Tool 2: Mental Exposures

This type of exposure means exposing yourself to thoughts and memories that are distressing to you.

For example:

Ellen had a difficult childbirth that she found traumatic. Even 6 weeks later, she found herself having intense memories of being wheeled to the operating room for an emergency C-section. Even though she knows it was in the past, and she and her baby are fine and healthy now, when the memories come she feels anxious and frightened. She tries not to think about it, and has hidden mementos from the hospital that she thought she wanted to keep for her son’s baby book, because she gets upset whenever she thinks about it.

Though some thoughts and memories can be painful and disturbing, it is best to allow yourself to think about them, in a purposeful and controlled way, at a time and place you feel safe. You may want to be with a caring person whom you trust will listen and help you express any strong emotions that may come up. You may want to seek out professional help from a mental health therapist if you are feeling unsure.

Although this may seem strange, research has shown that trying not to think about something and suppressing thoughts paradoxically makes them more likely to occur. It’s like trying to push a beach ball under water: the harder you force it down, the more it wants to pop back up.

How to do mental exposures

STEP 1: Write the story

Write a first draft of the story of an event that is still causing distressing memories. Write it in “first person, present tense,” as if it is happening right now.

For example, Ellen’s story might start with:

I am lying on the hospital bed and the midwife is checking the baby’s heart rate. She looks concerned, tells the nurses to call for an obstetrician right away, and asks me to move onto my right side immediately. I can tell that something is not right but I don’t know what it is. When the obstetrician comes she tells me the baby is in trouble and I have to have a C-section right away. Nurses and other people are everywhere, putting needles in me, and I am trying to will the baby to live. Now I’m being wheeled down the hall to the operating room; I can tell there are people all around but all I can see is the ceiling tiles ...

Ellen would finish the story at what seems like the end point for her. It might be getting home from the hospital, or it might be some days later.

Before you begin, decide how long you are going to give yourself to do this exercise: somewhere between 30 and 60 minutes. Set a timer when you begin, and stop when it goes off. Plan a pleasant activity to do afterwards, like calling a friend, having a bath, or watching a funny movie.

Write out the story as best you can, in as much detail as you can manage, but don’t worry about trying to include absolutely everything. Try to just get to the end, and make a note of how much distress you feel while writing out the story, from 0 to 10.

It is okay to find this exercise upsetting. This distress is not new, and it was not caused by writing it out: you have already been carrying it around. The ultimate goal of this exposure is to no longer have so much current emotion attached to the past. You can write a very plain, “just the facts” version of the story if that helps you get through it the first time.

STEP 2: Re-reading

Again, set a timer for 30 to 60 minutes and plan a pleasant activity to do once you are finished.

Read the script you wrote in Step 1. Re-read it slowly, out loud if you can. Note how much distress you feel re-reading the script, from 0 to 10. Then re-read it again, and rate it again.

Over several readings, you will often find that the distress becomes less and less. The event becomes less emotionally intense as you read it. It feels more like something that happened a while ago and less like something that you have just experienced.

Feeling gradually less distressed does not mean you condone what happened or trivialize how upset you felt at the time. It just means the event is taking its proper place in your mind as a memory of something that happened in the past, without so much power to make you feel intense emotions about it in the present.

This is similar to what we go through when we grieve the death of a beloved person or a pet: initially the emotions are intense, and we cannot think of our loved one without feeling great loss and sadness. But as time goes by, we can remember our loved one, even the circumstances of their death, without feeling so much emotion again. This is a natural, adaptive process. It does not mean that we don’t love the person or pet anymore. It means that we have the capacity to recover from loss and trauma. We don’t have to fight the memories and emotions that come up anymore, we can give them room. In doing so, we are more able to be present and focus on engaging meaningfully in the world around us.

STEP 3: Re-write and re-read

The next time you practise, try rewriting the script again, but this time see if you can put in more details, even things like sensations you remember having in your body or thoughts you remember having at the time.

It can also be helpful to read your script to someone you trust, to share your experience, especially if it is something you have not told anyone about.

With time and practice – lots of daily practice, as opposed to once in a while, which is much less helpful – many people with traumatic memories find that the memories begin to feel less distressing. They begin to seem more like things that happened in the past rather than something that is happening again right now.

Research has shown that people can really benefit from writing about their traumatic experiences, especially experiences that they have kept secret from others.