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PROCESSING

1. Each imaginal exposure should be followed by 15-20 minutes of processing.
   1. In processing, the therapist and patient explore thoughts and feelings that came up in the imaginal exposure.
   2. The goal of processing is to lead the patient to new insights about the trauma and about herself, and for the patient to integrate new information into her memory.
   3. The standard method of processing is Socratic questioning, though some clinicians prefer to use other methods, such as cognitive restructuring.
2. It is not uncommon for patients to finish an imaginal exposure in a distressed state.
   1. That is perfectly fine! Distress does not obstruct therapy, and often diminishes during processing.
   2. It is rarely necessary to use breathing relaxation after imaginal exposure.
   3. In fact, calming the patient with breathing exercises may reinforce the idea that anxiety is dangerous and must be avoided or eliminated, when the patient needs to be learning exactly the opposite.
3. A good thing to begin processing with is commenting on distress levels during the imaginal exposure.
   1. "I noticed your SUDS got lower and lower during the exposure, even though you were telling your story in more and more detail. I'm thrilled to see you making progress!"
   2. "I noticed your anxiety did not decrease as we did the exposure. Why do you think that is? ...I just want you to know that it's very common for anxiety to stay high through these first few sessions."
   3. "What did you notice about your anxiety levels? ...Why do you think that happened?"