In Vivo Exposure Therapy for PTSD: The Importance of Safety
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
- The situations chosen for in vivo exposure must be objectively safe.
- Discuss these considerations with your patient and teach them how to assess the danger.
- Modify them as necessary for special circumstances.
Materials Downloads
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Transcript
Video 7: Safety considerations when constructing the in vivo exposure hierarchy.
It’s important that the situations chosen for in vivo exposure are objectively safe or low risk. The in vivo exposure exercises are selected by the patient and the therapist with consideration of safety and the relevance of the situation to the patient’s daily functioning. If you’re unfamiliar with the places, activities, or situations that the patient avoids, it’s important to ask about normative behavior for the patient’s peer group in that situation. For example, if you’re considering whether or not it’s safe for a woman to walk outside alone in her neighborhood, ask the other women you know do this. Do women in your neighborhood walk outside alone? And how late do they do this?
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.
Situations that are objectively dangerous or high risk should not be assigned. For example, the patient should not be asked to walk alone in areas where drugs are known to be sold or in a park where ongoing criminal activities are known to take place. Instead, alternate exposures should be designed that include elements that trigger anxiety but preserve safety. For example, the patient could walk in a public park with another person or arrange to walk alone in a relatively safe area of the city.
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.