Handling Emotional Over-Engagement in PE Therapy for PTSD: Tips for Therapists
Associate Vice-Chair of Clinical Research, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
Director, Emory Healthcare Veterans Program
Director, Emory Trauma and Anxiety Recovery Program
Paul A. Janssen Chair in Neuropsychopharmacology
Key Points
- True over-engagement is very rare.
- High distress isn’t over-engagement.
- With over-engagement, they’re not learning what they need to learn.
- Techniques for reducing over-engagement include:
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- Using the past tense,
- Keeping their eyes open, and
- The increased use of empathic grounding statements.
Materials Downloads
PE for PTSD Online Training
Learn how to apply prolonged exposure therapy principles for patients with PTSD.
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Transcript
Video 6: Over-Engagement.
Therapists new to exposure therapy worry more about over-engagement, but under-engagement is really the larger issue. I’ve rarely seen true over-engagement.
Foa, E., Hembree, E. A., Rothbaum, B. O., & Rauch, S. (2019). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences - Therapist guide (2nd ed.). Oxford University Press.,Rothbaum, B. O., Foa, E., Hembree, E. A., & Rauch, S. (2019). Reclaiming your life from a traumatic experience: Client workbook (2nd ed.). Oxford University Press.
High distress is not over-engagement. They’re learning. They’re learning that they can handle it and that it will go down the longer they stay with it. Over-engagement is when they are so distressed that they’re not learning what they need to learn. In the example I used in earlier sessions about the child with a dog phobia after being bitten by a dog, if you exposed him to a dog and it attacked him, that’s analogous to over-engagement. He didn’t learn that the animal posed no threat.
Foa, E., Hembree, E. A., Rothbaum, B. O., & Rauch, S. (2019). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences - Therapist guide (2nd ed.). Oxford University Press.,Rothbaum, B. O., Foa, E., Hembree, E. A., & Rauch, S. (2019). Reclaiming your life from a traumatic experience: Client workbook (2nd ed.). Oxford University Press.