Tool 2: Mental Exposures (Building your Confidence)
This type of exposure means exposing yourself to thoughts and memories that are distressing to you.
Anjali experienced a miscarriage one year ago. She was devastated initially but gradually recovered. Now that she is pregnant again, she is having more thoughts and memories about the miscarriage. Sometimes if she experiences a twinge of pain in her abdomen, she becomes very distressed by memories of the events surrounding the miscarriage: cramping pain and bleeding, going to the hospital having an ultrasound that failed to show a heartbeat, and having to tell her family that she “lost the baby.”
Important: Trying to suppress thoughts and memories just makes them more frequent!
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, Anjali’s story might start with:
I’m getting out of bed and I’m happy that I don’t feel sick to my stomach in the mornings anymore this past week, even though I’m 9 weeks pregnant. I am using the toilet and there is a small amount of blood when I wipe. I start to feel freaked out but I try to tell myself it’s nothing, and I’m getting ready for work as usual. I don’t tell my husband because I don’t want to freak him out. Now it’s a few hours later, I’m at work, and I realize I’m really bleeding, and I have bad cramps too. I call my husband and ask him to come to get me. I’m crying, trying to tell him that I think I’m having a miscarriage…
Anjali 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, once the pain and bleeding have subsided and she is talking about it with her family, or it might even be later than that, remembering how she criticized herself for being happy that her morning sickness was over, when it really had meant that the embryo had stopped developing some time earlier.
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 can 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.