Questions about exposure therapy. Help!?!?!

[Deep Blue]

About 5 months ago, my T had me make a list of triggers/things I avoid.

The next step was to take baby steps and see if I could make some of those triggers more tolerable.  I was able to do that pretty easily with a couple of the triggers.

Then about 2 months ago We tried to tackle my biggest trigger.  We hadn't even really started but I SNAPPED.  I dissociated for an agonizing 3 days and went back to unhealthy coping strategies.  It was a mess and I do not want to do that again.

For the last week and a half I have been feeling much better.  I feel strong and in a good place.  So I told my T I was open to trying exposure again.

She said great! Then asked if I wanted to tackle my 2nd biggest trigger. I thought about it and then asked if she thought it would hurt me, or set me back to try. 

She replied this:  What do you think? We tried it once before but it turned out it was too early. What is something you feel you are ready for? You need to challenge yourself but not overdo it.

So now I'm second guessing myself! Does anyone have any advice here?  I don't want to set myself up for failure but avoiding some of my triggers is a nearly impossible task.  Help! 

[sanmagic7]

personally, i think going slow with baby steps is the best way to tackle this stuff.  like you discovered, taking on 'the big one' was not helpful for you. 

you said that you were able to tolerate tackling a couple of smaller triggers.  why not continue doing that, rather than moving ahead to triggers that are bigger, scarier, and more likely to send you spinning again.  i think that the more you get experience in managing the smaller triggers, eventually moving ever so slowly into larger or more potent ones, the more you build up inner resources for dealing with the bigger ones. 

i think going slowly is the quickest way to finding the confidence in yourself for managing triggers that are more volatile.   you are the only one who knows how big a trigger is, how debilitating it might be, how much of a 'punch' it might have for you.  i think you did really well in even being able to write them down without experiencing a neg. reaction.

it's ok to go slowly, ok to take a break from exposure, especially if you're feeling unsteady within yourself, and ok to give it another go when you're ready.  i do believe, tho, that a more natural progression from least to worst would be in your best interest.  it's your therapy, your recovery, your process.  you can do what feels best for you with no pressure or expectation to take on more than is beneficial or healthy for you.

best to you with this.  i'd love to know how it works out, if you'd care to share.  take care of yourself first, always.  love and hugs to you, deep blue. 

[woodsgnome]

It seems as if your therapist is flexible enough to allow you to take a break if you feel it's necessary. So I guess I'd also encourage you to step back if it seems wise. And not consider it some failure to make the progress you, and your t, anticipated. This is a fragile ride, and it helps to not force yourself into the rough spots 'just because'.

Presumably you've carefully considered this even as you started down the path. And it's fortunate your t doesn't seem to be pressing the issue, which runs the risk of a setback you don't need. Pulling back appropriately is as important as diving in...there's a saying about moving towards one's worst fears; but I have a suspicion those who are quick with that sort of logic are just unknowingly creating unnecessary guilt feeling.

[Deep Blue]

Sanmagic,
I thought a lot about what you said.  Number 2 on my list would probably be too much.  I'm just getting over the anniversary of my 2nd biggest trigger so I think it wouldn't be a "baby step". I did give some serious consideration to a different trigger though.  Kizzie posted an image in her mind and basically rewrote the narrative for me.  I think I'm going to use Kizzie's narrative to try to face that trigger tomorrow. 

Woods gnome,
Thanks so much for your advice on this.  I'm going to deal with a different trigger than the one she suggested.  Tomorrow is my session.  You are right.  I guess I shouldn't consider it a failure if things don't go the way I hope.  It just means I'm not there yet.  I'm nervous for tomorrow.  She told me to "prep myself beforehand, however I need to". So yeah deep breathing beforehand and probably some distractions loaded on my phone Incase I need them to ground.

[sanmagic7]

hope your session goes well.  do what works for you, always.  share if you care to.  love and hugs.

[Deep Blue]

Did some exposure therapy slowly today.  I chose a trigger armed with a new lovely image that Kizzie created for me. 

I tend to tap dance a bit.  Is anyone else like this? I hate talking trauma! Hate hate hate!

Anyway, she asked if I wanted to talk about it first or if I wanted to read my journal.  I talked with serious prodding on her part.  I was doing ok.. till she asked about smells.  I flashed back when talking about it.  After fighting the flashback I think I stuttered no smells! I'm not talking smells!

She was about to explain the connection about the olfactory sense and memory and I shut her down.  I'm a psychology teacher so she knows I know the connection.  Anyway I think her original plan was to show me some pictures but we ended up pumping the brake instead.  I just wasn't up for it.

