Trauma

Should I be concerned about PTSD?

If you have survived a traumatic experience, it’s natural that you are feeling worried about how to proceed. You may have many concerns running through your mind: How long will I feel this way? Am I supposed to seek treatment? Is it normal for me to feel like this? Whether it’s an unsettling birth experience, a difficult pregnancy, a sexual assault, or any other traumatic event, we are left feeling vulnerable and distressed. This post is for anyone concerned about experiencing posttraumatic stress disorder (PTSD). I hope the following information will provide you some clarity and empower you to seek the support that best meets your needs.

What is PTSD?

PTSD is a mental health diagnosis that occurs after an individual has survived or witnessed a traumatic event. What qualifies as a traumatic event differs for every individual. Whatever the circumstance, the individual experiences a significant threat to their physical, emotional or psychological safety, or the safety of a loved one. The situation is so distressing , that the person feels unable to cope.

In working with prenatal and postpartum parents, I see a lot of caregivers who have experienced trauma in the following circumstances:

Is it PTSD? What to do about trauma. Kasi Shan Therapy: counselling in Kitchener, ON

Prenatal Loss: e.g. stillbirths, miscarriages, unsuccessful IVF treatment
Unplanned pregnancies and abortions
Domestic violence, affairs, or marital separation
Pregnancy complications: e.g. infections, preeclampsia
Early labor or NICU visits
Unexpected health complications: e.g. positive screening for trisomy 21 or 18, car accidents

Not every traumatic experience leads to PTSD. There are many components that can influence your healing. Having resiliency factors (e.g. coping strategies, support from loved ones) can greatly improve how you process and move forward from this experience. Having a relatively safe life and limited trauma prior to this event can help us trust that the world is a safe place once again.

Depending on whether the traumatic event was a one time incident (e.g. mugging) versus a repeated event (e.g. ongoing civil war) can impact your healing. When it’s a one time event, our system is better able to see the situation as an anomaly. When there are repeated infractions, we struggle to see the world as a safe and predictable place, and there is increased risk for PTSD.

During a traumatic event:

PTSD versus trauma. what to do after a traumatic event. how to recover from trauma. Kasi Shan therapy: online counselling. Kitchener, Ontario

During a traumatic situation, our survival system kicks in automatically. We are outside of our window of tolerance because this event was unexpected, and our nervous system is experiencing a threat to our well-being. Without conscious effort, our traumatized mind shifts to a state of flight, fight or freeze. We try and escape the situation as quickly as possible, or we try and attack and fight our way forward. If neither option works, we fall into a state of shock or freeze response. When safety is returned, most of us can calm down. However, for traumatized individuals, it’s like their mind is still hooked in that place of danger, and they continue to respond in a flight, fight or freeze manner.

Symptoms of Trauma

A traumatized individual will show symptoms such as:

What should I do about trauma? Being aware of PTSD. Kasi Shan Therapy. Online therapy. Counselling in Kitchener, Ontario

Hypervigilance: a need to assess for constant threat. This involves a high degree of alertness for anything related to the disturbing event.
Reliving the traumatic event: e.g. through flashbacks, memories, dreams or intrusive thoughts
Avoiding reminders of the disturbing event: this can involve avoiding even the most basic connection. For example, a mother with birth trauma may avoid going to hospitals or visiting medical professionals. She may refuse to talk about her birth experience or listen to others’ birth stories. In the hardest of scenarios, she may avoid any interactions with her newborn.
Increase in negative thoughts and feelings: e.g. numbness, guilt, shame, anxiety, irritability, hopelessness. The traumatized person often feels the world is unsafe or unfair. He or she may be cautious about trusting others.
Hyperarousal: Feeling on edge, jittery, difficulty relaxing
Dissociation or impaired memory recall: In some cases, the individual may forget parts of the trauma, or have blocked out this entire event.

Usually, we experience these symptoms right after a traumatic event; however, some individuals have a delayed onset.

When is it “normal” and when is it PTSD?

Posttraumatic stress disorder. What does it mean, and how do you get help? Kasi Shan Therapy. Online support. Kitchener, ON

The majority of us have survived a traumatic situation. In the beginning, we feel jittery, hyperalert, and avoidant. This is normal. There are parts of our system that are scared of a similar event happening again. In order to ensure safety, these parts will assess for danger and remain hypervigilant of repeat offences. During this time, you will likely experience a lot of distress. However, trauma symptoms tend to dissipate on their own within a month without any major influence. Short-term therapies, medication, and support from loved ones are effective tools that can help with this transition.

