General Provide insight on “Exposure Therapy”?

[Jay02]

Hi everyone. It’s been a long time since I’ve posted on here. A little update: my boyfriend will be undergoing exposure therapy and he is not looking forward to it. In addition, he warned me that the next twelve weeks are going to be exceptionally difficult.

He was in the Marines and have been overseas twice. As a supporter of a combat-PTSD sufferer, what can I expect for this exposure therapy? And what can I do to help my boyfriend?

 

[Never_falter2]

Hi,
during exposure therapy people have to do things they fear. The goal is to help them get accustomed to the things so that they aren’t afraid that much anymore. For example: when your vet is afraid of dirt he has to touch dirty things, first for a short while, than longer... and longer.
There is a good description in “Once a Warrior - always a Warrior: Navigating the transition from combat to home“ and I think there is a even better one in “Courage After Fire: Coping Strategies for Troops Returning from Iraq and Afghanistan and their families“. I cannot find it now but I think it was somewhere in “Courage After Fire“.

What can you do? Let him talk when he wants to talk, do not judge. I have been told that it is wrong to say “What’s so stressful about going to the shopping mall/touching the trash?“ and so on is wrong but it is good to say “while I might not understand what you are going through see that this must be very stressful to you“. When he did exposure therapy my vet would repeatedly ask me if everything was alright, if he was really not contaminated by germs and I always pointed out to him that he wasn’t.

Another thing you can do to help: encourage him to do things he enjoys, but that are not to stressful, for example like having a bath (unless they say he might not do this - my vet in a few cases was not allowed because they wanted him to stay dirty for a while), like working out if he feels like it, watching TV.
Maybe have a cigarette or some chocolate or a drink (if he is not on medication) or whatever he likes for him.

I don’t know if this is always the case but sometimes they are not really interested in sex - just be patient in this case.

 

[lostforgottensoul]

Exposure therapy is always hard for me. I freak and then I am on edge for weeks. I am very sensitive, over react to seemingly mundane things, get upset super easily and am pushed to the edge faster and easier. I will also want to numb out more. Will disocciate more. And have many more flashbacks, panic attacks and the like. All of my symptoms will peak super high.

This would be a trying time for any supporter. For me just being there, be understanding of these things. Not ask much from me until it passes. Being accepting of it. Having good rock solid boundries so that I don't accidently take everything out on you. And being still and calm can REALLY help to calm me faster. It's like a rock I can ground myself on. If someone else is calm, it helps me see the over reaction.

I think knowing what to expect will help you. I'd start doing self care on a routine so that you ensure your mental health is taken care of. If anything is too much for you, its ok to excuse yourself. Maybe start the communicate now about what you can and can't handle. What your boundries look like and what his looks like. What you can do and so forth. Any communication you two can do now will help when it starts. Because not all can communicate during. Some can though. I personally can't. All my symptoms are at their peak and so communicating anything is out the window.

Anyway, this is just me. Has he been through exposure therapy before? Maybe he can help you understand what happens for him during it so you'll know what to expect? Cause all are so very different in what happens for them during it.

 

[Jay02]

Exposure therapy is always hard for me. I freak and then I am on edge for weeks. I am very sensitive, over react to seemingly mundane things, get upset super easily and am pushed to the edge faster and easier. I will also want to numb out more. Will disocciate more. And have many more flashbacks, panic attacks and the like. All of my symptoms will peak super high.

This would be a trying time for any supporter. For me just being there, be understanding of these things. Not ask much from me until it passes. Being accepting of it. Having good rock solid boundries so that I don't accidently take everything out on you. And being still and calm can REALLY help to calm me faster. It's like a rock I can ground myself on. If someone else is calm, it helps me see the over reaction.

I think knowing what to expect will help you. I'd start doing self care on a routine so that you ensure your mental health is taken care of. If anything is too much for you, its ok to excuse yourself. Maybe start the communicate now about what you can and can't handle. What your boundries look like and what his looks like. What you can do and so forth. Any communication you two can do now will help when it starts. Because not all can communicate during. Some can though. I personally can't. All my symptoms are at their peak and so communicating anything is out the window.

Anyway, this is just me. Has he been through exposure therapy before? Maybe he can help you understand what happens for him during it so you'll know what to expect? Cause all are so very different in what happens for them during it.

Thank you for responding. It’s giving me more insight on what to expect. We moved in together so, it’s a bit of a different playing field than before but this, I believe, is his first time doing exposure therapy. He’s done group sessions and the like and absolutely hated it.

But I will definitely utilize what you’ve told me. Honestly, thank you very much.

 

[Warrior Chicken]

I’m a vet. Did 2 sessions of exposure therapy this past year. It was most definitely challenging and I’m certain everyone responds differently. I have a long standing tendency to dissociate in order to maintain functional integrity. So, we didn’t push the exposure. It’s left open to when I’m ready.

