What is “exposure,” and why is it used in treatment?

To explain how exposure works in treatment, it may be helpful to understand how our brains process and store memories of events that are traumatic in nature. The following analogy is adapted from Foa, Hembree, and Rothbaum (2007) and is useful in better understanding how exposure can actually help in the treatment of PTSD:

Think of your brain as if it were a filing cabinet, with neatly labeled and organized folders that contain all the memories and events in your life. You have folders for all the experiences you generally have in life. For instance, you might have a “Grocery Shopping” folder, a “Birthdays” folder, a “Work” folder, and so on.  Each experience we have on a day-to-day basis is neatly filed away in its proper place in these folders.

Because traumatic events are so far outside one’s day-to-day experience, our brains do not have a file folder already labeled and ready to store the memory as neatly as those from our day-to-day lives. As a result, when someone experiences a traumatic event, the brain doesn’t know where to file the experience. The pages are shoved into the cabinet haphazardly, and the door is slammed shut as quickly as possible. From time to time, the pages begin to slip out, in the form of symptoms such as intrusive memories or nightmares. The automatic reaction is often to quickly stuff the pages (memories) back into the cabinet and slam the file drawer shut again and again and again. These pages, however, are slipping out for a reason—it’s your brain’s way of reminding you that there is still an experience that needs to be processed and organized.

Exposure treatment allows for the emotional processing of a traumatic event. With the guidance and support of our trauma experts at your side every step of the way, you can learn to regain control over these memories, taking the trauma pages out, looking through them when you wish, and then placing them back in their own neatly labeled folder, closing the drawer of the file cabinet, and return to living your life.

Through exposure, the trauma memory becomes more organized. That is, rather than existing as isolated bits and pieces of the entire experience, the memory comes to be one with a beginning, middle, and end. This is often very useful for people in the processing of the memory. Additionally, in treatment the memory of the event can be put into context (e.g., for a person whose trauma involves killing someone in combat, recalling that this occurred in the context of war) and as a result, it can be seen from a new perspective. Distinctions between what was true in the past and what is true in the present are also made. For example, when a traumatic experience occurred, it may have been important for survival to be constantly on guard, but when no longer in that situation, it may not always be necessary to be hypervigilant.

Of course, this process can seem overwhelming at first glance. You may face internal conflict—wanting to seek treatment but also hesitant due to worry about experiencing distressing emotions that may come up or due to feeling that pressure to “suck it up” and just “deal with it.” Remember, treatment for PTSD is not aimed to make you feel worse; treatment is designed to help alleviate these unpleasant symptoms and take the power out of the trauma memory and put it back in your hands. This is the ultimate goal of trauma treatment—by processing the memory, you can regain control over your life and fully engage in the things that were meaningful to you once again. And this time, you are free to go forward without the shadow of the trauma looming over you.