I was an exposure therapy skeptic. What I knew of exposure therapy came from abusers. More than one had justified their abuse by claiming it was helping me “face my fears” or “making me tougher.” This is nonsense. Such inhumane behavior will only make someone’s fear less manageable, even potentially debilitating.
Research shows fear and anxiety are best managed if a person chooses to engage with their fears, such as heights, spiders, or the dark, on their own terms. The key is that the individual initiates the experience and remains in control of it, free to exit the situation at any point. Short of strapping them into a mandatory safety harness or providing licensed training, no one else gets any say in it. Overcoming fear is not helped by feeling powerless, victimized by another person who takes away our agency.
Overcoming fear is about courage. To quote the poet June Jordan who was writing about South African women, “We are the ones we have been waiting for.” We are our own knights. We alone can slay our own dragons. And to be prepared for that, we must discover our own courage, on our own terms.
Still, as a trauma survivor, what I was afraid of was what had already happened. So unless the plan was for me to seek out abuse and violence until I stopped caring about my own survival, which was kind of what I had already done with my twenties, then I didn’t see what exposure therapy possibly had to do with PTSD.
PTSD is not an anxiety disorder, although it was initially misclassified as such and plenty of people online continue to claim it is. It’s not. Since 2013, it has been classified as a trauma-related disorder. People with anxiety disorders are fearful of what might happen. People with PTSD are haunted by what already happened. To those outside the experience of either disorder, it can seem like a subtle distinction. To those of us on the inside, it’s not. Our brains are different. Our emotional lives are different. Our experience of time is different. Our relationships are different. It logically follows that treatment, too, should be different.
And it is.
But at the same time, there is undeniably some overlap. For those of us with PTSD, our brains formed associations amidst trauma. Because our brains are programmed to learn, we try to turn trauma into a learning experience as well. But what we learn from trauma is sometimes:
- It was a life-threatening experience, which I should try to prevent from reoccurring through any means necessary.
- I shouldn’t avoid just my attacker, or combat, or driving at night. I should avoid all men, all loud noises, all cars everywhere. Anything remotely similar to the stimuli present during the trauma.
- Therefore, any stimulus I subconsciously associate with the trauma (music, incense, wearing jeans, cologne) is itself dangerous and should be avoided at all costs.
This aspect of PTSD mimics anxiety disorders in that anxiety symptoms (racing pulse, shortness of breath, fight-flight-or-freeze responses, muscle tension, and adrenaline) can become paired to stimuli that are not dangerous in and of themselves.
So you can imagine this gets real impractical, real fast.
If a sexual assault survivor gets nauseous and tense with fear every time she smells Axe body spray, she’s going to find it hard to be in bars, restaurants, or even in line at the grocery checkout.
In my case, I can be triggered by disagreements, pressure on my legs, any kind of restraint, people touching my waist, public speaking (or any other event that renders me “visible” to more people), and other people’s anger.
Like I said, impractical.
And this is where exposure therapy comes in handy.
We can’t live our lives this way. We just can’t. Trying to prevent what already happened from happening again is, largely, pointless. Yes, we should learn about ourselves and our relationships. Yes, we should learn how to relate to people in healthy ways and to assert our needs. I took an online assertive communication class for $50 three years ago, and it changed my life. I highly recommend such training, especially for child abuse survivors or anyone else triggered by conflict.
But, as Nicole Bedera and other sexual assault researchers have shown, sexual assault, child abuse, and other forms of interpersonal violence have nothing to do with victims and everything to do with perpetrators. For those of us on the receiving end of trauma, we either had a run of stupendous bad luck, or we bumped up against something that is far more common than most people are willing to acknowledge (about half of children experience abuse and 76% of their abusers are also their parents; nearly half a million people are sexually assaulted each year, and 90% of victims are women).
You can’t know the car accident is coming until after it’s done.
You can’t know the person who just boarded the bus will pull out a knife until it happens (true story).
It’s not your fault.
We can’t control these things.
But our brains are desperate to pretend we can. And our first line of defense is avoidance.
This is another area where PTSD overlaps with anxiety disorders. Not only does our fear response become paired to certain stimuli, but we then avoid anything related to those reminders. Avoidance is a central behavior of anxiety disorders, and for many of us, it also becomes a hallmark of our PTSD.
We begin to avoid our triggers, until we can no longer stand them. And then we generalize. The longer our PTSD has gone untreated, the more likely our triggers are to become generalized. It starts out as white men in their twenties, then expands to all white men, then all men in general, and finally people.
Exposure therapy says nuh-uh.
I’m going to stop you right there.
Let’s find another way.
You deserve a life that isn’t this small.
I’ve been tackling exposure therapy (yes, from home, during a pandemic) since September. And I want to spend the next few weeks sharing this journey with you. What has worked for me, what hasn’t, what I’ve learned.
Exposure therapy aims to teach the brain a very different lesson. Instead of fearing everything that dredges up the trauma, we learn: That day was unsafe. That man was your rapist. That place was where your life was threatened. And also? You have to let go of this desire to ensure it never happens again if you want to live your life the way you deserve to.
I want to say right here what I think not enough PTSD recovery resources say explicitly. It is healthy to fear and avoid your abuser. It is healthy to fear and avoid people who threatened your life. And it is healthy to fear rape, abuse, and torture as well as racism, sexism, homophobia, transphobia, and ableism.
It is healthy.
Trauma teaches us these things are more common than the average person likes to think. It teaches us just how vulnerable, exactly how mortal, we really are. A little fear about the fragility of our own lives isn’t a bad thing. It means we value ourselves and our lives.
Fear also means we took at least one useful lesson out of the trauma.
That person (or group of people) sucks. Maybe no one else knows how much. But we know. Car crashes suck. Abuse sucks. Being mugged sucks. These things are awful, and they are terrifying, and they are real. Being fearful of them only means we know.
Exposure therapy is not, and never should be, about convincing yourself that what happened to you is okay. It should never be about “coming to terms with” the unbelievable cruelty that some people can inflict on others. And it should never, ever be about resigning ourselves to an unjust society that overwhelmingly targets women as well as all BIPOC and LGBTQIA+ people with violence.
What exposure therapy is supposed to do is help us identify what new fears our assailants planted within us and how these have constricted our lives. And then, baby-step by baby-step, we start weeding. One seed, one root at a time. We tend our garden. We plant new seeds. We make this little plot of earth that is our soul into something that is our own.
And we go on doing that until our lives reflect our true selves, trees towering above us, palm fronds open wide to the sky, as rich and big-hearted as our courage.
I don’t know if that’s how this story ends. But I’m hoping.
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*I am not a therapist or treatment provider and am only recounting my personal experience of PTSD and its treatment. This blog is not intended to be a substitute for professional advice, diagnosis, or treatment. Always seek the advice of a physician, licensed therapist, or other qualified health provider with any questions you may have regarding PTSD or any other mental health disorder.