"The idea that Mr. Kyle was engaged in prolonged exposure therapy (with Mr. Routh) is completely uninformed about what prolonged exposure is. In prolonged
exposure we encourage the patient with PTSD to gradually approach safe situations that they fear and avoid because they remind them of their trauma"
Prolonged exposure (PE) therapy seeks to overcome irrationally fearful and anxious reactions to situations that have become associated with a traumatic
event in the mind of the patient that are actually not dangerous to them. For example, rape victims may come to fear all men, even those who love and
support them, and may actively avoid encountering any men to avoid the fear and anxiety being near a man produces. Gradually reintroducing distressing
stimulus in a safe environment allows the traumatized person to process "disconfirming information" that challenges their irrational fear and then process
the emotional response to it. PE therapy may start in a therapists office, and after a number of sessions where progressively more potentially distressing
encounters have been successfully processed, the therapy may if necessary move "in vivo," or into real life settings where the traumatized person can
confront their feared thing in real time with the help of a professional.
Dr. Foa, who routinely works with battle scarred veterans and active duty soldiers, is the premier trainer of mental health professionals to perform PE
therapy. Disregarding the fact that PE therapy is a highly specific system that should only be implemented by licensed professionals, she says that it
makes no sense to say Chris Kyle was engaged in PE therapy with Eddie Routh because there's no indication that Routh was afraid of shooting weapons; in
fact, all reports indicate that he was quite attached to them and became upset when people tried to take them away from him.
"In my experience with veterans and soldiers, most of them have not been afraid of holding weapons or shooting, that's not what they fear. So going
shooting as a therapy would not help the patient getting over their problems. Veterans with PTSD are afraid of things like driving on highways, they're
afraid of crowded places like a supermarket when it's crowded, of places like shopping malls." Oppositely, Dr. Foa says many veterans with PTSD go to these
safe places they irrationally fear only if they have weapons on them, because weapons provide them a feeling of safety.
Eddie Ray Routh [Reuters]
Dr. Foa says that an extensive evaluation precedes transitioning a patient to in vivo exposure to assure that the experience is safe and constructive for
both patient and clinician. Routh is not a person Foa would consider treating with PE therapy; it was clear at the time of the incident that he was
struggling with substance abuse, and twice in the weeks before he murdered Kyle he was in a full blown mental health crisis, threatening to end his life.
He had left a VA psychiatric unit just days before the incident.