Trauma, Triggers, and Exposure Therapy

“Unlearning trauma also means unlearning the behaviours you adopted and inherited as survival tactics.”

Many people who’ve experienced trauma are triggered intensely and frequently. This can make it hard to live a normal life.

There are triggers we can manage, and some we can avoid, but usually there are others that we simply can’t escape. And that makes things difficult – for we have to deal with them.  

So what can’t we do if we want to react less? One possibility is exposure therapy.

What is Exposure Therapy?

Exposure therapy targets the learned association between objects, situations, sounds, images, smells and memories that trigger an intense response.

For example, a woman who’s been raped may avoid dark rooms, going on dates, or certain music or smells – because these are major triggers for her.

Exposure therapy’s goal is reducing this response by actively confronting the thing the person fears (especially if it’s something that is hard to avoid like a song being played on the radio).

How Exactly is this Done?

Through in vivo exposure, imaginal exposure, interoceptive exposure or prolonged exposure.

1. In Vivo Exposure

This exposes the client directly to the object, sound, smell, image, situation, or thoughts – but always with a counsellor or therapist at hand, and with the use of proven relaxation skills. (For example, this might include techniques and skills like mindfulness, meditation, and specific relaxed breathing techniques.)

For example, a woman who can’t bear to be anywhere near the building or street where she was attacked may be accompanied to that place by her therapist.

She’s no longer alone, and she’s no longer at risk. Her therapist is there, and will give her support as she experiences the feelings and reactions once again.  

Note: In vivo exposure usually occurs after successfully working on imaginal exposure and interoceptive exposure.

2. Imaginal Exposure

In imaginal exposure, the client is encouraged to imagine different images, sounds, memories, smells, situations or venues that evoke a response. Again, the therapist is there to provide her with support, and to talk the client through the reactions she might have (such as feelings of terror, or anxiety attacks).

Thus, the person’s not alone, and they learn that they can cope. They’ve survived the ordeal. They did not fall apart.

This helps them to feel more in control of their life – very slowly, and with help, one small step by one small step.

3. Interoceptive exposure

Interoceptive exposure is designed to assist with the fears we experience as soon as we begin to be aware that the feelings of anxiety are starting to build up.

This might take the form of: an increase in our heart rate, a shortness of breath, tingling in our feet, and the desire to escape.

The therapist might help by encouraging the client to hyperventilate for a short period of time – but always where the client is aware that they are there. (That is, there is someone they can trust who is right there by their side.)

He or she can guide them through all the steps they can take for calming their breathing, and feeling what they feel – and allowing these to pass, and to slowly dissipate. This must be done very slowly, with great sensitivity.

4. Prolonged exposure therapy

This combines the three methods we’ve outlined above. But it also includes the following as well: teaching the client helpful breathing techniques, ways to ground themselves in the here-and-now, and practising these strategies in their daily life (so they are able to use them when they find themselves alone, and at times when the therapist cannot be there with them).

In summary: “Exposure therapy works by exposing someone to their fears and anxieties repeatedly, and for long periods of time. The idea is that after being exposed to these things on a regular basis, and seeing that they pose no real threat (apart from anxiety and stress), you will eventually become more desensitized to them.”   

As with all of these techniques, it takes persistence and time.

Note: Exposure therapy is not appropriate for all types of trauma. For example, it is not recommended for PTSD, or complex childhood PTSD

Also, therapists should be trained in using this technique, and you should only continue if you feel comfortable and safe with the technique and the therapist. This is crucially important.

12 thoughts on “Trauma, Triggers, and Exposure Therapy

  1. Exposure therapy can fry a Ptsd sufferer if he/she is not ready

    I have done exposure therapy

    Some were attempted way to soon

    For me meditation was my first successful exposure therapy

    I could experience my trauma focused on my breath and dissipate the chemicals

    My fight or flight mechanism does not fire like it use too

    I can go out and navigate the world

    But my life will never be the same

    I do not trust people and avoid them

    Childhood abuse wires the brain differently

    My brain was wired to survive
    My father

    To ensure beatings and criticism and still breathe

    Exposure therapy will never fix that

    People think childhood trauma can be fixed

    I navigate my life and find my happiness


    • It has to be done with a counsellor or therapist, not on your own, and it has to be done in a calm state where you withdraw from the trigger as soon as you start to experience arousal. It doesn’t suit everyone or every type of trauma. It works well for traumas like being in a car accident where you feel you need to be able to get into car again.

      Liked by 1 person

      • Your speaking of Ptsd, not complex Ptsd

        Child abuse skaters the way the mind wires as it develops

        Abused kids are raised in survival mode

        I had a therapist accompany me and she fried me

        I shook for days and fired her

        Not many therapist are required to handle complex childhood PTSD

        The ki, itary uses Cognitive behavioral therapy and prolonged exposure therapy

        They are decades behind the current use if mindfulness mixed with CBT

        Exposure therapy is one of the last therapies that should be used only after many improvements.

        You have to be careful, I would say half or more therapists do not have the skills to handle serious childhood PTSD

        My opinion


      • Childhood PTSD is another situation entirely and requires a completely different set of strategies and skills. I am sorry your therapist caused you so much suffering. It sounds like he or she wasn’t knowledgeable and skilled enough to work with client who had suffered such severe childhood traumas. I’m glad you have found someone who has specific training in childhood PTSD,

        Liked by 1 person

      • I think we need to be vigilant in selecting a therapist

        It is hard because we do not know what a good or not so good therapist looks or sounds like

        With experience I know now.

        Some therapists have only one therapy they use for everything

        That is not optimal because for me healing and been incremental with many different gnerpies helping out

        Liked by 1 person

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