The principle of exposure therapy: repeating, tirelessly, the memory, with its emotional charge, to gradually eliminate cognitive distortions and dysfunctional thoughts that inhibit integration. Before hospitalization, patients are received by the team during a pre-admission day. “I filled out a long questionnaire to assess my condition: how is my sleep, do I tend to devalue myself,” recalls Olivia, a 23-year-old former patient. The care team also establishes an exposure plan. “I ask the patient to reflect on traumatic memories they want to work on. I outline a sort of life thread, noting on post-its the significant events from a traumatic point of view,” explains Noémie Thoiry, a psychologist within the unit. “Once this work is done, we select four, the most impactful, the toughest, that we can work on during hospitalization: this is what we call traumatic scenes or clusters.” And what if the patient suffers from traumatic amnesia? “In this case, we will try to identify starting targets, whether they are bodily sensations or just a fragment of a memory.” It is from this initial material that each, patient and therapists, will work on.
Two to three exposure sessions per day
The typical day consists of two to three exposure sessions, sometimes a session with the psychomotor therapist and a psychoeducation session on various topics depending on the profiles (dissociation, grounding, emotional regulation, interpersonal relationships, addictions), interspersed with three sessions of adapted physical activity (walking, collective sports sessions). Repeating the memory tirelessly, with its painful charge, to emotionally digest it. “It’s the very principle of exposure theories to confront oneself in a structured way with the emotional charge associated with the event, in order to reintegrate the memory into the memory,” specifies Noémie Thoiry. The exercise is truly exhausting, both for the patients and the caregivers. “When we are on a standard exposure rhythm, we can go up to two, three exposures per week in a service where time allows,” emphasizes the psychologist. “Here, we have two exposure sessions per day, so it’s extremely intense! ” Especially since patients, exhausted by what is being replayed emotionally and bodily, experience a resurgence of symptoms: nightmares, flashbacks. This is what Olivia went through. “These two weeks are very physically challenging because during this period, nightmares can come back, flashbacks, or even suicidal thoughts because we work intensively on the trauma. We live trauma, eat trauma, sleep trauma for two intense weeks, so inevitably, it stirs up a lot of things.”
Extremely challenging two weeks
“When patients arrive, they are very stressed, very anxious because they have been warned by the psychiatrist that it was going to be particularly intensive and that they were going to relive the worst traumas of their lives,” says Adéline Serez, a nurse at the REPII day hospital. “So these are extremely motivated people; the psychological suffering is so unbearable that they want it to stop.”
“We will indeed ask the patient, either in imagination or through narration, to tell us about their traumatic event so that they experience the event here and now,” explains the caregiver. “Bringing the patient back here safely to relive their trauma will allow for desensitization. We can thus work on avoidance, talk about negative cognitions (what the subject thinks of himself at that moment – generally we find great feelings of powerlessness, shame, guilt for not being able to cope, but also statements of terror: I thought I was going to die, I saw myself dead). A challenging experience, which unfolds.”
The team also practices double exposures. “With the help of the psychomotor therapist, I embarked on a work of desensitization of body parts reactive to trauma (in my case, it was the arms, pelvis, back, knees). I had to replay the scene of a sexual assault, through gestures, positions, sensations (weight or friction) while exploring the thoughts or flashbacks associated with it,” recounts Olivia. “The person is confronted with their trauma on a cerebral and bodily level, but at the same time, we secure them by bringing them back to the present,” specifies Davina Nogé, another nurse in the unit. Caregivers also accompany patients to the scene of their trauma (the train station in the case of a transportation accident, or in a store, on the street depending on the situations), in “in vivo” exposures.