In order to have a diagnosis of PTSD, you must experience continue to experience trauma symptoms a month after the traumatic event. These symptoms may last for months or years following, and they cause significant impairment in the person’s daily life and relationships. If you are concerned about experiencing, PTSD, you can take the Posttraumatic Stress Disorder Checklist (PCL-5) as a self-assessment. Any scores approaching 40 warrant a conversation with your family doctor or a mental health professional.

What can I do if I still feel traumatized after a month?

I encourage you to seek therapy as soon as you feel ready to process the traumatic event. While counselling is not meant to be triggering, it can be hard to revisit a difficult memory. If you feel too overwhelmed to even think about the traumatic incident, your system may benefit from extra support to manage this anxiety first. This may involve medication, or specific counselling strategies focusing on distress management.

There are many different counselling approaches that can be used to process traumatic events. Some well known options include: include cognitive processing therapy, sensorimotor psychotherapy and narrative therapies. The following three options are services that can be provided via Kasi Shan Therapy.

Eye movement Desensitization and Reprocessing (EMDR)

EMDR. Eye movement desensitization and reprocessing. treating traumatic events. Kasi Shan Therapy. Counselling in Kitchener, ON and online.

EMDR is a powerful approach that divides a traumatic experience into smaller, manageable chunks to slowly process each part of the incident. Typically, the work starts with either the first or worst part of the memory, depending on what feels manageable for you. In EMDR therapy, we use a process called bilateral stimulation to help process traumatic memories (learn more about how EMDR works vis this post). IN EMDR, with each passing of bilateral stimulations, the traumatized individual starts to feel some distance from the traumatic event. The event feels less personal, and there is a continued lowering of distress level. An individual quickly moves from negative beliefs and high distress to more positive beliefs about themselves, less fear when thinking of the memory, and calmness in the body.

EMDR does not require you to go into specifics of a traumatic event. Instead, clients can express barebone details aloud while still making sense of a unpredictable and nonsensical event. This can feel helpful for those who are not ready to speak about the traumatic event in detail as of yet. In fact, for those who do get stuck in the narrative of a traumatic event, your therapist will keep checking that you are properly processing a memory versus getting retriggered.

Cognitive therapies and prolonged exposure

When it comes to traumatic events, we form negative beliefs about ourselves and about the world. Cognitive therapies help us challenge these beliefs by assessing their validity. We look at whether our assumptions about the world, others, and ourselves are fair and consistent. The therapist and client works to start formulating more neutral or balanced thoughts.

In addition, many therapists will encourage clients to practice in some form of exposure therapy. With trauma, there is a lot of avoidance of the traumatic event. Prolonged exposure involves slowly approaching the activities or individuals that remind us of the traumatic event. This is done at a gradual pace in order to not overwhelm the system, and to help build confidence in our capacity to manage distress and test out problematic beliefs.

Internal Family Systems Therapy (IFS)

IFS recognizes that our system can become divided following a traumatic event. There are parts of us that carry the wound of a traumatic event. We often bury or push this part away from our awareness. These exiled parts typically carry a lot of shame, guilt, fear or overwhelm. Because they are so overwhelming, we have other protective parts that compensate. We have proactive parts that prevent us from triggering these wounds. We also have reactive parts that respond when we are triggered trying to manage the intensity of these exiled emotions.

For example, following a miscarriage, we may have an exiled part of us that believes we are responsible for the pregnancy not lasting. Because this is such a painful burden to carry, we may have proactive parts that do not let us get pregnant again, cancel IVF appointments, or push fights with our partner to prevent intimacy. If another miscarriage occurs, we may have reactive parts that become extremely angry at ourselves or our partners. This part may lash out through verbal attacks, or may cause physical harm onto our own bodies in order to deal with the pain.

In using IFS to treat trauma, we have to work with all parts of your system. Rather than diving straight into addressing the wound, we work with these protective layers first. We focus on building trust and safety with these protective parts. When they have relaxed, we then start to work with the core traumatic wound.

