I am finishing up my February 1st Hope for Healing Newsletter and am looking for a therapist to answer these questions regarding Exposure Therapy. Any help would be greatly appreciated! I will be glad to tag you (or not, if that's your preference) in the newsletter. Thank you in advance.

1) What exactly is Exposure Therapy?

2) Are therapists all trained in it or is it a specialized modality?

3) Why should someone consider Exposure Therapy?

4) How long does it take to notice a therapeutic impact?

5) What is a typical session like?

6) Do you assign homework to clients?

7) What are some goals a client might seek to attain while utilizing Exposure Therapy?  

Peace,

Teri

 

Original Post

Teri, I hope you'll forgive this non-answer to your question. What I've heard about simple exposure therapy is that the research only shows benefit if it ignores the many subjects who drop out because they are too triggered. There are therapies that combine exposure with more effective methods to calm the stress reactions the exposure causes. Those are EFT tapping, EMDR and other less known but similar techniques. Exposure uses stress reduction techniques such as mindful breathing to calm down from the exposure, but tapping and eye movement techniques are much more powerful at relieving stress. Therapy using modalities such as EFT tapping and EMDR are more gentle, more effective and take less time than simple exposure therapy.

I have to be very careful because everybody knows everybody in the area I live. I'll just say I have seen EFT tapping and a little art (drawing) therapy work in a couple sessions with a child. It takes longer with adults because we have more layers of stuff. EFT has a reputation of being effective in just one session with simple phobias.

good luck with your search.

The above post is full of misleading information. Prolonged Exposure (PE) is the most researched treatment for trauma related disorders around. It is also a "gold standard" treatment- meaning it's efficacy is top of the line. Again, the  above post is extremely misleading because no other trauma treatments have received gold standard status for its treatment outcomes, so the following statement is patently false. "Therapy using modalities such as EFT tapping and EMDR are more gentle, more effective and take less time than simple exposure therapy."  Drop out rates for trauma treatments are statistically the same for all approaches. Part of the symptomatology of PTSD is avoidance. That is basis for the prolonged exposure, to have the client face what they are avoiding, especially the more disturbing aspects of the traumatic event(s) as measured by subjective units of distress (SUDs).

PE involves having the client relive the trauma over and over again until SUDs begin to go down. Your homework would include listening to recordings of your sessions outside the treatment room. You may also be assigned to expose yourself to anxiety provoking stimuli outside of sessions based on a hierarchy of fears and anxieties working on the most anxiety-provoking antecedent first.  As previously stated, the goal of therapy is to reduce your SUDs level to a manageable point. Even though SUDs were developed by a behavior therapist (the "B" in CBT which is the general classification of PE), the late psychiatrist, Josepf Wolpe, SUDs are also used in Eye Movement Desensitization and Reprocessing (EMDR) and Emotional Freedom Techniques (EFT). PE is considered a short term therapy, not a longer therapy as the above, misleading post has indicated. 

I'm trained in several types of CBT for trauma, hypnosis, EMDR, EFT, psychodynamic, humanistic-existential, postmodern and several somatic approaches for trauma. The research indicates there is no statistically significant in any of the approaches with the exception of EFT, which doesn't have a significant research base, though the relatively fewer studies indicate EFT yields promising results. I use software from the VA that asks clients questions and attempts to match their answers with the best fir for the client. I also discuss the treatment strengths and weaknesses of each treatment per professional ethics of informed consent.

If you would like more information on PE, you might want to get a hold of a copy of Edna Foa's, the creator of PE workbook, that is written for PE clients titled  Reclaiming Your Life From a Traumatic Experience (2007).

Rich, there is a lot of bias and infighting within the therapy world. I, for the benefit of the traumatized people I work with, refuse to take sides when the research indicates they all work (equifinality or the dodo bird effect). I always get input from the client on what they think is the best fit for them, and every session I use feedback from the client to tailor the therapy. The critique that PE re-traumatizes people is weak since PTSD itself re-traumatizes people. This top down- horizontal and bottom up argument is not based on sound research but personal bias. This article might help to clarify. http://www.scottdmiller.com/what-heals-trauma/

Rich Featherly posted:

Teri, I hope you'll forgive this non-answer to your question. What I've heard about simple exposure therapy is that the research only shows benefit if it ignores the many subjects who drop out because they are too triggered. There are therapies that combine exposure with more effective methods to calm the stress reactions the exposure causes. Those are EFT tapping, EMDR and other less known but similar techniques. Exposure uses stress reduction techniques such as mindful breathing to calm down from the exposure, but tapping and eye movement techniques are much more powerful at relieving stress. Therapy using modalities such as EFT tapping and EMDR are more gentle, more effective and take less time than simple exposure therapy.

I have to be very careful because everybody knows everybody in the area I live. I'll just say I have seen EFT tapping and a little art (drawing) therapy work in a couple sessions with a child. It takes longer with adults because we have more layers of stuff. EFT has a reputation of being effective in just one session with simple phobias.

good luck with your search.

