What is exposure therapy and how does it work for TBI and PTSD?
[Lt. Col. Jeffrey Yarvis] The reason to go back and have multiple exposures in a safe environment
is to do a number of things at once.
And first of all—again, it's going to be tailored on the patient.
We use words like patient-centered.
This is truly a patient-centered therapy,
and—so when the patient feels safe, that's number one.
They feel safe in this environment because we don't want to make
the situation worse, open Pandora's box,
and not be able to shut it back down again.
We're essentially giving them an opportunity to practice skills.
Over the course of practicing, they are getting more competency.
They're also—as a result of these multiple exposures,
the level of intensity of the symptoms ideally is diminishing,
and so they're gaining more and more confidence
that they can function when exposed to things in this category.
So even if it's not just Iraq, that other things have made them anxious before.
That even if we don't talk about it, these skills will generalize to it.
This is where being able to articulate theory
without psychobabble is really helpful to a patient.
So we know that the reason why post-traumatic stress is debilitating
is in part because of what's a process from learning theory
called response generalization.
So for example, I'm in Afghanistan, I fire off a weapon that has explosives,
it blows up my enemy, and I smell burning bodies.
And you understood—and even maybe you had a morbid curiosity
about—how your weapon worked and that this might happen.
And then when you come home, you're walking through a park one day,
and you're trying to reintegrate, and you stop in your tracks.
You don't even know why—because you smell that smell.
And it turns out somebody is barbecuing chicken.
And then you stop going to the park because parks are where that smell is.
And then you stop going outside at all because trees are in parks,
and don't want to go outside because trees are there.
And you're not even really aware that you're doing all this.
You just know that if you go outside you might feel this way,
lose the sense of safety and competency,
and react and potential embrace yourself or scare your kids.
And so you just stop doing that.
That's response generalization.
We're going to tell the patient, we're going to use the same process
that created this problem to heal you.
When you gain competency in the lab, whether it's VR or hypnosis in the room,
that the healing process is also going to generalize
the situations we didn't talk about.
So if you learn to feel less anxious in this situation,
there's a really good chance these skills will apply too.
Because again, we are using your body to cure you, not the situation.
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Lt. Col. Jeffrey Yarvis, PhD is the first integrated service chief of the Fort Belvoir Community Hospital. He is an assistant professor of Family Medicine and director of Social Work at the Uniformed Services University of the Health Sciences.
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