What is exposure?
Exposure is a treatment that focuses on confronting your fears. Exposure in vivo involves confronting situations and/or stimuli from the outside world that provoke anxiety. This can range from encountering a spider, car, or dog to visiting the dentist or doctor, taking the bus, attending a job interview, or stopping the repeated checking of the stove. It can also be used for traumatic complaints when, for example, you avoid certain places or people, or when you avoid triggers such as news, movies, smells, or touches.
The goal of Exposure is to confront anxiety-provoking situations to gain new information. Through this process, you learn to think more realistically and learn to experience bodily sensations, ultimately leading to a reduction in tension, anxiety, and other symptoms. Your avoidance and safety behaviours will also decrease.
What can you expect?
Because the exercises are intended to confront anxiety, it means you are going to feel anxious. So, it’s not unusual if you immediately feel some resistance or hesitation to do them. Overcoming that resistance and crossing that threshold is precisely the goal of exposure, to overcome your fear.
During treatment, you may encounter various challenges. You might find yourself postponing or avoiding exercises, fearing that the emotions will be too overwhelming, or seeking new ways to calm yourself. You might also prefer to start with relatively easier exercises or seek reassurance more often. These are all normal reactions, and it’s important to discuss them openly with your therapist!
What is exposure?
Exposure is a treatment that focuses on confronting your fears. In Imaginary Exposure, we refer to exposure to an anxious or traumatic memory. This occurs in your mind, or ‘imaginary’. The goal is to reduce anxiety or tension and revise any incorrect or unhelpful beliefs about the event. The idea behind this is that an event may not have been properly processed because there were possibly such intense emotions that it was repressed or suppressed. With Imaginary Exposure, you will initiate this processing anew.
During treatment, the aim is to vividly recall a memory from start to finish and go through it multiple times. You describe the event aloud as if you are watching a movie. Your therapist will assist you in doing this in as detailed a manner as possible. Often, a treatment session will also be recorded, and you will be assigned homework to listen to the recording several times.
What can you expect?
During Imaginary Exposure, it will feel like you are reliving the event. Of course this happens in a safe setting with your therapist but can still evoke intense emotions. As a result, you may feel tired, overwhelmed, or drained after a session. It’s also not uncommon to experience some restless nights. You may also feel reluctant to do the homework, feel anxious to fully recall the memories, or even attempt to avoid the sessions. These are all normal reactions and can be openly discussed with your therapist!
Sources:
https://psycholoog.nl/behandelingen/imaginaire-exposure/
What is EMDR?
Eye Movement Desensitization and Reprocessing (EMDR) is a treatment aimed at processing a shocking, painful, or frightening event. This could include instances such as sexual abuse, a car accident, or a war event, as well as a history of bullying at school or the loss of a partner. When you are stuck in processing a particular event, there may be various feelings, thoughts, flashbacks, or nightmares you struggle with. EMDR assists in processing by reducing the emotional charge of the event.
How does it work?
During EMDR, your therapist will ask you to vividly recall an event, including all associated images, thoughts, and feelings. According to the latest scientific insights, this retrieves the memory from your long-term memory and places it into your working memory. Then, your therapist will increase the load on your working memory by having you perform tasks simultaneously, such as moving your eyes back and forth. This is done, for example, by following the therapist’s fingers, or by following a ball or light on a screen. To further increase the difficulty, your therapist may suggest additional tasks. These could include pointing out or naming objects or text on a screen, solving math problems, repeating certain movements, etc.
Because your working memory has limited capacity, a kind of competition unfolds between the different tasks. In other words, recalling the memory is becoming more difficult because of the additional tasks. If you continue to do this for a period of time, the emotional charge of the memory will decrease. Depending on the events, the number of required sessions may vary.
What can you expect?
During EMDR, it will feel like you are reliving the event. This naturally occurs in a safe setting with your therapist but can still evoke intense emotions. As a result, you may feel tired, overwhelmed, or drained after a session. It’s also not uncommon to experience some restless nights. You may also feel reluctant to fully recall the memories or even attempt to avoid the sessions. These are all normal reactions and can be openly discussed with your therapist!
