us because our brain has associated them with the traumatic event. It's very important, therefore, to expose ourselves to the things that remind us of the trauma, even though it's uncomfortable to do so, because then we can form new connections in our brain that help us to feel safe in the face of those cues. So if we go back to our concert example, concerts themselves are not dangerous. And the more times that I go to a concert or approach cues or things that remind me of concerts, the more opportunities my brain will have to see that concerts are actually kind of like a neutral stimulus or maybe even a positive stimulus, right? Something that's really enjoyable when I can teach my brain that concerts are not actually dangerous. So back to what exposure therapy is. The goal of exposure therapy is to begin recognizing what is being avoided that reminds us of traumatic events and begin to expose to or approach these triggers that cause us distress. Now, a caveat here, we of course would only apply exposure to things that are not factually dangerous. We want to only expose when we know in our rational brain that it is safe to do so. It is usually going to be safe to go to a concert. Typically, right, it's very rare that something bad would happen at a concert. And so we would, in our rational mind, we might know that, but in our traumatized brain, we might feel like concerts were not safe. Okay, so we need to make sure that we're distinguishing the difference. And if in our rational mind we understand that concerts are safe, then we want to apply exposure. However, let's say that we were dealing with a different scenario where maybe somebody had ended up being uh assaulted in a dark alley somewhere at like three o'clock in the morning. As a therapist, I would never say to somebody, we're going to go do exposure in a dark alley at three o'clock in the morning, because there's a possibility maybe that's not going to be a safe situation. So I wouldn't do exposure towards something that logically I understand might be unsafe. However, if somebody was dealing with trauma related to being assaulted in an alley, what I might start to do is get them to do exposure to walking down a lit street in their neighborhood at like 7, 8 p.m. as it's just starting to turn a little bit dusky when there's other people out. That scenario is much more likely to be safe compared to, say, walking down the dark street at three o'clock in the morning. With repeated exposure, our brains begin to learn that there's nothing dangerous about the situation. And with time, what we're going to find is that the more times that we're exposing to this, eventually the distress that we're experiencing decreases significantly. And eventually we should get back to the point where we don't experience very much distress, if any distress at all, to the scenarios that previously were causing us a lot of distress. Techniques like this are used in lots of different types of trauma therapies, as well as, as I mentioned, other therapies. These can include things like cognitive behavior therapy, dialectical behavior therapy, EMDR, which is a specific type of trauma treatment, as well as prolonged exposure, which is another evidence-based trauma treatment. In future episodes, I'm going to talk about prolonged exposure and EMDR in a little bit more detail, just to make sure that people who are listening and are perhaps interested in those treatments will have a better understanding of what we actually do in the treatments. So stay tuned for that. And thanks today for listening. Thanks so much for listening. If you found today's episode helpful, please go ahead and leave us a review. And you can also follow the show so that you don't miss out on any future episodes. For more information about us, you can check out our website, www.innersolutions.ca