Prolonged exposure is an exposure-based, behavioral treatment embedded in the theories of classical conditioning that relies primarily on the processes of repeated and prolonged exposure, desensitization, habituation, and extinction to facilitate change.  The primary focus of prolonged exposure is on significantly reducing trauma-related fear, anxiety, and avoidance.  Specifically, posttraumatic sufferers are taught that avoidance does not lead to long-term symptom relief, that traumatic memories are manageable and tolerable, and that the fear and anxiety provoked by these memories will eventually subside and extinguish as exposure continues.  As such, it is the repeated, prolonged exposure to the fear elements of the trauma that is thought to enhance emotional processing of the trauma memories by means of the processes of habituation and desensitization from which emerges critical “corrective information” (e.g., that the traumatic event is in the past, that the trauma-related fear and anxiety are not harmful and are manageable). Imaginal exposure -- a central component of PE -- is used as a means of exposing trauma sufferers to their fear-based memories and facilitating adaptive emotional processing.  However, considerable scientific evidence has emerged in the trauma literature indicating that exposure treatment alone is less effective when non-fear emotions are predominant and that non-fear emotions – such as anger, guilt and shame – are often more predominant than fear in traumatic memories. Such findings underscore the need for developing trauma treatments that go beyond exposure techniques, especially in the treatment of non-fear emotions relating to trauma.
 
Symptoms of increased arousal sometimes emerge as the most prominent and distressing clinical symptoms (e.g., hypervigilance, exaggerated startle response, chronic sleep disturbance, generalized fear/anxiety). Although upsetting and disruptive, such responses may sometimes be viewed as “peripheral manifestations” of a PTSD syndrome not yet fully activated that serve to “block out” intrusive traumatic recollections, flashbacks, and associated affect. While increased arousal symptoms may serve to keep specific trauma-related stimuli outside their conscious level of awareness, such individuals appear extremely tense, rigid, fearful and anxious, and are unable to relax as they constantly on the lookout for the next “bomb to drop.”

Mervin Smucker


 
For individuals with a borderline personality disorder, life is a daily challenge often filled with intense emotional pain. They appear to be living through one crisis after another and often see themselves as incapable of changing or underserving of a life worth living. Dialectical behavioral therapy is a treatment developed by Marsha Linehan (1993) designed to treat borderline phenomena, and is based on the notion that people with difficulty managing their emotions have never learned certain critical skills or how to apply them. DBT teaches individuals to increase awareness of thoughts and feelings, improve their ability to tolerate distress, and regulate emotions. DBT is based on well-researched and tested cognitive and behavioural therapy principles and has consistently produced positive therapeutic effects.

Dr. Mervin Smucker is an international trauma consultant and author of numerous articles and books on trauma and cognitive-behavioural therapy interventions.

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Signal anxiety was a term introduced by Sigmund Freud in the context of his revision of the Theory of Anxiety (Freud, 1929) to designate a subsconscious internal response activated by the ego to protect onself from being overwhelmed by threatening internal stimuli (e.g., thoughts/images entering into one’s conscious level of awareness stemming from an earlier traumatic event or situation). The activation of signal anxiety may result in the onset of other anxiety neuroses (e.g., panic disorder, obsessive-compulsive disorder) that consume enormous psychological resources and function to „protect“ the individual from re-experiencing the original traumamatic situation and its accompanying effects.

Dr. Mervin Smucker is an international trauma consultant and author of numerous articles and books on trauma and cognitive-behavioural therapy interventions.

Mervin Smucker

 
 
Family and group identity is highly valued in Amish culture. Members are constantly admonished that self-surrender and humility are essential to experiencing the rewards of family and community life. Disobedience, non-conformity, and individuality are not tolerated. Deviant members are excommunicated and shunned for life if they do not confess and change their ways. A certain amount of “rowdyism” and anti-social behavior does occur among the unmarried, unbaptized Amish youth who are not yet subject to the Ordnung (the rules of the church). This “running wild” is especially common in the life of the young single adult male. After marriage, however, the individual must adhere to the basic principles of the Ordnung or risk being ostracized by the Amish community.
Mervin Smucker (2012)