Reach Out

You may notice signs of healing within the first month, and not require additional support. However, if it’s been longer than a month and you continue to express traumatic symptoms, interventions can be helpful. Trauma and PTSD do not have to be a life sentence, and there are ways to help your recovery. If you or a loved one is struggling after a traumatic experience, reach out.

Take care,

Kasi

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Kasi Shan, MSW, RSW

Kasi Shan Therapy is located in Kitchener, Ontario. She offers in-person and online appointments supporting individuals with struggling with trauma and perinatal mental health.

Support for the avoidant parent

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Sure, you and your partner have talked about having a child. In theory, it seemed fine. But now that your baby has arrived, it feels harder than you ever expected. It is exhausting trying to connect with this unresponsive baby. It feels like everytime you pick up your child, he or she knows to scream at the highest decibel. And while you’re feeling stuck, your partner has somehow become the baby whisperer, whipping out breasts, bottles, and toys and magically making this tiny human succumb into a peaceful and serene state. This post is for parents who are feeling avoidant and helpless. It is for the fathers and mothers who are painfully aware of feeling incompetent, and continue to think “I’m not good at this”. I want you to know, it can get better. I hope the following points leave you comforted and empowered.

Stop comparing yourself with your partner

I hear a lot of fathers commenting that their partners can do it better. They see their partner staying patient and rocking the baby, doing midnight feeds, and changing multiple diapers. They see how the baby settles shortly after these interactions. While it’s wonderful to see your partner becoming a successful parent, it can bring up a lot of our own insecurities. It’s really hard not to compare. When your partner picks up the baby, the baby calms down. When you pick up the baby, your adorable little human screams bloody murder. It makes a lot of sense that you feel avoidant.

avoidant parent. new parent. difficulty bonding. perinatal mental health. postpartum depression.

If you have always found security and confidence by doing things well, parenting can bring you outside your safe zone. Rather than work with this struggle, it’s easier to encourage your partner to take the lead since he or she is doing it better. I imagine you already know the consequences to this decision. Sure, the baby is calmer, but your partner is fried. Their arms are aching from constantly holding the baby. They haven’t slept or showered properly in days. And, chances are high, that they are frustrated with you for not taking a more active role. Meanwhile, your own insecurities of being a competent parent continues to worsen.

Parenting is not always about doing things right. It involves time, patience, and some trial and error to figure out how to best help your little person. Chances are that you have a screaming infant on your hands for the first little while. Please know that this is normal. Your partner has also gone through this trial and error period of being hollered at, and it does get better. If you hand over the baby, your confidence does not improve. It only reinforces to you that your partner is capable and you are not.

Forget perfection

There is a steep and fast learning curve with parenting. We make mistakes, work through the stress, and try again. We don’t have the option of quitting, and so we keep going back and figuring things out. The stress of doing things perfectly can make us avoidant in getting started. Rather than perfection, please accept that you will screw this up. Accept that you are going to make mistakes, and this will lead to tears (some of it will be yours and some will be from the baby). This is perfectly normal even though it sucks.

avoidant parent. struggles to bond with baby. postpartum depression.

While there are umpteen books and blogs out there about parenting strategies, no one has published a book for your child. Take what you know and try it out. Watch your baby’s cues to see if he or she responds well, or freaks out. It tooks me months of rocking my child to sleep and feeling frustrated before I realized this strategy wasn’t working. We’ve all gone through the nightmare of bathtime and the stress of barely keeping the baby above water. Some of us keep losing the soother- the only thing in the whole world that will make your child stop wailing. It happens. We all make mistakes, and it makes us human.

We don’t know what will work until we take the time to try it, evaluate its efficacy, and continue or introduce a new habit. This is a normal part of learning new skills. We all start with a keen awareness of our incompetence. We practice and fine tune our skills, and eventually get to a place of being unconsciously competent. Wanting to be a perfect parent right from the start prolongs this very normal learning experience.

Making mistakes is not the issue. Usually that error in judgment lasts a mere seconds before it’s done. However, our mind can keep us fixated on this mistake, and we get easily sucked into a world of shame, embarrassment or guilt. That small moment plagues us for days. Gently remind your system that you are human and you are learning. Mistakes are inevitable, and you did not do it maliciously or intentionally. You can and will learn from these errors.