What I can say for me is that I needed space after. Completely separate from my supporter so that I could process the work. Then it took a good week for me to lower my symptoms....each person will be different in how long and how they do that.
I may be different from your sufferer, but having to even participate in the relationship was difficult. I did of course, because ptsd is not an excuse to check out for me. Just know that this time is indeed very taxing on the system. Everything is brought to the forefront and he’ll be asked to take a deeper look at the meaning in order to reframe how it affects him.

Hope that helps. Can try to answer more questions if you like.

 

[Jay02]

I’m a vet. Did 2 sessions of exposure therapy this past year. It was most definitely challenging and I’m certain everyone responds differently. I have a long standing tendency to dissociate in order to maintain functional integrity. So, we didn’t push the exposure. It’s left open to when I’m ready.

What I can say for me is that I needed space after. Completely separate from my supporter so that I could process the work. Then it took a good week for me to lower my symptoms....each person will be different in how long and how they do that.
I may be different from your sufferer, but having to even participate in the relationship was difficult. I did of course, because ptsd is not an excuse to check out for me. Just know that this time is indeed very taxing on the system. Everything is brought to the forefront and he’ll be asked to take a deeper look at the meaning in order to reframe how it affects him.

Hope that helps. Can try to answer more questions if you like.

Thank you for your response. I’m not sure yet how he will react to it, but they are telling him that he will be paired with some type of medication that they are still researching on to see if it will help with the therapy. We have broken up before because he didn’t want me to be around for what was to come, but this time, he asked for a second chance and finally admitted that it was better with me around; he was less angry.

He has been drinking. A lot. I’m not sure how I approach that situation either because I will never understand what he (or you) go through, but space, it seems like is the best bet. The only thing is we live in a small apartment together now. I guess talking about boundaries will shed light on this entire thing.

What are some boundaries that would help you, and also help your significant other?

 

[Warrior Chicken]

I had to take propranolol before my exposure sessions. There’s some new research that when propranolol is used just after the exposure and the person is able to get a decent sleep, the intensity decreases faster....I couldn’t find the paper to link here but will try to.
The sleep part as you can imagine is challenging....but if he could get some rest after then it could help.
That might mean, only needing to worry about himself, having the space he needs.

We also live in a small apartment, so there is no space at the best of times. I actually stayed in a hotel after exposure therapy. Might be something to consider for you or him?
Or if he has a trusted buddy that understands and can give him a room where he can be left alone to rest.

If I remember correctly, your vet tends on the isolation side....so space and zero expectation from others you will know already.
Please take good care of yourself, we aren’t easy to live with. But so so lucky when the right special person is willing to share their lives with us.

 

[Friday]

There are a lot of different kinds of exposure therapy. EMDR is one of the better known kinds, but a 12 week course is more likely to be CPT or PE (cognitive processing therapy, a fave of the military; or prolonged exposure therapy, which is difficult to do in-office and is mostly homework) which both have a 12 week intro (it’s not do it, done. It’s just getting started).

Some more on the most common types/applications of exposure therapy below:

Ptsd therapies
Prolonged exposure therapy for ptsd
Dead Link Removed
Eye movement desensitization and reprocessing (emdr)
Reading Forum Increases Symptoms!
How to use triggers as a means to recovery?

ANY kind of trauma therapy, not just exposure therapy, carries the very real risk of suicide & rapid decompensation (IE, losing your mind / on the road to -if not plane landed 3 hours ago- psychosis). Clearly, death is a bad outcome. Psychosis, otoh, whilst temporary comes along with the oh so cheerful potential side effects of losing everything (job, home, relationships*, and liberty). There are only 2 good ways to minimize those risks 1) Be Stable or 2) Inpatient Hospitalization (Which is rarely focused on trauma therapy, but rather emergency stabilization)...so that just loops right on back around to “be stable”. The name of the game with trauma therapy is stabilize-stabilize-stabilize. Because no matter how bad things are? They can always get worse. And the “worse” with trauma? Is reeeeeeeally really bad. Like death. And madness. And losing everyhing.

* I’m going to hit the asterisk right here. If you have even a whisper of an idea of “I would never leave him” in your head? Kick it to the curb right here & now. Because there is a VERY good reason whole TEAMS of people are sent to deal with people in psychosis. Civilians can usually be managed with police & EMTs, vets often take a SWAT team to bring in safely. People who have lost their minds do things that “he would never / she would never” do. Because they’ve lost their minds. Broken with reality. And people who feel like they’re losing their minds do umpteen gazillion different things out of sheer desperation, trying to get back in control, that are nothing short of completely f*cked up. Most people? Never hit that line, although they come close, and many many others blast right through it.

