Research Are You Getting Exposure Therapy? Just Testing The Grounds...

[Nicolas Connault]

Thanks Contessa, I will email you shortly.

 

[anthony]

I mean there is a breakdown in treatment by therapists with PTSD... like you're examining yourself with exposure therapy, therapy with PTSD patients in general is getting to the point of little useful therapy and more attempts to "quick fix" the client, whether it be with medication or some quick fix model.

America is overwhelmed with PTSD right now, primarily due to the their military commitment, which also heightens PTSD in the media. Australia is not much better, with psychiatrists primary treatment starting and ending with medication, psychologists here aren't too bad, but they are starting to fall down the counselling role dealing with PTSD versus the psychotherapy role of pushing the person and getting them healing.

Its getting ugly all round IMHO. Lack of therapists, over commitment by Governments with troops, as another thread outlines, Government downgrading mental health funding, the list goes on...

When anyone says they've been in therapy for 10 years, I think the therapist should have their license revoked.

 

[Nicolas Connault]

I agree, therapists tend to like the nice "talk therapies" better than the tough exposure techniques, which are anxiety-provoking for both client and therapists, though to a much lesser degree for the latter. It's not "nice" or pleasant to induce panic symptoms in oneself by hyperventilating, it feels horrible, yet live demonstration is a very powerful way for therapists to earn their clients' trust and help them make the plunge into the world of exposure.

I also think that the whole profession of clinical and counselling psychology is in jeopardy right now in Australia. Being better at what we do may play a critical part in preserving this vital segment of mental health care.

 

[maddog]

Extremely interesting and thought-provoking topic. I too have utilised a combination of cognitive and exposure therapies to date, probably more so the former, but with an increasing trend towards the latter as we speak.

Perhaps that's partly why I don't feel very eloquent tonight, or very able to contribute the same level of insight and intellect to this discussion that others have, but suffice to say I would be willing to participate in any appropriate study and I share the concerns that others have expressed as to the state and foreseeable future of trauma therapy in Australia in particular.

Maddog

 

[PTSD sufferer]

Nicolas, I'd be happy to complete a survey for you.

My therapy has been more CBT than exposure therapy. I went through a bit of EMDR at the start with CBT in between. Now its CBT all the way.

My Therapist is pretty amazing actually, and I am lucky to have had this support since being diagnosed. I see a psychiatrist and the psychologist privately. Both are excellent and although I take most of the credit for my current state of wellness, they take the rest of the credit. :p

I put more pressure on myself to do the work to get well. I push myself sooo much - I have actually been told to be a little more patient with myself on this front. :D I take all the responsibility for getting well.

The NHS system (government health care) in the UK was terrible for PTSD. Although my GP is great, the psychiatrists and psychologists are probably more used to dealing with other mental conditions, rather than treating PTSD. That showed with the medications and conversations I had initially with them. Hence why I sought to pay privately for good quality mental health care.

 

[Nicolas Connault]

Thanks Happy Head, maddog and PTSD sufferer for your interest, it's quite encouraging!

PTSD sufferer (please let me know if you use a shorter nickname!), I'm wondering if the recent massive funding for CBT therapists in the UK (IAPT) has had an influence on the treatment type and quality you have been receiving? I've been reading up on this mass-training of low and high intensity therapists, and I wonder how many of them are actually getting trained in exposure therapy. My concern is that therapists can be great at making clients feel good in the short term (between sessions), but can miss the lack of long-term progress that might help a person become independent of frequent therapy and/or medication.

 

[Sterre]

In all the years i've been in therapy, with different therapist, there were no real exposure techniques applied. Only mild exposure in talking and sometimes re-telling the story of my trauma.
But I still dont get what you define as exposure therapy? Do you mean that you go outside or to the place where it happend, or to re-enact the situation, or something like that?

EMDR is a form of exposure right?

CBT here in the Netherlands is only applied when you are diagnosed with BPD. There are no real trauma specialists /trauma therapy's here for complex trauma related to chilhood events, or maybe I just cant find them.
There are trauma therapy's for veterans or refugees, but when your trauma stems from childhood there are no real traumatherapy's. If you're lucky you will meet a therapist that knows how to treat complex trauma ( including exposure therapy), but I have not run into someone like that yet.

 

[Nicolas Connault]

Sterre, when the feared situation cannot be approached through live (or in vivo) exposure, other types of exposure are used. The most common is imaginal exposure, where the person closes their eyes and tries to re-live or revisit what happened, and tell the therapist what they are experiencing. The therapist guides them and helps them to stay "grounded", because dissociation can happen and can be very traumatic itself. This is sometimes called Prolonged Exposure or Flooding. If done properly, this can have very powerful therapeutic effects, as Anthony has explained here and elsewhere on this forum.

EMDR uses some techniques that are conceptually exposure-based, and in fact many therapists and researchers believe that it is the exposure component of EMDR that contributes the most to its therapeutic effectiveness.

Unfortunately, since the vast majority or published research is in English, English-speaking countries are always a few years (sometimes decades) ahead of other countries in being up-to-date with the latest treatments. It's hard to get access to specialists that can offer training, because of translation issues, and there are probably other limitations too. There is a wealth of knowledge on the Internet, though, but you need to know what is trustworthy and what isn't. Trying to improve the awareness of exposure-based therapy in the Netherlands sounds like a very worthy project :-)

 

[KP the nut]

I struck NHS gold with my therapist.

He did EMDR which was one of the hardest things I have ever done. However he also helped me set goals. Driving was a major issue for me, likewise leaving the house, contacting friends etc.

He would encourage me to do short drives, phone a neighbour and arrange to meet for coffee or visit a local shopping centre. He encouraged me to leave my comfort zone and to reward myself for doing that. He showed me that in order to heal, I needed to be kind to myself and to not be so hard on myself. He also asked me to keep a book in which I would write things for which I was grateful for, proud about or just made me smile. I continue to do this even though I finished therapy in August.

It is still hard but for the most, I am managing my symptoms. I still push myself and expose myself to things out of my comfort zone.

I would also be willing to complete a short survey.

 

[Nicolas Connault]

Thanks KP! Isn't interesting that, while you're constantly pushing yourself and stepping out of your comfort zone, you're also being "kind" to yourself!

 

[KP the nut]

while you're constantly pushing yourself and stepping out of your comfort zone, you're also being "kind" to yourself!

I have had a busy few days, going way beyond my usual boundaries.
1) fancy dress Party on Sat night
2) Hosted a Partylite candle party on Mon
3) Had a first meeting with another member of the forum, which involved a 115 mile round drive yesterday.
4) Had a horrid dental session this morning

I did have an appointment this afternoon, however I woke feeling a bit overwhelmed and v tired, so I moved the appointment to tomorrow and I will shortly go for a nap. I will spend the rest of the day recharging my energy reserves AND I don't feel guilty about it.

I firmly believe being kind to yourself is vital. I believed I was so worthless, some days those thoughts try to reappear but I have techniques to keep them at bay.

 

[Nicolas Connault]

I did have an appointment this afternoon, however I woke feeling a bit overwhelmed and v tired, so I moved the appointment to tomorrow and I will shortly go for a nap. I will spend the rest of the day recharging my energy reserves AND I don't feel guilty about it.

The "Balanced" mood seems very appropriate then :-)