Prolonged Exposure Therapy and Treating Employees with PTSD
Post-traumatic stress disorder (PTSD) is a mental health condition that significantly affects an individual’s quality of life. It is characterized by psychologically re-experiencing an initial traumatic event and can result in a variety of symptoms that can affect one’s ability to engage in meaningful activity.
According to recent findings from Statistics Canada in their Survey on Mental Health and Stressful Events, 5% of Canadians report having diagnosable PTSD and 8% meet the criteria for PTSD (2021). Yet only 55% of Canadians who met the criteria sought professional help and 82% had difficulty accessing the health care services they needed (Statistics Canada, 2021).
With mental health declining across the board and more barriers than ever in accessing health care services, it is important to look at strategies for helping employees with PTSD. Employees can build resilience to the consequences of PTSD and employers can provide funding and support to enable employees to return to work after their traumatic event. Engaging an Occupational Therapist who is trained in prolonged exposure therapy can help employees successfully return to work. Prolonged exposure therapy treatment has shown to improve symptoms in 80% to 90% of individuals who do it and helps achieve lasting recovery (NIH, 2010).
What is Prolonged Exposure Therapy?
Prolonged Exposure therapy is a form of treatment to help those with various mental health concerns, typically revolving around fear, trauma, and avoidance. It is frequently used to help treat individuals who suffer from anxiety disorders including post-traumatic stress disorder (PTSD), social and generalized anxiety disorders, obsessive-compulsive disorders (OCD), as well as overcoming phobias.
We use exposure therapy to assist those with these disorders in facing their fears to break their pattern of fear and avoidance. Avoidance to a fear is a short-term solution that manifests into a bigger issue further down the road. When we engage in avoidance to fears, we are reinforcing the notion that what we fear is truly dangerous, when in a lot of situations, it isn’t. The idea of exposure therapy, to force someone to face their fears, may seem torturous; however, it is actually conducted in a safe, controlled manner and has multiple positive outcomes.
How is Prolonged Exposure Therapy Conducted?
When first beginning with a client, an Occupational Therapist will provide education about PTSD and how it works. The more a client can understand the disorder, the fear response and the impact on the nervous system, the more effective the treatment will be.
2. Imaginal Exposure – This is exposure to memories, emotions, and thoughts surrounding the traumatic event.
The Occupational Therapist works with the client to gradually expose them to “imagined” scenarios or memories related to the event or fear. This is often a starting point as the client can be assured that there is no real or potential threat in the moment. However, imaginal exposure (such as reading a script about the situation) can induce a real fear response in the client. While being exposed to imagined situations, the client is learning and practicing ways to calm the nervous system. The more they are exposed to imagined situations, memories, emotions, or thoughts, the better they can use the tools (such as grounding tools) to reduce the fear response.
Imaginal exposure may include use of virtual reality to create a real-life replication of situations related to the traumatic event in a controlled environment
3. In Vivo Exposure – This is direct exposure to the feared object, place, or situation. The individual will be forced to face their fear in a real-life setting.
An Occupational Therapist will work with the client to develop a “fear hierarchy” where they will list all the things that may remind them of the traumatic event or feared item. For example, if the traumatic event was witnessing an individual getting assaulted at a bus station, reminders may be buses, watching movies or videogames involving violence, walking on the street near the bus stop, or hearing a bus drive along the road.
After this list is developed, the therapist will work with the client to gradually expose the client to more potentially distressing events. The goal is not to jump immediately to the most stressful event but to work up the ladder, beginning with the item that induces the least amount of fear. For the example above, this may be starting by walking together outside when no buses are around because the potential of hearing a bus may trigger a fear response.
During the exposure activities, the client is using symptom management strategies that have been taught previously in therapy sessions to manage the fear response. As the client is exposed to more distressing events and can effectively use strategies to manage the fear response, they recondition the nervous system to associate these activities with safety.
Meet James: A Case Study in Prolonged Exposure Therapy
After an isolated and traumatic event occurred during his work as a TTC driver, James feared his safety whenever he came near the site of the incident or saw news or images that triggered memories of the trauma. Antonella Finateri, an Occupational Therapist at Gowan Consulting, started working with James after he had been off work for two years. They used a team-based approach to organize the exposure plan with the rest of James’ healthcare team and social network. They had one-on-one sessions that gradually reintroduced him back into an accommodated work role. At discharge, James was able to return to work independently, equipped with the tools and skills to work effectively without tirelessly worrying about his safety. With exposure therapy, James built up confidence in his ability to manage feelings of anxiety.
How Gowan Consulting Can Help with Exposure Therapy
For various reasons, an incident can occur in the workplace that results in an employee engaging in avoidance behaviour. When this happens, employees may avoid certain work tasks or avoid coming to work altogether. With the proper resources, Occupational Therapists can assist in implementing a reactivation and return to work plan that involves in-vivo exposure therapy to help get the employee back to work. Afterwards, the Occupational Therapist will help with stay at work strategies to ensure the employee can be productive at work and does not relapse.
Our Occupational Therapists are experienced in providing exposure therapy and have helped many clients face their fears and reduce their anxiety. Our clients are able to return to their daily activities and enter unfamiliar situations equipped with the tools that are gained from exposure. All of our therapists are certified with the College of Occupational Therapists of Ontario (COTO) and many have additional training in mental health treatment.
American Psychological Association. (2019). Clinical Practice Guideline for the Treatment of Post-traumatic Stress Disorder. What is Exposure Therapy? Retrieved from: https://www.apa.org/ptsd-guideline/patients-and-families/exposure-therapy
National Library of Medicine. (2010). Clinical Psychology Review. A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/20546985/