Assess if you have postpartum anxiety or depression

While we often think of postpartum mental health as a mom’s issue, this is just not true. 1 in 10 dads have postpartum depression, although only 3% of dads actually seek treatment. 1 in 7 mothers have postpartum depression. Unfortunately, there is limited research available about sexual minority couples, and the published statistics vary widely. That being said, postpartum mental health does not discriminate based on sex, culture, socioeconomic status, education, or age. It can happen to anyone.

avoidant parent. struggling to bond with new baby. new dads. postpartum depression and perinatal mental health.

When it comes to depression, symptoms can include lack of energy, disinterest, poor sleep or eating habits, or limited social interaction. Postpartum mental health shows up differently. We want to pay attention to signs like irritability, anger, excessive worries, avoidant behaviours, and poor concentration. Because these are painful struggles, many people try to cope by drinking, avoiding parenting, or getting into arguments. Unfortunately, our friends notice that we are drinking a lot and disengaged with the baby, but they don’t recognize that we are struggling with postpartum depression.

When it comes to mental health or any diagnosis, we need a treatment plan. This can include: help with emotional processing, behavioural changes, professional interventions, medication, or increased social support. Mental health does not go away with sheer will power. It is legitimate and painful, and requires proper attention. The Edinburgh Postnatal Depression Scale is a helpful assessment that can confirm if you are struggling with postpartum mental health. I would encourage anyone who is questioning their postpartum experience to take this self-assessment.

Exposure therapy can help

If you are struggling with your mental health, you do not have the effort or patience to invest into a new relationship. Depression will make you feel irritable and unmotivated, and anxiety will cause you to worry or panic. Your system just wants to shut down. When we shut down from our relationships and our environment, we address the problem briefly. We find temporary relief because we don’t have to spend time with the newborn. This relief is short-lived because, let’s face it, that baby is not going anywhere. Unfortunately, we fall into this repetitive pattern of feeling overwhelmed by our emotions, and avoiding the stress. This works temporarily until we face yet another scenario where we feel overwhelmed.

I encourage you to take small steps to help your system see that you can become a strong parent. Exposure therapy involves creating a consistent and gradual plan to do things that you are fearful or avoidant of in order to build your confidence and reduce your fears. We want to first create a list of tasks that provoke anxiety and avoidant behaviours. Then we start with fears that are unpleasant, but manageable, and practice this repeatedly. It is only when the distress goes down and the confidence increases, that we move on to a more challenging task. Everyone’s exposure plan will differ based on his or her comfort zone and anxiety level. The following post explains exposure therapy in more detail, and I encourage you to reach out if you’d like to fine tune or problem solve your specific circumstance.

Finding the balance between Me and We

Parenting can be a serious buzz kill for our social lives. Chances are that your kid is passing out by 7 PM, which means you’re likely starting a bedtime routine by 6:30 PM. It’s hard to nurture our hobbies, interests, or social lives if you need to be home by that early hour. Parenting can also influence our career path. Signing up for that new project or taking a promotion are incredible opportunities that you’ve worked so hard to accomplish. That being said, these activities mean more hours away from home.

There is not a simple answer that will help you find balance between your interests and ambitions with your new parenting role. However, I’d recommend first sitting down with your partner and working on a plan. Parenting should not be an all-or-nothing experience. You should not give up all your interests, friendships, or goals. However, being a parent does involve some compromise. You may not be able to take on every project at work. Or, if you do, you will face the wrath and frustration of your kids and partner. It’s hard to win at everything, and we need to let go of the expectation to achieve it all. Instead, pay attention to your priorities. Some activities will feel easy to drop, whereas others may cause a lot of resentment. Fight for the priorities that matter.

While routines and schedules are not sexy, they do ensure you have time for yourself. It’s helpful to speak with your partner to ensure you both have time to do your own things. This might involve you taking on morning chores in order for your partner to go to the gym. As a result, he or she is more flexible about you playing hockey and hang out with your friends during the evenings. The predictability in knowing Mondays nights are yours to do as you please will help settle your anxiety.

There will come a time when your child is old enough to be more self-reliant. He or she will not need you to play such a supervisory role. When this happens, sign up for more things. Until then, work with your spouse in understanding what priorities you would like to invest in during the next few months. Talk about this plan regularly so that there are no surprises and there is room to make changes.

The pressure to do it all

As the sole parent attending work, you may feel a huge financial responsibility on your shoulders. You may also come home to a very drained spouse, and your guilt prevents you from taking time for your own self-care. Perhaps the added stress of taking care of another person can feel overwhelming.

avoidant parent. stressed new parent. building a better bond with your baby. postpartum mental health.