Sources:
https://www.watisemdr.nl/
When someone in your close environment has experienced a traumatic event, it can have a significant impact on both themselves and the people around them. In this article, we share information and tips on how to best handle this situation and how to provide support to someone who has experienced a traumatic event.
What is trauma or PTSD?
Trauma is essentially the direct experience or witnessing of a shocking, frightening, or life-threatening event. When someone experiences prolonged symptoms such as reliving the event, avoiding situations that remind them of the trauma, negative changes in thoughts and mood, and increased irritability or startle responses, they may have Post-Traumatic Stress Disorder (PTSD).
For loved ones, it can be difficult to understand what is happening. For example, it may seem unusual that someone is easily startled by small things like a slamming door or a hand on the shoulder. Or that someone avoids certain news or places. Or can no longer tolerate certain smells, sounds, or touches. It is likely that all these things have become triggers due to the trauma, which can evoke strong emotions in someone.
What can you do if your loved one is struggling with a traumatic event or PTSD?
- Engage in conversation with your loved one and offer a listening ear. Support without judgment. It shows that you are caring and understanding and that they can turn to you.
- Shame and guilt are common after traumatic events and can even lead to self-blame and self-reproach. It is important to give space to these emotions and to be able to talk about them openly.
- By offering help in areas where someone is struggling, you can be a valuable support. For example, if someone finds it difficult to do groceries, offer to do it together.
- Encourage professional help and support your loved one in the process. Trauma symptoms are treatable, but they also require a lot from someone. In trauma therapy, you will be confronted with intense emotions. After a session, someone may feel quite exhausted.
- Learn more about trauma symptoms so you can better understand what someone is going through. Information can be found in the Trauma Library of NiceDay.
You may experience more complaints before, during and after the treatment sessions. Therefore, it is useful to assemble a ‘toolbox’ with tools that you can use to help you during difficult moments for yourself.
How well do I manage my emotions?
You would like to prevent your emotions from running higher than you can cope with.
Therefore, it is good to estimate how well you can already cope with certain emotions.
You may answer the following questions:
- How well do I cope with sadness?
Write this down on a scale from 0-10, where 0 is ‘not at all’ and 10 is ‘very good’.
What do you do to help yourself when you are very sad? What can others do for you?
- How well do I cope with anxiety?
Write this down on a scale from 0-10, where 0 is ‘not at all’ and 10 is ‘very good’.
What do you do to help yourself when you are very anxious? What can others do for you?
- How well do I cope with anger?
Write this down on a scale from 0-10, where 0 is ‘not at all’ and 10 is ‘very good’.
What do you do to help yourself when you are very angry? What can others do for you?
What should I do before, during and after the session?
Before the session
Before each session, take 15 minutes to prepare yourself for the session.
If you have your session online, you can for example grab a blanket that you can use after the session, something that will give you some comfort. Grab a glass of water, possibly something that smells strong, a cold washcloth for your head/neck and inform your social circle not to disturb you for the time being.
It can help to think about what you can do when various complaints arise in advance. In the midst of such a situation, it can be difficult to come up with something that will be able help you in that moment. That is why we recommend that you think about this in advance and plan for it. You can also prepare for this with the help of your professional.
For example:
- When I have a nightmare, then I will…
- When I have a flashback, I’ll ask… for help
- If I suffer from…, it helps me to…
- When I think about…, then the best thing for me to do is…
After the session
Schedule approximately 30 minutes after each session to relax and do something that makes you feel good or calms you down. For example, take a bath, prepare yourself a treat, light a scented candle, listen to your favourite music, be creative by painting, drawing or writing, fantasize about a beautiful place, work in the garden or do a relaxation or mindfulness exercise. For more inspiration, take a look at this list.
Sometimes, it can help to vent your emotions instead of relaxing. The following activities may help you to vent:
- A long walk
- Rip up paper
- Throw something
- Squeeze in something (for example, a pillow)
- Listen to loud music
- Dance
- Exercise
- Cry
After a traumatic event, many people tend to avoid thoughts, feelings, situations, and activities that remind them of the event. Memories of the traumatic event evoke anxiety. Understandably, you therefore try to avoid these memories.
