You will notice that as therapy continues, the patient will habituate to his narrative. SUDS values in most of the narrative will decrease, but SUDS values at the worst moments of the narrative will tend to stay high. These are called "hot spots."
Rather than having the patient retell his entire narrative to work on a single hot spot, it is much more efficient to work on these spots in isolation.
Work with the patient to select the most currently distressing parts of the narrative. These will be the hot spots you work on.
If there is more than one hot spot, focus on the most distressing one first. Work on hot spots one at a time, only moving on to the next one when the current hot spot has been sufficiently processed.
Signs of habituation, that the patient is ready to move on to hot spots, include decreased SUDS ratings in most of the narrative, fewer signs of anxiety, more detail volunteered. This will typically happen around session six.
Work on hot spots will usually continue until the end of therapy.
When working on hot spots, the procedure for imaginal exposure is a bit different.
Start the narrative just before the hot spot begins and conclude it just after the hot spot ends.
Have the patient retell the hot spot as many times as possible in the session.
Probe for as much detail as possible. Work through the hot spot "in slow motion," getting every detail the patient has in memory.