Thursday, May 15, 2014

Exposure Therapy

Trigger warning:  This is an article about exposure therapy for rape survivors and contains some details about one patients experience.

I am reposting this article for information purposes only.  This is last type of  therapy I went through.  It was extreme and difficult and also the one that was finally successful.   Your mileage may vary.

Watch part one and part two of Lori Jane Gliha's report
With her eyes closed and a nervous smile, Tyhira Stovall wiggled uncomfortably in the swivel chair at her therapist’s office in Philadelphia.
As part of her treatment for post-traumatic stress disorder (PTSD) five years ago, the then-17-year-old had been asked to revisit a terrifying experience that she had tried hard to forget.  
In the video recording made by her therapist for research purposes, she tugged on the fashion beads hanging from her neck with one hand, while she rubbed her face and eyes with the other. Slowly, she began to recount what happened to her more than a year before on the afternoon she skipped high school.
“He’s kissing the inside of my leg,” she recalled of the man who raped her that day. “It feels so weird. It sucks because I don’t want him touching me. Oh my God.”
As details started pouring out, the teen – with her eyes still shut – squirmed in the office chair, covered her face with her hands and rested her head against the wall, shaking with sobs.
“Great job, Tyhira. You can do this,” said her therapist Dr. Sandy Capaldi. “I know it’s hard.”

Stovall was an outgoing teenager before her rape. Afterwards, she described herself as a “walking zombie.” She couldn’t hug anybody, or look at her father, who she said had a similar look to her rapist. Her mother started homeschooling her, because she was too anxious to go to school. And she stopped dancing.

“She lost her dance, she lost her joy. She just became like a shell,” said her mother Juanita Sojourner. “I remember I used to tell her, I wanted to see her dance, because I knew somehow that was how she had to fight back.”
Stovall tried various types of treatment, from group therapy to medication. And then she tried something unorthodox.

Prolonged exposure therapy requires rape victims who suffer from PTSD to repeatedly recount intimate details of their attack during a series of therapy sessions. For years, Virginia hospitals have used the therapy to treat veterans with PTSD. And a new study has now revealed it's effective on another group with even higher rates of PTSD than war veterans: adolescent rape victims like Stovall.

How it works

The therapy isn't easy.
The patients are asked to relive their rapes in as much detail as possible, over and over and over again in a single 30 or 45-minute session. According to Capaldi, a clinical psychologist at the University of Pennsylvania, it often takes 14 to 17 sessions before a patient finds success.
“What we know is that by engaging with the memory, really feeling the way that they felt when it happened is really part of what helps [them] to habituate or get used to it,” Capaldi explained.

“The idea is that we want them to keep one foot in the past and one foot in the present," Capaldi said.  

But it’s also important that the patients, while gripped in the emotions of their memories, know that they’re in an office, and completely safe.

The patients must also carry out various anxiety-evoking tasks associated with their rapes, on a gradual basis. Capaldi instructed Stovall to keep her bedroom door open at night, because she only felt safe when it was closed. Stovall also went on walks to the house where she was raped, not far from her own home.

New hope

Dr. Edna Foa, who developed the therapy, regularly teaches her methods to doctors from around the world.

Developed in 1980 by Dr. Edna Foa, a professor of Clinical Psychology and Psychiatry at the University of Pennsylvania, prolonged exposure therapy has been used by the Department of Veterans Affairs for more than a decade to aid adult service members in their battles with PTSD. Multiple studies have found the therapy successful in helping veteransand civilians alike.

“About 85 percent [of patients] are being helped, but there are about between 10 and 15 percent that are not helped,” she told America Tonight. “But we also know from studies that we’ve done that nobody got worse.”

In 2007, Pennsylvania researchers, including Foa and Capaldi embarked on a five-year study of adolescent girls who had been raped and suffered from PTSD, like Stovall, to see if the results would be similar.

Doctors compared prolonged exposure therapy with a more traditional counseling approach in which patients are not pushed to remember traumatic incidents.
“I thought we were going to see at the end of the study that everybody got better and there was no difference [between the two types],” Foa said.

But that wasn’t what they found. The study, published by the Journal of the American Medical Association in December 2013, concluded that 83 percent of the adolescents who received prolonged exposure therapy no longer had PTSD at clinically significant levels, compared with 54 percent of patients who received traditional, supportive counseling.

Doctors assessed patients multiple times throughout the project, including halfway through the therapy sessions and at the end of treatment. Capaldi said researchers also conducted assessments at three months, six months and 12 months after treatment.
“If we can disseminate…prolonged exposure into community centers, clinics, centers for child sexual abuse, rape crisis centers," Capaldi said, "we’re going to help these people [be] cured.”

Despite the research showing the treatment’s success, many doctors don’t currently use the therapy. A lot of them aren’t trained in the technique. Some have said the treatment is so repetitive that it becomes monotonous, while others are hesitant to witness their patients enduring such a stressful treatment.