While avoidance can make you feel calmer and more relaxed in the short term, it actually worsens the problem in the long run. Your experiences are not properly processed, and your fears are not overcome. Breaking the avoidance is therefore an important focus point of treatment. We will confront your fears step by step and under safe conditions, aiming to gradually allow your fears and anxieties to diminish.
During trauma treatment, you will actively recall your traumatic memories so that you can process and store them again. There are several types of trauma treatment, but the two most effective treatments are EMDR and Imaginary Exposure. More information about these types of treatment can be found in their respective explanations.
What results can I expect after trauma treatment?
The treatment will lead to your memories losing their strength and emotional charge. Therefore, it will become easier and easier to recall and think about the original event. In many cases, the image of the memory itself also changes and becomes, for example, blurrier or smaller. It may be the case that less painful aspects of the event begin to emerge. Another possibility is that new thoughts or insights arise that give a different, less threatening meaning to the event. In turn, this will hopefully help the distressing experience find a better place in your life history.
What is trauma?
Trauma is the Greek word for ‘open wound’. It has the same meaning in the medical world, too. Within psychology, however, it refers to a psychological wound, caused by a negative event that you experienced in the past that was too difficult to properly cope with. Thus, an event that was traumatic for one person may be an event that was difficult for another but not necessarily traumatic.
Does that mean that all events that are difficult for you to deal with are traumatic events? What about a dismissal, a divorce or a big fight? Although these are all events that can have a lot of impact on you and can also lead to psychological complaints, they are not necessarily traumatic. According to the DSM-5 – the manual for psychological complaints – there is a criterium that a situation must meet in order to refer to as a trauma.
Why a specific event leads to complaints in one person and not in another depends on a large number of factors. Consider, for example, the care and support you received after the event, but also whether you are someone who finds it easy or difficult to talk about their feelings. In addition, the meaning that the event has for you can play a role; an event that affects something that is important to you increases the risk of developing complaints. Biological factors, such as the regulation of cortisol (stress hormone), also have an influence. The degree of hardship you experience from an event does not, therefore, depend on how ‘strong’ or how ‘weak’ you are as a person.
What complaints can occur after a traumatic event?
There are a number of physical and psychological complaints that can arise as a result of a trauma. You may notice that you have difficulty sleeping, that you suffer from nightmares, or that you have flashbacks of your trauma. You may be jumpy, withdrawn, or very irritable. In addition, you can feel guilty, be constantly tense or have difficulty enjoying the things that you used to enjoy. If the trauma forces itself on you in such a way that it interferes with your daily life, you may be suffering from post-traumatic stress disorder (PTSD).
When you are confronted with one or more traumatic events early in your life (or chronically), the trauma may have caused flashbacks, avoidance, tension and negative thoughts or emotions. These overwhelming thoughts and emotions can sometimes even cause you to mentally “check out” to cope. This is also known as dissociation and makes the world around you or even your own body feel unreal or strange.
In addition, we see that people who suffer from PTSD often also have other complaints, such as depressive symptoms or problems with substance abuse.
Many people with PTSD symptoms feel different, are ashamed of their symptoms or are afraid that they are ‘crazy’. Therefore, it is important to keep reminding yourself that what you have had to experience was far from normal or is even abnormal, but that your resulting symptoms are normal.
Do you want to break a habit or stop unwanted behaviour? It can help to think about what the advantages and disadvantages of this behaviour are. Often, we only consider breaking a bad habit when we start to experience more disadvantages than advantages. You can make an overview of these by writing down and balancing the advantages and disadvantages. Below, you will find an example explaining how you can do this.
For example: You would like to stop worrying as much as you do because you notice that it costs a lot of energy, it makes you feel insecure, and the worrying hinders your ability at work.
Step 1: Short- and Long-Term Disadvantages of Worrying
Consider the disadvantages of excessive worrying. What are the short-term drawbacks? And the long-term? What negative effect has it had on your physical and mental health, on your social life or on your work/study? Has it affected how you take care of yourself, your daily structure or your sleep pattern? Be honest!
