Regulating emotions in Imaginal exposure for PTSD
Exposure therapy is a simple and highly effective treatment for symptoms of Post Traumatic Stress Disorder. The combination of efficacy and simplicity has made it ideal for dissemination in many settings, and it’s use has become commonplace in many trauma treatment centers. Although the protocol for treatment is straightforward, some clients find exposure easier to approach than others. For example, some clients may be highly avoidant, distancing themselves from the emotions related with the traumatic memory. They could share the story of their trauma, while maintaining that they are not feeling anything special. On the other end of the emotional spectrum, we find patients who are highly dysregulated, finding it hard to perform the exposure due to the overwhelming rush of emotions.
In both such cases, regulating emotions is vital for the success of the treatment process. For the first treatment case, we would want to help the client deepen emotion, and be in touch with the impact the trauma has on his experience. For the second case, we would want to down-regulate emotions, helping the client approach the feared memories and perform the exposure task. Below the trainer, you will find examples of interventions and clinical nuances that can help in regulating emotions.
Specific guidelines for this trainer:
unlike many of the other trainers, you will not get feedback, unless you ask for it. Continue the role play until you find a moment where you are challenged or would like to rethink your response. At that point, ask the trainer for some feedback.
This is a longer role-play, meaning there is a greater chance that the AI system will make a mistake. If it does, just tell it so, and it should correct itself.
As always, Speak your responses.
(first time?? read the ‘how to get the best out of practice’!)
Tools for emotion regulation (and there are many others)
Up-regulating emotions:
1. Talking about interpersonally sensitive issues
2. Talking about the present moment
3. Talking about the therapeutic alliance
4. Using emotionally charged words. For example calling rape by it’s name, instead of ‘sexual assault’ or ‘the trauma’. Another example could be, instead of saying ‘he’s not clever’, saying ‘he’s an idiot’ or even ‘he’s an f%@king idiot’.
5. Using shorter sentences and more silences.
6. Asking for concrete and vivid descriptions of specific events.
Down-regulating emotions:
1. Reflect and validate patient experiences
2. Normalize experiences in relation to what many people experience and do.
3. Talk with more cognitive and distant terms, less emotionally charged words.
4. Less silences, more talking.
5. Focus the discussion more on fact and less on relationships and experiences.
