The problem with this article is that it doesn't address "why" exposure therapy works. I'm a psychotherapist who treats PTSD everyday with EMDR and several other trauma therapy protocols (all involve some type of "exposure" therapy) and have "successfully" treated victims of sexual abuse, rape and physical assault, torture, etc. "Successful" meaning the people go home to happy lives. This last is dependent upon how long the person has been suffering from the effects of trauma, how many other extreme traumatic events there have been in the person's life (before or after), how successful they are in the rest of their life, their support system in the sense of the friends and family around them and lack of financial and career-satisfaction stress. It is also dependent upon genetic precursors of depression or mental disorders in their family and how healthy their family of origin was in coping with those. It's also dependent upon the trust in the relationship - not every therapist is able to work for everyone.

Exposure therapy seems contradictory and contraindicated because the victim is often reliving the trauma in flashbacks and in any associations that are similar to the trauma in every day life. Why in the world would anyone want to re-expose themselves to it to get better? So it's understandable some of the responses here.

When someone is in any "life-threatening" situation that they have no control over and are there is no release from or it's unknown whether they will survive or they witness the violent or traumatic death of another person, or being made to inflict life-threatening consequence upon another person (as in torture), that person is at risk for PTSD or trauma related emotional disorders/physical disorders. What happens is that the parasympathetic nervous system goes into overdrive in flight or fight and the person can't actually do either and "GET AWAY" from the life-threatening situation. The "get-away" part is key here in understanding why exposure therapy works. It actually represents a completion and mastery of the trauma and then the parasympathetic system can then calm down.

A good example of this in nature is some wild animals that are caught and being transported out to being released somewhere else. They literally cannot be kept caged for more than 24 to 48 hours or they will die. Being caged is "life-threatening" to them and they can't do anything about it. They can't "get-away". Think of the coyote caught in New York not too long ago. Their nervous system is in overload while they are caged and will literally shut down and kill them if not released within that time period. If an animal is released in time it's nervous system releases the overload through the physical and emotional experience of "get away" and the trauma is therefore "completed" for them. Human beings don't die, at least not right away but their nervous system often will remain in overload if the traumatic event is ongoing or even a short period of time. Soldiers in war have no escape from the horrifying events they see and the constant danger to their life, so their system is in overload constantly. There is no "get away" and no emotional or physical release because the experience for many of them has never been completed or mastered in the their nervous/emotional system.

Exposure therapy in all of its forms and in its BEST form allows the person to master the trauma by allowing them to relive and "get away" and complete the traumatic event. The nervous system is then able to release the flight or fight stress by that completion and the feeling of "get away" that was not possible in the original event(s). Flashbacks or panic attacks are just bits and pieces of the whole and are the nervous system trying to complete the trauma on its own. Sometimes the system heals itself, sometimes not.

When I work with people with EMDR or any other exposure protocol, we usually master the trauma in bits of it so that people are not re-traumatized. In essence, it’s like peeling an onion. There is usually a center or main piece that we get to and when we get past that, it's all uphill from there because the nervous system starts to release the flight or fight anxiety or energy. A main piece of recovery is the knowledge that the person has survived and from a safe place with a safe person is reaching back and completing the trauma.

Having said all this, exposure therapy must be done very carefully. The danger I fear with this article is that soldiers will think that just getting some war video game will help them and end up re-traumatizing themselves severely. There are a lot of highly complex emotional pieces that vary from individual to individual in exposure therapy and the victimization of war on soldiers or any life-threatening traumatic event. There is a whole set of therapeutic groundwork that must be set up first with certain victims to ensure success. Regardless, when it works, it works well. I have had people come into my office with their lives in devastation and when we're through, be able to have not much more than a fleeting thought about what happened. They're done and they move on. When it doesn't work, often the people have been through prolonged horrific experiences, usually as a small child or held in prison for a long time. You must have a shred of a memory of or an experience of life with hope/safety in it to hold onto and work with. Without that life experience of safety or hope, recovery is very difficult. You can't recreate it afterward.

By the way, "talk therapy" is any psychotherapy that involves "talk" between the person and the therapist as opposed to something like hypnotherapy, where the person is just listening. In some ways, all psychotherapy is exposure therapy.