Exposure therapy is when someone is “exposed” to something that makes them feel anxious or uncomfortable as a way to decrease anxiety and discomfort around that thing in the future.

PET is a type of trauma therapy. In PET, there are two parts of the core work: 1) In-vivo exposure and 2) Imaginal exposure. “In Vivo” means “in life,” so for “in vivo exposure,” first, I work my client to make a list of places, people, activities, and other functions that they have been avoiding since the trauma and would like to get back to; also included in this list are activities that a client used to do but hasn’t done since the trauma happened. Then, I walk through each item with my client and ask them to rate their anxiety level for each of those items. Then, we work together to pick one item with a score in the middle of the anxiety scale as homework for that week.

This is a collaborative effort! For example, if Susie was struggling with anxiety after she was in a car crash and rates her anxiety about sitting in a car that isn’t moving at a 50/100, that would be a good place to start with in vivo exposure, as long as Susie agrees! If Susie’s not ready to go there, we pick something that she rated lower on her in-vivo hierarchy.

Imaginal exposure is the part of the therapy that we do during session. During this time, I ask my client to tell me about the trauma in as much detail as possible, and I am there to help guide them through it. We may go through the memory more than once if we have time. At the end of session, I stop the imaginal exposure and work with my client to process their experience and emotions that have come up. I will ask them to record their imaginal exposure on their phone and listen to the recording between sessions to help them further process the trauma.

Generally, after we have selected a memory to work on and set up the in-vivo hierarchy, the process looks like this:

1) We work together to pick the homework assignment.

2) We start imaginal exposure (which the client records on their phone).

3) At the end of the session, we process what happened in session.

4) At the beginning of the next session, I check in with my client about their progress with homework and their anxiety levels.

We continue with these steps until my client’s distress has lowered significantly and they can get back to doing the things that they want to do.

PET is an effective trauma treatment with over 20 years of research backing it up. PET is endorsed as effective by the American Psychological Association, Veteran’s Administration (VA) and the U.S. Department of Defense.

This is just a brief introduction to PET, and you can learn more about it here and by checking out this handout.