I’ve debated laundry listing out some of the f*cked up shit people do whilst dysregulated or decompensating or in psychosis, and am going to skip it... just think of everything he would “never” do, and fill in the blank. Seriously. THAT is what a person is trying to avoid whilst in trauma therapy, and why absolutely everything else takes a distant second to doing whatever he f*ck they need to do in order to stay as stable as possible. Including ending relationships on relatively good terms, or at least hitting pause for a few months, rather than because you’ve landed your ass in prison for 25 years after killing someone driving drunk, or lashing out and assaulting them in a flashback, etc. Trauma therapy is brutal. Whilst people can often maintain a semblance of a normal life in it, it become your number 1 priority, whilst everything else takes a very necessary back seat.

 

[Jay02]

I had to take propranolol before my exposure sessions. There’s some new research that when propranolol is used just after the exposure and the person is able to get a decent sleep, the intensity decreases faster....I couldn’t find the paper to link here but will try to.
The sleep part as you can imagine is challenging....but if he could get some rest after then it could help.
That might mean, only needing to worry about himself, having the space he needs.

We also live in a small apartment, so there is no space at the best of times. I actually stayed in a hotel after exposure therapy. Might be something to consider for you or him?
Or if he has a trusted buddy that understands and can give him a room where he can be left alone to rest.

If I remember correctly, your vet tends on the isolation side....so space and zero expectation from others you will know already.
Please take good care of yourself, we aren’t easy to live with. But so so lucky when the right special person is willing to share their lives with us.

I appreciate you for responding once again. He hasn’t gotten much sleep since then, and I did talk to him about boundaries and what to do if things do get a bit too difficult.

I’m reminding him that he’s got me and that I’m in this for the long haul, and that he’s the strongest person I know.

 

[Jay02]

There are a lot of different kinds of exposure therapy. EMDR is one of the better known kinds, but a 12 week course is more likely to be CPT or PE (cognitive processing therapy, a fave of the military; or prolonged exposure therapy, which is difficult to do in-office and is mostly homework) which both have a 12 week intro (it’s not do it, done. It’s just getting started).

Some more on the most common types/applications of exposure therapy below:

Ptsd therapies
Prolonged exposure therapy for ptsd
Dead Link Removed
Eye movement desensitization and reprocessing (emdr)
Reading Forum Increases Symptoms!
How to use triggers as a means to recovery?

ANY kind of trauma therapy, not just exposure therapy, carries the very real risk of suicide & rapid decompensation (IE, losing your mind / on the road to -if not plane landed 3 hours ago- psychosis). Clearly, death is a bad outcome. Psychosis, otoh, whilst temporary comes along with the oh so cheerful potential side effects of losing everything (job, home, relationships*, and liberty). There are only 2 good ways to minimize those risks 1) Be Stable or 2) Inpatient Hospitalization (Which is rarely focused on trauma therapy, but rather emergency stabilization)...so that just loops right on back around to “be stable”. The name of the game with trauma therapy is stabilize-stabilize-stabilize. Because no matter how bad things are? They can always get worse. And the “worse” with trauma? Is reeeeeeeally really bad. Like death. And madness. And losing everyhing.

* I’m going to hit the asterisk right here. If you have even a whisper of an idea of “I would never leave him” in your head? Kick it to the curb right here & now. Because there is a VERY good reason whole TEAMS of people are sent to deal with people in psychosis. Civilians can usually be managed with police & EMTs, vets often take a SWAT team to bring in safely. People who have lost their minds do things that “he would never / she would never” do. Because they’ve lost their minds. Broken with reality. And people who feel like they’re losing their minds do umpteen gazillion different things out of sheer desperation, trying to get back in control, that are nothing short of completely f*cked up. Most people? Never hit that line, although they come close, and many many others blast right through it.

I’ve debated laundry listing out some of the f*cked up shit people do whilst dysregulated or decompensating or in psychosis, and am going to skip it... just think of everything he would “never” do, and fill in the blank. Seriously. THAT is what a person is trying to avoid whilst in trauma therapy, and why absolutely everything else takes a distant second to doing whatever he f*ck they need to do in order to stay as stable as possible. Including ending relationships on relatively good terms, or at least hitting pause for a few months, rather than because you’ve landed your ass in prison for 25 years after killing someone driving drunk, or lashing out and assaulting them in a flashback, etc. Trauma therapy is brutal. Whilst people can often maintain a semblance of a normal life in it, it become your number 1 priority, whilst everything else takes a very necessary back seat.

Wow. Thank you for the detailed response. You put everything into perspective for me and showed me I can’t live in this fantasy world. I do believe in us, but this time around, I feel like I’m a stronger individual too. I’ll look into the links that you sent me so I can gather more research. Honestly, I appreciate it.

 

[Never_falter2]

@Jay02 I am not a medical doctor but please tell hi. To be careful mixing medication with alcohol. In extreme cases this even might be deadly. I googled it and propanol should not be mixed with alcohol.

 

[Jay02]

@Jay02 I am not a medical doctor but please tell hi. To be careful mixing medication with alcohol. In extreme cases this even might be deadly. I googled it and propanol should not be mixed with alcohol.

Okay. Thank you so much. I’ll let him know and definitely keep an eye out. I really appreciate you telling me!