Possible short-term drawbacks:
- Negative thoughts come to mind
- Getting distracted from a task
- Unhealthy eating/snacking
- Increased uncertainty about my performance
- Increased anxiety
Possible long-term drawbacks:
- Negative effect on sleeping pattern
- Increased feelings of depression/anxiousness
- Increasingly negative self-image
- Feeling tired
- Stop exercising
- Feeling like a bad employee
Step 2: Short- and Long-Term Advantages of Worrying
Also, think about the benefits of worrying. How does worrying help you? Is it a way to avoid feeling insecure for a while? Is it a way to help you prepare for everything? Are there any long-term benefits of excessive worrying? Some benefits may overlap. Be honest with yourself and take the time to write them all down.
Step 3: Short- and Long-Term Disadvantages of Stopping with Worrying
What are the disadvantages, both short- and long-term, of worrying less? What makes it so difficult to break this habit? Are there certain emotions that you find difficult to experience? Do you feel physical or mental discomfort that becomes more noticeable when you stop worrying? What are you afraid of regarding living a life that deals with uncertainty in a different way besides worrying?
Step 4: Short- and Long-Term Advantages of Stopping with Worrying
What are the benefits of worrying less? What’s in it for you? Consider the benefits on a physical, mental and social level. Are there any other hobbies that you can pick up again because you have more time and energy after a working day? Take your time on this step as this is the motivation to stop an unhealthy habit or behaviour.
Possible short-term benefits:
- I acknowledge my insecurities and can sit with them
- I eat healthier
- I can concentrate better
- I can become more present and get out of my own head
- I can be satisfied with my performance
Possible long-term benefits:
- I sleep better
- I have more energy to exercise
- I am more in touch with my colleagues
- I acknowledge my strengths
- I experience more emotions instead of always worrying
Better insight
If you have drawn up the overview, you will hopefully have a better understanding of the function of your worrying behaviour. You should now also be able to see why your previous attempts to worry less were unsuccessful. Also, you should now have an idea of what difficulties you may face in the future. Now, with the help of your professional, you can work to see what you need to adopt new habits or behaviour.
Sources:
Keijsers, G. P. J., Van Minnen, A., Verbraak, M., Hoogduin, C. A. L. & Emmelkamp, P., (2017). Protocollaire behandelingen voor volwassenen met psychische klachten.
Boek: Cognitieve therapie, de basisvaardigheden
Digitaal boek: Gedachten uitpluizen
Involving your social circle in your recovery process is important. It can contribute to a better understanding of your situation. It can also provide insight into the origin and course of your complaints. Your social circle can also think about what you are going to need during your recovery process.
How can I ask for help during the treatment?
Understandably, you may not immediately be eager to involve someone close to you in your treatment. Discuss this with your professional to find out how you can do this and what the best way to do so is. Who are the people who can help you? Do you want to involve someone at the beginning of your recovery process or later in the process instead? What obstacles might you run into? Are there certain themes that you would rather not talk about (yet)? Be open to discuss this with your professional, so that you can lower the threshold and take this step.
How can your social circle support you?
Support can be provided in various ways. Think about how you would prefer to be supported. Do you need emotional or practical support? Do you like it when the other person regularly asks you how the recovery process is going? Are there things you could use help with? Your household, study, financial administration or your children, for example?
Perhaps it’s sufficient that a person from your social circle receives information about your complaints and situation, so that they can better understand your situation. Finally, you can decide to share the relapse prevention plan that you will draw up at the end of your program with your loved one(s).
Does your social circle have questions?
If you decide to involve your social circle in your recovery process, you can also ask them what they think is important to discuss. Do they have any questions? Are there any uncertainties on their behalf? Are they worried about something? Perhaps they need professional support? These are all questions you can ask and which can be discussed during a session with your professional.
Be open to discuss potential relapses
Imagine you are experiencing a relapse. How are you going to discuss this? Honesty and openness about any relapse are important. Family members are often scared that someone will revert to their old behaviour or will experience complaints again. Unfortunately, sometimes, this is unavoidable. Consider in advance what steps you will take when you experience a relapse. How can your social circle support you? Chances are you haven’t talked about this in the past. Try to break this pattern by being open to discuss potential relapses. This will allow confidence to grow on both sides, and any associated shame will decrease.