She asked about what I could do to self care tonight.  She said what could I do to avoid nightmares?  I sorta laughed because I never go a night without nightmares.  I'm going to probably have nightmares of that particular trigger all night but at least I didn't have a panic attack.

[sanmagic7]

that smell part can really be a doozy.  i'm glad that you stopped when you did - nice show of personal empowerment.

wishing you a nightmare-free night.  thanks for sharing.  love and hugs to you.

[Deep Blue]

I'm so tired today.  I didn't really sleep last night.  Nightmares followed by panic attacks jolted me awake.

Got an email from my T saying I did a great job.  I'm tired... not like sleepy or physically but emotionally.

[Deep Blue]

I have a question that came up in therapy yesterday.  Last week my T asked me about the first time I was locked in the trunk of a car.  In general I have many memories being locked in a trunk... I don't remember the first time.

I have a pretty good memory, certainly much better than average.  Why can't I remember it? It's like hole in my past and I find it upsetting to no end.

***trigger warning***


I remember being hit the first time, I remember the first belt incident, I remember other terrible things... why is this memory missing??? 

[DecimalRocket]

The brain tries to handle stress by forgetting about it. It's too much to process, and so many of us with trauma forget about what happened. Dissociation.

I have a good memory too, though it can also have the habit of making me be aware of the details of many many many bad memories I rather forget. I think memories gradually come back though when we need and are ready for it. Usually, when I'm particularly dissociated, that means I probably need more rest and self-care before remembering again.

Take care. 

[sanmagic7]

i agree with d.r. that some traumas in our lives were simply too much for our minds to deal with, so were blocked.  that's not to say that they might not come to your consciousness in due time, but my guess is that until you're ready, feel safe and/or strong enough, that particular 'first' memory may remain beyond your grasp.

you might explain this to your t, and hopefully they will understand and simply go with the first one you do remember.  i would like to add a caution here for you - is that memory, whichever one it is, will it be tolerable to you?  is it small enough for you to deal with it without being overwhelmed?

that's something only you can answer, and if you don't feel strong enough yet for it, that would also be something to tell your t.  then you could pick a memory that has less punch to it and work on that instead.  please remember, therapy is for you, at your pace, and the best way for you.  you can make these decisions for yourself - your t does not know how a memory or emotion may trigger you, what level of intensity it might have, or how it may affect you.

best to you with this.  i hope it goes well for you.  it's pretty common to block traumatic memories from our consciousness if they're too much for our conscious mind to deal with them.   be patient with yourself - everything comes out in its own time.  love and hugs to you. 

[Blueberry]

if you don't feel strong enough yet for it, that would also be something to tell your t.  then you could pick a memory that has less punch to it and work on that instead.  please remember, therapy is for you, at your pace, and the best way for you.  you can make these decisions for yourself - your t does not know how a memory or emotion may trigger you, what level of intensity it might have, or how it may affect you.

I've been pushed too far by therapists, including trauma therapists, before. The results were never pretty. They usually set me way back.

My present T wanted to start with the easiest topic for me, the least triggering. Months and months later a different thing he was telling me explained why. Here it is: http://cptsd.org/forum/index.php?topic=8370.msg57699#msg57699

There's also a saying  in the CPTSD world (at least in my country): "The slower you go, the faster your healing takes place." Slow includes doing baby steps. Mind you, my T doesn't do exposure therapy with me. So that may be different.

[Rainagain]

I'm not sure exposure therapy is even appropriate for cptsd.

I thought it was meant for phobias?

Surviving trauma has little to do with an irrational fear, its a learned response.

I have gaps in memory and memories out if sequence, its part of trauma, the brain doesn't store memories in the usual way.

Deep blue, you have the right to set the pace with your T, you have the right to say no to exposure therapy, a ham fisted T can so easily re traumatise you.

If you are OK with it then great, if not say so, its all about your recovery.

[Deep Blue]

Rain again,
I'm in CBT.  The exposure isn't with the actual trauma.  It is focused on certain triggers.  They use it for PTSD quite a bit.

Update on the memory:
The memory came back to me.  I had decided to let it go and try not to force the memory.  It came back when I was sitting alone at my desk at work.  I had 2 panic attacks but I'm ok now.  It was horrific and I understand why it may have been suppressed now.  At first I was really upset about the memory itself.  Today I feel better about it.  One of my stuck points is that I always felt compliant in my abuse.  In the missing  piece, this memory, I was not compliant.  I'm thankful that the memory came through even though it was brutal.  It showed me that at one point I fought the abuse.  At one point I said no. I wasn't just a drone.  In some way I can let go of some guilt and shame because there was a point I fought it. 

[Blueberry]

Sounds like lots of progress Deep Blue. Sorry for all the pain though.