If you are feeling these types of pressure, pay attention to how you respond. Some parents will work more hours in hopes that they can manage this new financial burden. Some will feel resentful towards their baby or family because these changes feel so hard. Others will become avoidant, and spend all of their time outside of the home. All of these reactions are understandable given how much this postpartum year has left you unsettled.

If possible, take a moment to slow it down and reflect. What is it about this responsibility that is worrying you the most? What makes you doubt your capacity to manage these new tasks? Is your system aware that the financial strain will improve once your partner re-enters the work force? Would it be helpful to look at your budget and make changes so that you don’t spend all day working ? Are you feeling guilty because you are struggling to “fix” your partner’s exhaustion? Does your partner want you to take on this role? By understanding the root cause of our pressure, we are able to make wiser choices. We don’t have to react in impulsive or avoidant ways, and can instead focus on problem solving, communicating, or setting realistic expectations.

Talk about it

There are many supports and resources for new mothers, and I recognize that the same level of support is not readily available for dads and partners. A highly effective intervention for postpartum mental health is an increase to our support network. There is significant healing that happens when you are supported by others who truly understand and appreciate the hardships of the postpartum year. This can involve leaning on your parents, friends with older children, neighbours with newborns, or a local support group. It’s helpful to speak up, and receive support and compassion from the other end. It helps to talk with others who can share advice or normalize your experiences.

Reach out

There are many ways you can build a bond with your baby. While you can remain avoidant, this behaviour tends to bring a lot of consequences. If you or your partner is struggling with this new role of parenthood, reach out. You do not have to struggle in isolation.

Best wishes,

Kasi

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Anxiety

What is Exposure Therapy?

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Exposure therapy is a wonderful and challenging form of treatment that can improve phobias and anxieties. This treatment modality works off the assumption that, by slowly and continually facing a fearful situation, we become less scared. Gradual exposure involves creating a formal list of tasks that are completed in order to build confidence in facing our fears. Repeating the exposure task helps us become desensitized to a scary object or event. Exposure therapy is based on cognitive-behaviour therapy wherein clients address their anxiety by challenging negative thought patterns and shifting their behaviours. If you have struggled for years with anxiety, exposure work could be the effective approach that helps meet your needs.

Anxiety and Avoidance

When we experiences anxiety, our natural reaction is to avoid whatever it is that is causing fear. For example, if you’re scared of heights, you may avoid climbing ladders or standing out on a balcony. If you’re scared of roller coasters, you may avoid amusement parks. If you live with social anxiety, you may feel distressed at the idea of speaking to strangers or participating in group work.

When our anxiety gets triggered, it tells us there is some form of imminent threat. The safest option is to get away from that threat. Avoidance is an effective strategy, and it can work for many years. However, if your fears are more common place (e.g. public speaking, taking tests, speaking to strangers), it becomes harder to avoid these fears all together. At some point, facing the actual fear becomes a necessity, and our desire and need to address these fears becomes stronger.

How avoidance makes things more complicated:

When we become anxious, we worry that something bad will take place if we actually face our fears. This belief is so strong and uncomfortable that the idea of confronting our fears is overwhelming. Unfortunately, we can spend years avoiding this fearful object or event because of this feared negative consequence. So, we listen to these problematic beliefs without testing whether it is accurate or likely to occur. We trust this belief without assessing whether we have any evidence to back it up.

Because our anxiety naturally feels better when a scary or distressing threat is taken away, we feel like we have managed this situation. However, the next time we are presented with the same threat, our anxiety comes back. As we get into these habits of avoiding, our anxieties become stronger. We stop trusting that we have the skills or ability to face our fears.

If you are struggling with a phobia, take a moment to consider: What would happen if you actually faced this fear? If you take public speaking, for example, the problematic beliefs could be:

others will laugh at me
I will make a mistake
I will stutter and have a hard time being articulate.

Based on these beliefs, you may decide to avoid all forms of public speaking. While this makes sense, the unfortunate consequence is that we never actually test the validity of our belief. How likely is that you’ll make a mistake? If you do make a mistake, then what happens? Will you really be laughed at by your peers? Sometimes, we don’t quite know what would be so bad about these fearful consequences, but the sense of dread is so strong, we don’t want to test it out.