Hi Rich,

Thanks for taking the time to reply to my request. This is actually a request for info for my monthly newsletter. I try to provide an overview of a different modality each month (I have covered EMDR, Qigong, DBT, and more). I, personally, have utilized EMDR, EFT (tapping), traditional talk therapy, as well as Ho'oponopono Hawaiian healing, and other alternative methods for relieving my anxiety and panic attack symptoms. I believe it was a combination of all of these techniques along with utilizing mindfulness approaches that helped me reach this beautiful place of healing in which I currently reside. 

My sole goal with the newsletter is to provide information to my audience so they can make better informed decisions about their own healing journey or become better informed as practitioners.

Again, thanks for the feedback.

Peace,

Teri 

Michael McCarthy posted:

The above post is full of misleading information. Prolonged Exposure (PE) is the most researched treatment for trauma related disorders around. It is also a "gold standard" treatment- meaning it's efficacy is top of the line. Again, the  above post is extremely misleading because no other trauma treatments have received gold standard status for its treatment outcomes, so the following statement is patently false. "Therapy using modalities such as EFT tapping and EMDR are more gentle, more effective and take less time than simple exposure therapy."  Drop out rates for trauma treatments are statistically the same for all approaches. Part of the symptomatology of PTSD is avoidance. That is basis for the prolonged exposure, to have the client face what they are avoiding, especially the more disturbing aspects of the traumatic event(s) as measured by subjective units of distress (SUDs).

PE involves having the client relive the trauma over and over again until SUDs begin to go down. Your homework would include listening to recordings of your sessions outside the treatment room. You may also be assigned to expose yourself to anxiety provoking stimuli outside of sessions based on a hierarchy of fears and anxieties working on the most anxiety-provoking antecedent first.  As previously stated, the goal of therapy is to reduce your SUDs level to a manageable point. Even though SUDs were developed by a behavior therapist (the "B" in CBT which is the general classification of PE), the late psychiatrist, Josepf Wolpe, SUDs are also used in Eye Movement Desensitization and Reprocessing (EMDR) and Emotional Freedom Techniques (EFT). PE is considered a short term therapy, not a longer therapy as the above, misleading post has indicated. 

I'm trained in several types of CBT for trauma, hypnosis, EMDR, EFT, psychodynamic, humanistic-existential, postmodern and several somatic approaches for trauma. The research indicates there is no statistically significant in any of the approaches with the exception of EFT, which doesn't have a significant research base, though the relatively fewer studies indicate EFT yields promising results. I use software from the VA that asks clients questions and attempts to match their answers with the best fir for the client. I also discuss the treatment strengths and weaknesses of each treatment per professional ethics of informed consent.

If you would like more information on PE, you might want to get a hold of a copy of Edna Foa's, the creator of PE workbook, that is written for PE clients titled  Reclaiming Your Life From a Traumatic Experience (2007).

Thank you, Michael, for the book reference and the detailed explanation so I have a better feel for Exposure Therapy. As I stated in another response, my questions were put out into the ACEs community for info for my monthly newsletter. I try to provide an overview of a different modality each month (I have covered EMDR, Qigong, DBT, and more). I, personally, have utilized EMDR, EFT (tapping), traditional talk therapy, as well as Ho'oponopono Hawaiian healing, and other alternative methods for relieving my anxiety and panic attack symptoms. I believe it was a combination of all of these techniques along with utilizing mindfulness approaches that helped me reach this beautiful place of healing in which I currently reside. 

My sole goal with the newsletter is to provide information to my audience so they can make better informed decisions about their own healing journey or become better informed as practitioners. Do you mind if I utilize some of your response in my newsletter? 

Here was a response a therapist friend had given me in response to these same questions in regards to Dialectical Behavioral Therapy (DBT):

* * * * * * * * *

What is Dialectical Behavior Therapy (DBT)?
 
A friend of mine is a therapist, working with adults/teens in the Greater Cincinnati area, and one of her specialties in DBT or dialectical behavior therapy. I decided an interview with her would be a great addition to this newsletter. Thank you, Lauren O'Keefe, MS, for sharing your brilliant DBT insights with us.

1) What exactly is DBT?

This is such a common question! My immediate thought, “Um, DBT is DBT, what do you mean!” But, in all seriousness, it refers to “Dialectical Behavioral Therapy.” It is a life changing treatment modality pioneered by the fantastic Marsha Linehan

DBT focuses on high sensitivity and high reactivity to triggers. It focuses and can address so many things.The main focus is to target parasuicidal and suicidal behaviors. It’s also one of the only effective and research-based treatments for borderline personality disorder and eating disorders. It assists with allowing opposite and dialectical functioning to be true. For an example: “You can be scared AND strong.” Or, “ You can be trying your best AND still need to do better.” DBT is all about acceptance, peace and non judgment. 

DBT is effective when the treatment as a whole is being followed. This treatment includes group therapy, individual therapy and phone coaching components. 

2) Are therapists all trained in it or is it a specialized modality?

Like most modalities, you can do either. In order to specialize, you must demonstrate proficiency. This includes but not limited to: frequent trainings, research, frequent practice of the skills, etc.  

If you decide to certify rather than specialize, the certification process is extensive for this modality. It is one personally I am preparing for. I currently identify as highly specialized, with over 2 years of DBT use and experience. 

