What Are the Three Es of Trauma?

The Three Es of Trauma are an important framework for understanding and treating trauma. They are:

1. Event: The traumatic event itself.

2. Emotion: The intense emotions that are experienced in the aftermath of a traumatic event.

3. Effect: The long-term effects of trauma on a person’s mental and physical health.

If you or someone you know is struggling with trauma, it’s important to seek professional help.

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Trauma, especially PTSD, can have a lasting and profound effect on a person’s mental and emotional health. The three es of trauma are Event, Exposure, and Effect. Event is the actual traumatic experience, Exposure is the reliving of the event through intrusive thoughts, flashbacks, and nightmares, and Effect is the lasting change in the person’s emotional state.

In vivo exposure

In vivo exposure is a type of behavioral therapy that involves gradually and repeatedly confronting a feared object or situation in real life, under the guidance of a trained therapist. The goal is to help you to overcome your fear and ultimately become less anxious or phobic.

In vivo exposure usually starts with easy, less-feared situations and objects, and gradually progresses to more challenging exposures. The therapist will work with you to create a hierarchy of feared objects or situations, starting with the least feared (e.g., touching a doorknob) to the most feared (e.g., walking outside).

Depending on your specific anxiety problem, in vivo exposure may involve confronting your fears in imagination first (imaginal exposure), and then in real life (in vivo exposure). For example, if you have a fear of snakes, the therapist may have you imagine seeing a snake before actually going outside and seeing one in nature.

Imaginal exposure

Imaginal exposure is a trauma-focused psychological treatment that allows people to safely face their fears and work through their memories of a traumatic event. The aim is to help people process their memories so that they no longer cause distress.

During imaginal exposure, people are asked to imagine the details of their trauma in a safe and controlled environment. They may be asked to recount the story of what happened, or to describe the event in detail. This can be done either in writing or out loud. The aim is to help people confront their memories and work through them in a way that is manageable and does not cause further distress.

Imaginal exposure is usually done as part of a wider treatment programme that also includes other therapies, such as cognitive behavioural therapy (CBT). It can be a very effective treatment for post-traumatic stress disorder (PTSD) and other anxiety disorders.

Emotional Processing

One key element to processing trauma is understanding the three Es of trauma. The first E is for Event. This is when the traumatic experience happens. The second E is for Encoding. This is how the brain stores the memory of the event. The third E is for Engagement. This is when you begin to process the event and start to work through your emotions.


One of the three E’s of trauma, arousal refers to the body’s natural fight-or-flight response. When we are faced with a threat, our body kicks into gear to help us defend ourselves or escape the danger. We might feel our heart rate increase, our breathing quicken, and our muscles tense up. This physical response is designed to help us protect ourselves, but it can also be triggered by memories of a traumatic event.


Cognitive processing refers to the ways in which we take in and store information about our experiences. This type of processing is believed to be largely unconscious and happens outside of our awareness. It is thought to be influenced by our worldview, previous experiences, and current emotional state. For example, if you grew up in a household where violence was common, you may be more likely to see violence as a normal part of life and less likely to be upset by it.

Cognitive processing is important for understanding and responding to our environment. It allows us to make sense of what is happening around us and make decisions about how to best protect ourselves. When we are unable to process information about a traumatic event, we may experience problems such as intrusive thoughts, avoidance, and difficulty concentrating. These symptoms can interfere with our ability to function in everyday life.


Trauma can be an isolating and overwhelming experience. The three Es of trauma are an evidence-based approach to understanding and helping people who have experienced trauma. The three Es refer to Event(s), Extinction, and Engagement.

Spontaneous recovery

Spontaneous recovery is the tendency for symptoms of a traumatic event to lessen or disappear over time, even without treatment. This phenomenon was first observed in soldiers who experienced shell shock during World War I. Many of these soldiers appeared to recover from their symptoms within a few weeks or months, even though they had not received any specific treatment.


The fourth “R” in the three Rs of trauma is renewal. Just as fire burns away the deadwood in a forest, making room for new growth, so too does trauma have the potential to renew our lives. When we have faced and overcome difficult experiences, we often find that we are stronger and more resilient than we ever thought possible. We may also find that we have a renewed sense of appreciation for life, and a deeper understanding of what is truly important to us. Renewal is a natural part of the healing process, and it is an essential step on the road to recovery.

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