Exposure Therapy!

Today I made the decision to do exposure therapy for my PTSD!

Prolonged Exposure (PE) is offered as an optional part of the DBT treatment program I’m doing (so it’s DBT-PE if you want to be technical). My prior-to-DBT therapist and my DBT therapist have both been talking to me about doing exposure or processing through my trauma in some way for a while. I’ve been very hesitant to try it because it sounds so scary to expose myself to the things I fear most.

There’s a part of me that really wants to do the exposure therapy so that I can finally get over the trauma and leave it behind me. This part of me, my wise mind, knows it will be good to process it through. It knows that the symptoms are taking a toll on my life.

There’s another part of me, my emotion mind, that has an intense gut reaction of “NO!” to the idea of exposure. Exposure sounds terrifying. It sounds dangerous.

Wise mind — a DBT concept

My wise mind argues back that a memory isn’t dangerous. I will not be put in any objectively dangerous situations as part of the exposure. And my reluctance to do the exposure is another form of avoidance, part of what exposure is trying to solve (so meta!).

Still, my emotion mind is strong. I have a lot of fear.

My DBT therapist had me do a pros and cons of continuing to avoid the trauma versus doing the exposure for it. Even after doing the pros and cons and seeing how much of my life I could get back by doing this, I wasn’t sure.

After showing my completed pros and cons chart, discussing it, and getting some more info about DBT-PE, I left therapy feeling kind of sad and hopeless. A lot of hope had been riding on this treatment program and especially the PTSD treatment (the prolonged exposure). I was really hoping this would “cure” me, if not fully, then at least a good amount. I started feeling more depressed than I had been before. I didn’t want to do anything. I saw no future for myself.

I kept thinking about it, and a few hours later, I sat down and wrote my decision below my pros and cons list.

Decision: Do exposure stuff.

Because…

• I’m sick of this!
• It’s been too long
• I could feel better
• It’s worked for other people
• I could be more of myself
• If I don’t, I’ll probably keep being like this, and that makes me sad.
• I can use skills, so it won’t be THAT that bad.
• My therapist can help me. I won’t be doing this alone.
• Wise mind me wants to do this!
• I am doing this because it is safe to do, and I want to feel better, not because I’m being forced into it by anyone. This is my decision.
• Memories aren’t actually dangerous!
• I can always decide not to do something later. I am in control of the exposures and the pace, and I can always say no.

Exposure therapy sounds like the obvious choice when I write it out like this. But I’m writing this from wise mind. It was really hard to think about this and to even consider exposure when I was in emotion mind. And I kept getting drawn into emotion mind every time I tried to think about this.

I don’t know exactly what made me switch into wise mind and finally be able to consider this rationally. Maybe the organized pros and cons list helped. Maybe all the handouts and diagrams and evidence helped make it more empirical. Maybe I needed enough time to think about it. Maybe seeing how sad I felt when I thought about deciding to not do it showed me how essential this treatment is for me right now.

This was a really hard decision, but I feel so much more hopeful now that I’ve made it.

(More info on DBT-PE: https://dbtpe.org/treatment-overview/)

What do you think of choosing to avoid something vs. expose yourself to it?