How to Stop Avoiding and Start Living
If you have Post-Traumatic Stress Disorder (PTSD), it is common to avoid things that remind you of the traumatic event. While this may make sense in the short term, long term avoidance can lead to us stop doing the very things that make life meaningful.
If we start avoiding crowds because we fear for our safety, we may have to start sacrificing going to important events like our child’s graduation, a close friend’s wedding, or that comedy show we’ve been wanting to see.
If we start avoiding driving after a car accident, how are we going to get to work, meet up with friends, or take kids to their sports games?
While avoidance may start small, it can easily grow until our life becomes more about avoiding than it is about living.
Prolonged Exposure is a research based treatment for PTSD that helps individuals confront the things that scare them so they can start taking their life back.
What Does Therapy With PE Look Like?
When you start PE, you and your therapist will identify all the things you have been avoiding since the trauma.
I like to ask my clients:
- What do you want your life to look like?
- What is the life you want to live?
- How is avoidance getting in the way of you living that life?
- What are the things you are no longer doing or stopping yourself from doing because of fear?
- Are you willing to risk being uncomfortable to build the life you want?
Once you answer these questions, you create a plan for how you can actually work through the avoidance to build the life you want to live. Your plan starts by creating a list of the activities that you’ve been avoiding.
An example of PE therapy in real life
If you want to be able to go to your daughter’s graduation but are afraid of crowds, you and your therapist would create a list of situations that bring up your fear of crowds. Then, you would start doing the things that scare you so you can actually go to that graduation.
Instead of starting with a really difficult task like going to Costco on a weekend, you would start with going to a smaller grocery store during off hours to practice being around others. Over time, you would gradually increase the difficulty of tasks until you were able to go to your daughter’s graduation and celebrate that special moment.
With practice, you learn to not let fear limit you.
In addition to getting back out there, you and your therapist will also spend time challenging your avoidance of talking about the traumatic event. Starting around session three, you will spend time each session talking in detail about the trauma.
The first time you do this, it is understandably difficult. However, with more practice, it becomes easier and easier. You will also record your sessions so that you can practice listening to your sessions at home. As you work through the memory, you may start to make connections you hadn’t been able to because you were so busy avoiding the memory.
Over time, your anxiety talking about the trauma will go down (just like a scary movie you’ve watched too many times). By working through what happened, you will have fewer memories of the trauma showing up in your day to day life.
In PE, clients meet with their therapist for about 12, 90-min sessions. Clients do daily homework where they listen to the recording of their trauma account and practice doing one thing that they have been avoiding a day.
Summary of Prolonged Exposure Treatment
- Prolonged Exposure (PE) is a well researched treatment that is shown to decrease symptoms of PTSD and depression
- Recommended by the American Psychological Association and the Department of Veterans Affairs as a first line treatment for PTSD
- Excellent at helping you stop avoiding, get back out there, and live your life
- Requires a memory of a specific trauma which will be the focus of in session discussions for the trauma account
- Duration of treatment: Approximately 12 individual therapy sessions
- Length of session: 90 min
- Practice assignments: Listening to recording of session (~ 45 min) and doing one thing you have been avoiding (~45 min)
- Clients must be willing to talk about the trauma
To learn more about PTSD and research-based interventions, see the following resources:
- What is PTSD?
- STAIR: Taking the First Step Towards Trauma Recovery
- CPT: Cognitive Processing Therapy
- Prolonged Exposure for PTSD by the Veterans Health Administration
Don't let avoidance take control of your life. If you are struggling with trauma symptoms, reach out to schedule a free 15 min consultation with Dr. Dautenhahn.
Contact Us TodayReferences
Courtois, C. A., Sonis, J., Brown, L. S., Cook, J., Fairbank, J. A., Friedman, M., … & Schulz, P. (2017). Clinical practice guideline for the treatment of PTSD.
Lang, A. J., Hamblen, J. L., Holtzheimer, P., Kelly, U., Norman, S. B., Riggs, D., … & Wiechers, I. (2024). A clinician’s guide to the 2023 VA/DoD clinical practice guideline for management of posttraumatic stress disorder and acute stress disorder. Journal of Traumatic Stress, 37(1), 19-34.
McLean, C. P., & Foa, E. B. (2011). Prolonged exposure therapy for post-traumatic stress disorder: A review of evidence and dissemination. Expert review of neurotherapeutics, 11(8), 1151-1163.