Considering Safety Behaviors and In Vivo Exposure for PTSD Treatment
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
- Make sure your patient isn’t engaging in safety behaviors.
- Safety behaviors are subtle and help them feel safer.
- These behaviors interfere with learning from in vivo exposure and should be eliminated.
Materials Downloads
PE for PTSD Online Training
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Transcript
Welcome to Module 4 where we’ll cover safety behaviors, tips for exposure therapy, and session 3. In video 1, we’ll discuss safety behaviors and in vivo exposure.
You assigned homework for your patient to practice in vivo exposure in session 2, so they should be reporting back to you how it went in session 3. So, I wanted to start the session 3 video with a discussion of safety behaviors.
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.
If patients have a good experience with in vivo exposure, that is if they picked the right item to practice with your help, stay in it long enough for their distress to go down, and leave thinking, “That was easier than I thought,” then that sets them up in a great position for the rest of treatment. You can always refer back to this experience and remind them that exposure worked for them. More than likely, if you picked the right items to practice for in vivo exposure, they will come back and report that their anxiety decreased and it got easier. Occasionally, it sounds like they did everything right but their anxiety doesn’t go down. In that case, you will need to explore with them why not. It may be that the item was too hard or that something unexpected happened. But there is also a chance they engaged in safety behaviors.
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.