Exposure Therapy: Emotional Processing Theory

    I have not previously used exposure therapy in my work and my only exposure to exposure therapy was our CBT class. I found these readings to be very informative and it was helpful to understand the underlying theory along with the clinical application. From what I have gathered from the CBT class and the readings, it is very important to explain the rationale behind exposure therapy. Therefore, it is important to believe in the theory behind exposure therapy and know the ins and outs of the theory. I agreed with the conceptualization of PTSD proposed in Emotional Processing Theory. The conceptualization is thorough, but it is also digestible. It uses a bit of jargon, but I still feel that I could explain it well to a client.  It will be interesting to compare this theory to other theories in relation to PTSD to see what conceptualization makes the most sense to me and has empirical support. It will also be interesting to compare how "user-friendly" or digestible the differing theories are for clients. 

    Though I have not had a lot of experience with PTSD or exposure work as of yet, I imagine that it will be a common treatment target in my work with female offenders. Even if they don't meet the full criteria for PTSD, most of the justice-involved female population has experienced at least one traumatic event. In the leading correctional rehabilitation model, the Risk Needs Responsivity model (RNR), trauma is not a primary treatment target because it is not associated with lowering a person's risk to reoffending. However, most of the studies that helped come to this conclusion were conducted on male populations. Furthermore, trauma may not be directly related to reducing recidivism, but it could impact the treatment of other areas. If I am trying to target criminal thinking, it may be important for me to address why a person perceives the world as dangerous and themselves as incompetent. So, it is likely that I will need to address trauma or PTSD symptoms within my clinical work and maybe advance research into this area. 

    One barrier or concern I thought of while reading was how I would implement exposure therapy within a correctional institution. As seen in the readings, between session exposures are an essential mechanism of change for PTSD. Completing exposures as homework helps the client to directly confront feared stimuli that may not be available in session, minimizes the likelihood that they discount their progress, and learn to confront the fears experienced in everyday life. How would between-session exposure work when the individual is within a controlled environment? If clients can't access traumatic stimuli, say a car or the voice recording of the narrative, how effective would exposures be?  How would they work when the environment isn't safe and there is a real risk of being traumatized again? Many women in the justice system have experienced sexual abuse and there is still a risk of being abused or assaulted while incarcerated. Would exposure therapy be the most useful tool for the treatment of PSTD while incarcerated? In a brief literature search on this topic, I found many papers discussing the trauma one is exposed to while incarcerated rather than using exposure therapy for trauma. There are trauma-informed treatments that account for trauma while incarcerated and how incarceration can exacerbate prior trauma. A key component of exposure is eliciting the response without the outcome, so how would I use exposures if the outcome has a higher chance of reoccurring than it does in the general public? Is it ethical to take that risk? 

    I can see the utility of exposure therapy and can see myself conceptualizing it through an EPT lens. However, it may not be a tool I can use with all clients. I would be hesitant to use exposure therapy with clients who are incarcerated or in high-stress/ unsafe environments. I am not sure what other method I would use- maybe I will find out in the future readings. 

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