Treating Trauma, Part 2: When Avoiding Trauma Keeps Us Stuck: How Prolonged Exposure (PE) Therapy Helps PTSD
Chanderbhan Psychological Services
In our April blog post we talked about Cognitive Processing Therapy (CPT)and how it helps us challenge the stuck points in our thinking that keep us trapped in the aftermath of trauma. This month, we want to introduce you to another highly effective, research-backed treatment for PTSD: Prolonged Exposure (PE) therapy. If you are looking for evidence-based trauma therapy in Laredo, TX, understanding how PE works can be a life-changing first step.
If you've ever experienced a traumatic event, you know that the mind and body do everything they can to protect you from experiencing that pain again. But sometimes, those very protective mechanisms are the very things that keep the trauma alive.
To understand how PE works, it helps to look at what keeps post-trauma difficulties going in the first place. When we experience a trauma, our natural reactions often don't get the chance to fade. Instead, they endure, largely driven by two things: avoidance and the development of unhelpful beliefs.
Two main ways we avoid:
1) Internal avoidance: We push away the memories, thoughts, and feelings associated with the trauma.
2) External avoidance: We stay away from the people, places, situations, or objects that remind us of what happened.
Avoidance is a natural response to trauma. In the short term, it works great. It gives us immediate relief. But in the long run, avoidance acts like a barrier that prevents us from emotionally processing what happened and learning that we can tolerate the memories, feelings, and reminders we've been avoiding.
It’s important to say that avoidance can look different depending on your life. For example, for first responders, avoidance doesn't always look like staying away. Police officers, firefighters, EMS professionals, and other first responders usually continue responding to difficult calls and appear to be functioning well but they may be avoiding specific memories, emotions, conversations, locations, or reminders connected to a traumatic event. Staying busy, compartmentalizing, or pushing through can become forms of avoidance. These strategies are helpful in the moment, especially when the job requires you to keep functioning, but they can become a problem when the nervous system never gets the opportunity to process what happened.
How Avoidance Keeps Us Stuck
You can think of trauma like a stack of messy files jammed into a drawer so tightly you can't close it. To move on, we've got to take the files out, organize them, and put them back where they belong so we can finally close the drawer. Avoidance, whatever form it takes, keeps those files jammed in place, preventing us from learning that we're actually safe now and capable of coping.
Prolonged Exposure therapy is designed to help us safely open that drawer. Typically spanning 10 to 15 sessions, PE uses two ways of doing this, called exposures, to help us reduce avoidance and engage in behaviors that help us to reduce avoidance, update unhelpful beliefs, and ultimately move toward recovery.
Imaginal exposure: This involves revisiting the trauma in your imagination and retelling the story out loud during our sessions. Repeatedly facing the memory in a safe space of the therapy session helps your brain process the experience and gain a new perspective on it.
In vivo exposure: This means gradually and systematically confronting the safe, real-life situations you’ve been avoiding. By slowly dipping your toes back into these situations, you build new learning and realize that these reminders aren't actually dangerous.
Ultimately, by facing these fears throughout the treatment, we start to shift our core beliefs from "the world is entirely dangerous and I can't cope" to “Some situations are dangerous, but not every reminder means I'm in danger and I can cope with what I feel.”
It’s important to know that we do exposures in PE at a safe, gradual pace; we plan exposures together. Talking about the trauma is difficult, but right now you’re probably spending a lot of time and emotional energy avoiding it; the trauma memory has a lot of power in your life. When we talk about the trauma memory or memories in PE, we’re doing it in a safe, controlled environment, and the goal is to help you make sense of it, organize it, and feel in control again.
What does the start of this journey look like?
In our very first session of PE, we lay the groundwork. We start by introducing you to the treatment and answering questions. We then spend time gathering detailed information about the specific trauma so we know exactly what we're working with, establishing a clear beginning and end point to the memory.
We also introduce a practical tool right away to help manage the physical anxiety that comes with facing these memories: Breathing Retraining.
When we get anxious, we tend to breathe quickly and hyperventilate. This actually creates physical sensations, like lightheadedness, that our brain interprets as fear, making us even more anxious. So breathing retraining is an important part of helping us manage the physical sensations associated with anxiety and fear, which in turn enables us to engage in the behaviors that move us toward recovery.
Fighting the urge to avoid
When you begin this therapy, the urge to avoid it is going to try to dig its claws in. That's why the work we do outside of the therapy room is just as important as the work we do inside it. We establish a clear homework plan to keep you on track outside of session and support your progress.
Ultimately, by consistently showing up for ourselves and resisting the instinct to avoid the discomfort, pain, and difficulty of trauma memories, we begin the hard work of facing what happened, taking back control, and moving forward with strength and purpose.
Therapy for Trauma in Laredo, TX
At Chanderbhan Psychological Services, we provide evidence-based trauma therapy and counseling in Laredo, TX for adults, as well as online trauma therapy and counseling across South Texas. Our clinicians are trained in structured treatments for PTSD and trauma-related symptoms, including Cognitive Processing Therapy.
We also have experience working with first responders and public safety professionals, who often face repeated exposure to high-stress and traumatic events.
If you’re wondering whether trauma counseling could help you, we’re available to talk through your questions and help you determine the right next step. You can reach out through the Contact Form on our website.
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Yes. Prolonged Exposure (PE) is an evidence-based treatment for PTSD that has been studied extensively. It helps people gradually approach trauma-related memories, feelings, and situations they have been avoiding so they can develop new learning, reduce PTSD symptoms, and regain a sense of control.
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PE does involve talking about the traumatic experience, but this is done intentionally and collaboratively in a structured therapy setting. You and your therapist work together at a manageable pace. The goal isn't simply to make you relive what happened, but to help you approach the memory safely, process the experience, and learn that you can tolerate the thoughts and feelings connected to it.
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Yes. Prolonged Exposure (PE) has been extensively studied as a treatment for PTSD, including PTSD related to combat and other traumatic experiences encountered by military personnel, veterans, and first responders. PE helps people gradually approach trauma memories, emotions, and safe reminders they have been avoiding, allowing them to develop new learning and reduce PTSD symptoms.
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Prolonged Exposure is a structured, time-limited treatment. A typical course is often around 10–15 sessions, although the exact length can vary depending on your needs, progress, and treatment plan.n
