8 Myths About Exposure Therapy

Barbara Rothbaum, Ph.D.

This presentation is an excerpt from the online course “Prolonged Exposure for PTSD: A Comprehensive Guide for Clinicians”.

Highlights

• Many therapists are reluctant to use PE due to myths about exposure therapy.
• Some myths include that patients can’t handle it, patients are too complicated for PE, exposure therapy is cruel and that it takes away the patient’s autonomy.
• These myths are not true.

Transcript

Welcome to video 5, Exposure Therapy: Myth Busting.
There are many myths about exposure therapy. And unfortunately, this keeps many therapists from using exposure therapy. So let’s talk about some of these myths.

One myth is encouraging trauma survivors to relive their trauma in imagination—which is the key component in exposure—is cruel and revictimizing. We don’t think that that is true at all. People are suffering. They are coming to therapy of their own accord. They’re consenting to therapy. I believe in full informed consent so we’re explaining what’s going to be involved in the therapy. And I actually think of exposure therapy almost like an exorcism that they’re haunted by these memories and we’re helping to get rid of them. So it’s the opposite of cruel and revictimizing. We are helping to get them better.

References

Astin, M. C., & Rothbaum, B. O. (2000). Exposure therapy for the treatment of posttraumatic stress disorder (9,4). National Center for Posttraumatic Stress Disorder.

Another myth is that exposure takes away the autonomy of trauma survivors because they’re confronted with what they don’t wish to remember. And again, it’s a myth because they are coming to therapy. They’re asking for help and they need our help. PTSD is a disorder of avoidance. If we don’t do anything, if they don’t do anything, they are stuck and they feel helpless. We are helping them take back control of their lives from PTSD.

References

Astin, M. C., & Rothbaum, B. O. (2000). Exposure therapy for the treatment of posttraumatic stress disorder (9,4). National Center for Posttraumatic Stress Disorder.

A third myth is that exposure can only be used with survivors of discrete traumas such as rape, natural disaster, or motor vehicle accidents.
The truth is that most of the people we treat are multiply victimized, multiply traumatized. Most people have experienced more than one traumatic event. And it works very well for those people.

References

Astin, M. C., & Rothbaum, B. O. (2000). Exposure therapy for the treatment of posttraumatic stress disorder (9,4). National Center for Posttraumatic Stress Disorder.

A fourth myth is that exposure can only be used with individuals who are healthy and stable; it can’t be used with the typical trauma survivor who is complex and fragile. The truth of the matter here is the majority of people with PTSD present with PTSD and 3 other diagnoses. Comorbidity is the rule rather than the exception.

References
Astin, M. C., & Rothbaum, B. O. (2000). Exposure therapy for the treatment of posttraumatic stress disorder (9,4). National Center for Posttraumatic Stress Disorder.

A fifth myth is that exposure may induce psychosis or severe depression. I have been doing this since 1986. I’ve been supervising a lot of people all over the country, actually all over the world. I have never seen exposure therapy induce psychosis. Sometimes, people will experience some depression as they’re moving through the exposure process, but I see that almost like Elisabeth Kubler-Ross’ stages of grief. And very often, they will move through fear. They’ll move through depression. They’ll move through anger. But that’s part of the emotional engagement and I see that as healthy. We don’t want someone stuck in the anger or depression. And in fact, PTSD—in all of our studies of PTSD when we also measured depression—it usually improves the depression as well. So it does not cause severe depression.

References

Astin, M. C., & Rothbaum, B. O. (2000). Exposure therapy for the treatment of posttraumatic stress disorder (9,4). National Center for Posttraumatic Stress Disorder.

Another myth is that exposure can’t address broader trauma-related symptoms other than anxiety and PTSD. And I just mentioned usually PTSD treatment decreases depression as well. We now have a number of studies that PTSD treatment with someone who is substance-using, especially if that substance use disorder developed after exposure to the trauma, that it decreases the substance use. We are treating people with traumatic brain injury and PTSD and we’re seeing decreases in their reports of TBI symptoms. So exposure therapy does address broader trauma-related problems.

References

Astin, M. C., & Rothbaum, B. O. (2000). Exposure therapy for the treatment of posttraumatic stress disorder (9,4). National Center for Posttraumatic Stress Disorder.

Another myth is that exposure doesn’t allow trauma survivors to recover at their own pace. This is partially true because their pace is stuck. Their pace is avoiding. Their pace is a painful existence with their lives becoming narrow. I do tell my patients sometimes that they’re going to have my fingerprints on their back and that I will be pushing them, but I’m going to push them outside of their comfort zone but not outside of their safety zone. And again, it’s a collaborative dance that they have consented to.

References

Astin, M. C., & Rothbaum, B. O. (2000). Exposure therapy for the treatment of posttraumatic stress disorder (9,4). National Center for Posttraumatic Stress Disorder.

Last myth that we’ll address now is that controlled studies of exposure therapy only use clean PTSD patients. People have tried to discount our studies saying, “Oh, that’s just with the clean PTSD patients. It’s not like the complicated patients that I see.” And again, I don’t even know what a clean PTSD patient looks like. Most people are multiply comorbid. Most people have multiple traumas.

References
Astin, M. C., & Rothbaum, B. O. (2000). Exposure therapy for the treatment of posttraumatic stress disorder (9,4). National Center for Posttraumatic Stress Disorder.

The key points from this video are that many therapists are reluctant to use PE due to myths about exposure therapy. Some of the myths about exposure therapy include that patients can’t handle it, patients are too complicated for PE, exposure therapy is cruel, and that exposure therapy takes away the patient’s autonomy. These myths are not true and research and therapists’ experience dispel them.

More PE presentations

• Assessing PTSD: Measurement-Based Therapy
• Breathing Retraining in PTSD: A Practical Exercise
• CBT for PTSD: Basics and Rationale
• CBT for PTSD: Summary
• Conducting Exposure Therapy and Virtual Reality for PTSD
• Constructing the In Vivo Exposure Hierarchy for PTSD Therapy
• Emotional Avoidance and Anxiety Sensitivity: Tips for Therapists
• Imaginal Exposure for PTSD: Emotional Processing First Steps
• Imaginal Exposure for PTSD: Hot Spots in Trauma Memories
• Imaginal Exposure Script: An Example
• Implementing Imaginal Exposure: Revisiting the Trauma Memory
• In Vivo Exposure Therapy for PTSD: The Essentials
• Managing Comorbidities in PE Therapy for PTSD
• Mechanisms of PE in PTSD: Emotional Processing and Cognition Modification
• PE for PTSD: Addressing Under-Engagement and Homework
• PE Therapy Sessions: Structure and Main Components
• Preparing Clients for PE: First Steps
• Processing Emotional Hot Spots for PTSD: Introduction
• PTSD from a PE View: The Fear Structure, Trauma, and Recovery
• Self-Care for PTSD Therapists: Developing Tolerance for Patient Distress
• Understanding DSM-5 Criteria for PTSD: A Disorder of Extinction
• Using PE to Overcome Fear: 4 Cornerstones