A success story

Stovall, now 22, said of all the treatments she received, prolonged exposure therapy helped her the most. At first, she didn’t want to relive the rape, and said that closing her eyes made it “all too real.”
“I would have moments where I’d cry, and I would have moments where I was like, ‘You know what?  I don’t want to talk about this anymore,’ and I’d stop," she said. "But at the end of the day, the more I talk about it, the more I’d get used to it and the more I’m comfortable with sharing what happened."
Now, Stovall is preparing to graduate college and expecting her first child. She also started dancing again.
“This move right here, that’s like washing the shame off, washing the fear off, washing everything I felt off,” she said, watching a video of her performing.
On stage, Stovall spins, wraps her arms around herself and then extends her leg high into the air.
“In this moment, I claim myself as not being a victim,” she said. “But I am a rape survivor.”


  1. 8, you are inspirational to me. i would have disagreed with this before reading it, but in my own practice my clients and i always made room for time to relive and talk about their trauma. sometimes only 10 minutes though, because it was equally painful for me to hear.

    you have a good life, 8, and that is just and right.

    good to know you, xo

    1. I would be interested to know why you would have disagreed with this.

      My therapist worked with a lot of people with severe traumas and would often need breaks to deal with the burnout. I can't imagine being on the other side of all those stories. I am very thankful there are people like you in the world to help people like me.

    2. 8, I would have disagreed because of the challenge and difficulty of triggers. They can take control. But I do know acknowledging and talking and sharing gets what's trapped inside out. I am so incredibly glad for you xoxo


  2. I have been doing EMDR therapy but I really don't feel like I'm getting any better. I asked my therapist about exposure therapy when you first told me about it but he didn't seem interested. Maybe its time to find a new therapist. I have been stuck for so long.

    1. That is obviously a very personal decision but if you no longer have confidence in your therapist it may very well be time to change. I could not have gone through the exposure therapy without literally trusting my life to Lauren. {{{hugs}}}}

  3. AnonymousMay 15, 2014

    I don't know how you did this. I couldn't. It's too fresh. It's too painful. It's too everything.

    1. Yes, I understand this completely. I went through a lot of other therapy before I reached this point. It was actually decades after that my therapist convinced me to try it. In hindsight I wish I had done it much earlier, but I suppose it took that long for me to be ready for it. And even then, I didn't think it was doing much for me until I was done with it. Only after I had gone all the way through those dark woods was I able to look back and know for certain that I was out of the woods.

  4. Prayers for you, and all those who have lived through and continue to live with,unfathomable trauma. And prayers for those healers who continue to find new paths toward health and wholeness for those who so richly deserve peace.

    1. Thanks Sue. Therapists are truly very special people. I think, as kj pointed out, we sometimes forget how they are also impacted.

  5. Isn't it amazing that exposure therapy works? I think our natural inclination is the opposite; to NOT talk about it, to not relive it. We are afraid that being with the memory gives it more power but somehow the opposite is true. There is a correlation (at least in my mind) between this therapy and the way abusers use silence to control their victims. "Don't tell. No one will believe you. I will kill you if you tell." And the reality is that you are safer if you tell, and other people are safer if you tell.

    Thanks for bringing this to the attention of your readers. I debated reading it, knowing that it would make me physically nauseous, but I'm glad I did. There is a kernel of hope in it for many.

    Thanks, 8, as always, for being a voice for so many who feel silenced.

    1. I am STILL amazed that it worked. I always felt the same way - that revisiting those events and feelings would make me drown in them. And truthfully, it did feel like that a lot to me as I was going through it. And yet, like magic, something clicked.

      I hadn't thought about that correlation before, but I think you have hit on something really, really important. Guilt and shame are huge emotions that render a victim silent - whether heaped on by the abuser or internally generated. Most of my previous therapy work had centered around those two things. Your comment has given me an "aha" moment and much to think about.

      And you are absolutely right, " the reality is that you are safer if you tell, and other people are safer if you tell." As they say, sunlight is the best disinfectant.

  6. I am surprised that this article refers to exposure therapy as unorthodox for rape survivors as I have known many women who have tried it. I am also surprised at the success rate they are claiming without any reference to important data like how many other therapies had the patients tried, how long after the rape was the therapy administered, etc. Nonetheless, this is an important article that I hope more therapists will take note of.

    I will echo e - Thanks for being a voice for so many who feel silenced, and for always being available to those who seek to learn from your story.

  7. I've read many medical articles about this therapy and the success rate is astonishing. Astonishing because, as therapists, most of us were taught to be very, very cautious when having patients relive their anguish. And then all these studies come out and in theory, it makes much more sense than what we previously tried. I know one man, a navy seal who was the lone survivor in an attack and it worked for him. I'm very optimistic.