Remember: you don’t have to do it alone
Facing the recovery process alone is very difficult. You may want to protect your social circle by not involving them in your treatment. They may also have had moments of uncertainty when you were experiencing complaints. Because of this, you may be inclined not to burden them with more pain or fear. Nevertheless, experience shows that involving loved ones helps in the recovery process.
During your recovery process, it is important to have a goal in mind. Then, with help from your professional, you can focus on this goal during your treatment. Goals help to make what you want to work on more tangible; they give your recovery direction, they make your progress transparent and give you an idea of when your treatment can be completed. This can give you the energy to keep going, increase your persistence and enhance your creativity to reach your goals despite the difficult circumstances that will undoubtedly arise along the way.
Answer the following questions:
- When will you see yourself as recovered or as having made significant progress?
- When would the treatment be seen as successful for you?
- What do you want to be able to do again that you are not able to do now?
- When would your partner/best friend/parent/colleague notice that something has changed?
The SMART method
You can elaborate on these goals in detail using the SMART method. This method helps to make your goals more tangible and supports you in achieving your goals. You can make your goals SMART by following these steps:
S – Specific: Describe the goal clearly and concretely. Be specific. It must describe an observable action, result or behaviour.
M – Measurable: Make your goal measurable by assigning a value to it. Based on this figure, you can determine whether your goal has been achieved.
A – Achievable: Is your goal achievable? An achievable goal can inspire you, motivate you and put you in ‘action mode’. Formulate your goal positively (‘I want to’, instead of ‘I don’t want to’).
R – Relevant/Realistic: Is your goal in line with your values and other goals? Is your goal realistically attainable? Do you have the right resources, skills and time to achieve your goal?
T – Time-bound: Take note of when your goal has been achieved. When are you going to start and when are you going to finish? This gives you a grip on the situation and puts the ending in sight.
Example of a SMART goal
You are feeling down and want to feel less lonely. Therefore, you set a goal to become more active again and to visit your friends more. You can make this goal SMART in the following way:
“I would like to meet my friends again (specific),
at least once a week (measurable and realistic),
by the end of the year (time-bound and achievable). ”
This goal is tangible; you know what to do and when you want to have achieved it. It gives an indication of the steps and actions you can take to realize your goals. This creates clarity, focus and motivation.
Some examples of goals which are not SMART are:
“I would like to socialize more”, “I don’t want to withdraw so much anymore”, “I have to go out more often”, and “I want to see my friends more because I am lonely”.
Does your goal motivate you?
It is important that you are intrinsically motivated to reach your goal. That means that the motivation to achieve the goal comes from within you. Therapy is hard work and if you have the motivation put in the work, you are more likely to achieve your goals! Are you really going for this goal? If necessary, adjust the goal until it feels right so that you can start working on it with the right motivation.
Write down your goal and visualize it
Visualizing your goals ensures that you can literally see your goals in front of you and work towards them. You can also always read back on your goals as a reminder to regain focus. Write down your goals as specifically and in as much detail as possible. The more details you write down, the clearer they will become. Your goals can even seep into your subconscious, making you not only consciously but also unconsciously work towards your goals.
Do more than just writing them down
Of course, there are more ways to envision your goals other than writing them down and reading them. You can also visualize your goal based on a drawing, painting, diagram, mood board, illustration, artwork or anything else that suits you. Let your creativity run wild! Then make sure that you can see your creation in a place you visit often so that you are regularly reminded of your journey and your goal.
Achieved your goal?
When you have achieved your goal and feel like you have enough tools at your disposal, you can continue independently with other (smaller) goals. Even if your treatment ends, your growth will continue.
Getting down to business
Write down your goals, leave them somewhere easy for you to see and get started. Good luck with your recovery!
Sources:
https://www.desteven.nl/leerdoelen/smart-leerdoelen
https://hetnlpinstituut.nl/kracht-van-visualisatie