Starting Exposure Therapy

Exposure therapy is a gradual and systemic approach to facing our fears. By slowly placing ourselves in situations that make us fearful, we can start to challenge our fears and our problematic beliefs. We learn to assess whether our feared beliefs are valid. By taking a gradual approach, we can start at a pace that feels uncomfortable, but manageable. For example, if you have a fear of spiders, your exposure task may involve looking at pictures of spiders as a starting point. The task is not pleasant; however, it is much more manageable than actually touching a spider or being in the same room as a spider.

Gradual exposure is incredible in helping build our confidence. The more often we practice an exposure task, the easier it becomes because we learn that these problematic beliefs are either a) not happening, or b) not as bad as we initially believed. With an increased level of confidence, we can then move on to a more challenging exposure task.

Step One: Creating an exposure tasks

The first step to starting exposure therapy is to create a list of exposure tasks. A therapist can support you in creating a list where you consider every anxiety-provoking and avoidance-inducing scenarios related to this single issue. This list can be extensive, and it’s recommended that there are at least 15 exposure tasks to help give enough varied scenarios to build your confidence. For example, your fear of public speaking can include exposure tasks such as:

Exposure Tasks

Providing a long presentation (10 min+)

Providing a short presentation (5 min+)

Introducing myself during ice breakers

Speaking in small groups

Speaking to strangers one on one

Having conversations with authority figures (e.g. boss, teachers)

Maintaining eye contact

Sample Exposure Hierarchy

Step Two: Rating Distress Level

The therapist and the client then review the created list of exposure tasks and assess how uncomfortable, distressing or avoidant-prone the task seems. This is a subjective score, and the distress level depends on how the client perceives a situation. These items are then ranked from highest to lowest level of distress to create an exposure hierarchy.

Exposure Tasks	How distress is it?
Providing a long presentation (10 min+)	100%
Providing a short presentation (5 min+)	90%
Introducing myself during ice breakers	80%
Speaking in small groups	80%
Speaking to strangers one on one	75%
Having conversations with authority figures (e.g. boss, teachers)	60%
Maintaining eye contact	40%

Sample Exposure Hierarchy with Distress Ratings (0= neutral. 100= highest level of distress)

If you are looking for some examples of exposure hierarchies, here are some great examples from Anxiety Canada.

Step Three: Gradual Exposure

This is the hardest step of exposure therapy. Now that we have created a list of exposure tasks, we want to begin the actual behavioural work. The general principal with exposure therapy is to start with tasks that are mildly distressing (in the 30-50% range). This way, we begin with tasks that are challenging, but not so overwhelming that the individual wants to give up or is overwhelmed.

When you start exposure therapy, it’s best to do an exposure task enough times that the distress level goes down. You can stop the task when you are either at a point of habituation (you’re used to it), or to a point of extinction (the distress rating is at a 0% and the task does not bother you). When either of these factors happen, you can move on to the next task on your exposure hierarchy.

Some considerations to note when doing exposure work:

Make sure you are actually focusing on the fearful experience. If your exposure task is to look at pictures of spiders, but you have music on in the background distracting you, this is preventing you from truly doing the work. The point is to practice being in that state of distress without any form of avoidance, so that you can recognize your own skill and ability to handle the situation. This is also part of the reason we start with an easier task when we begin exposure work.

Who is with you? Are you able to do the task on your own or do you always have someone nearby? In the beginning, it is okay to practice doing an exposure task with another person. However, it’s important to try a task on your own so that you can gain confidence in your ability to manage the situation.
Try and switch the length of time you practice exposure work. In the beginning, it’s okay to start for a small period of time, but as the days go on, see if you can lengthen your amount of time doing the work.

Step Four: Tracking using an Exposure Record

As you do these exposure tasks, it’s important to keep track of your distress level. Does it change over time? If not, it’s important to let your therapist know so that you can problem solve together, such as by creating additional steps to help bridge between a task that is manageable versus an overwhelming task. Keeping track of your distress level is also a great marker that tells you when you are ready to move on your exposure list to a task that is slightly harder. Your end goal is to ultimately face your fear in a variety of environments.

As always, everyone has their own specific and unique needs. If you have any questions about exposure therapy, or are looking for support, please feel free to reach out.

Cheers,

Kasi

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