To certify you must complete all 4-5 separate trainings that are each 1-2 day trainings. You must read the CBT for Borderline Personality Book, and lead a year of DBT groups. Among this, you must ask participate in the DBT consult teams, acquire a letter of recommendation, and sit for the exam. These guidelines can change; but, when I last researched this, this is what I found. As extensive as it is, I respect it. It ensures the integrity of the treatment program and those practicing it. 

3) Why should someone consider DBT?

Why wouldn’t you consider it? That’s the true question! Yes, it targets parasuicide and suicide behaviors. It also can address a slew of issues such as: interpersonal instability, distress tolerance, emotion regulation, anxiety of any degree, depression, bipolar disorder, eating disorders, obsessive compulsive disorder. It can also assist with trauma symptoms and providing a large amount of stability skills for those dealing with PTSD. The uses for this treatment are endless. It can be used for just about any clinical problem or concern. 

4) How long does it take to notice a therapeutic impact?

This is a very hard question to answer for any counseling approach. The effectiveness and improvement times are determined by client commitment. If you work in sessions and are committed to progress- in and out of appointments- then one can see progress within a few months. But, this is highly dependent on the patient. 

5) What is a typical session like?

A typical session is like a traditional therapy session, the only difference is we have a whole binder of skills we weave into the sessions and teach to assist the patient in acquiring, generalizing and strengthening. DBT differs in that it requires group therapy to be effective. The Groups assist with faster skill acquisition and they function as a skill classroom. Without the groups, progress can be slower in my opinion. 

6) Do you assign homework to clients?

ABSOLUTELY!!!! DBT group and individual rely heavily on homework and patient accountability. If they don’t commit, progress is stagnant. 

As a therapist, we have an easy job so to speak. We teach and guide. Patients have the hard job, they have to put it into action. You cannot expect things to get better if you do nothing to change the circumstances. Homework forces the circumstances to change— and boy do they! Trust the work!

7) What are some goals a client might seek to attain while utilizing DBT?  

One we use as a blanket goal is: “Create a life worth living.”  This leaves it up to the patient to self direct. Trouble with panic attacks? Trouble with maintaining friendships? Trouble with boundaries? Self harming? Done done done! DBT has got your back! You are the driver! You tell us what your perfect life would be, and we help you create and achieve it. 

In order to get through hell, you have to go through hell, and once you’re free, you are free. Trust the journey. 

Hope this helps! 
 
* * * * * * * * * 
 
Peace,
Teri
Michael McCarthy posted:

Rich, there is a lot of bias and infighting within the therapy world. I, for the benefit of the traumatized people I work with, refuse to take sides when the research indicates they all work (equifinality or the dodo bird effect). I always get input from the client on what they think is the best fit for them, and every session I use feedback from the client to tailor the therapy. The critique that PE re-traumatizes people is weak since PTSD itself re-traumatizes people. This top down- horizontal and bottom up argument is not based on sound research but personal bias. This article might help to clarify. http://www.scottdmiller.com/what-heals-trauma/

Excellent point. EMDR DID re-traumatize me . . . but, I knew that going in and fully expected to experience flashbacks and overwhelming emotions. The difference, this time around, however, was that I also knew I was safe, and supported, and could opt out of the moment at my command. THAT made it all worth re-visiting hell. And the relief I experienced with each session. I completed 98 EMDR and brain-spotting sessions over a 4 year period (we had quite a bit of unprocessed trauma to sort through!) and every single session brought with it just a little more resolve. It was life-altering. And for that I am forever grateful.

Thank you for your willingness to tailor your approach based upon your client's feedback and needs.

Peace,

Teri

Yes Teri,

There is a lot of research using DBT for trauma work. I welcome all such innovations. DBT has been proved effective for more than treating BPD (some would assert BPD is complex trauma). The third-wave cognitive-behavior therapies like DBT and ACT do work. Marsha is tough, but her approach is tempered with empathy and compassion. I went to graduate school with a Hawaiian man who was a Ho'oponopono practitioner. That's what I like about narrative therapy, they honor the indigenous practices. My view is that there are many paths to Brahman.

Michael McCarthy posted:

Thank you, Teri

I forgot to mention brain-spotting which was developed by David Grand who was an EMDR therapist who developed his own, unique approach. 

 

We utilized some brain-spotting session throughout my EMDR therapy. A good way to spark some deep-seated "stuff" I was having trouble accessing. I found it to be incredibly fascinating.

Thanks for the feedback!

Michael McCarthy posted:

Yes Teri,

There is a lot of research using DBT for trauma work. I welcome all such innovations. DBT has been proved effective for more than treating BPD (some would assert BPD is complex trauma). The third-wave cognitive-behavior therapies like DBT and ACT do work. Marsha is tough, but her approach is tempered with empathy and compassion. I went to graduate school with a Hawaiian man who was a Ho'oponopono practitioner. That's what I like about narrative therapy, they honor the indigenous practices. My view is that there are many paths to Brahman.

I incorporate Ho'oponopono into my daily life. I will use it when confronted with a difficult person or situation. I find it to be very grounding.

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