Prolonged Exposure Therapy and the Making of Shia LeBeouf’s ‘Honeyboy’

It was a blink and you miss it kind of interview: on November 5, 2019, Shia LaBeouf was on Ellen to talk about his most recent film, Honeyboy, an autobiographical film he wrote and starred in as his own father. Speaking to Ellen Degeneres, LaBeouf explained the process behind writing the film: he wrote a lot of it while in court-mandated therapy. When he got home, he saw his dad for the first time in seven years, recorded the meeting, and finished writing the film.

Those who follow LaBeouf know that he’s had a complicated history with the law, including a handful of arrests, stints in jail, and public freakouts that were, at the time, amounted to his alcoholism. The final straw — both personally and legally — came for LaBeouf when he was arrested in Savannah, Georgia in 2017 for terrorizing a police officer, a felony charge. The court gave him a chance to either go to therapy or prison for seven years. LaBeouf, understandably, chose therapy.

It was in that court mandated therapy where LaBeouf was diagnosed with Post Traumatic Stress Disorder, a condition he had no idea he had (In other interviews, he suggests he thought he was just a “screw up” and an alcoholic.) He promptly began a therapy called PET (Prolonged Exposure Therapy), one of the most commonly used therapies utilized to treat victims of Post Traumatic Stress.

PET works. It’s just that, often, many people don’t even realize they’re traumatized. LaBeouf, who experienced most of his traumatic memories in his childhood, certainly didn’t. That shouldn’t be that surprising. LaBeouf’s subsequent journey is — or rather, should be — a lesson for men everywhere — including dads.

“One thing that we know about PTSD is that most people following a trauma — specifically being confronted with, or personally experiencing, a life threatening situation — will actually have some of those symptoms that we might later call PTSD if they continue,” says Dr. Sheila Rauch, a major researcher in how PET works, Professor of Psychology at Emory University, and the Director of Research and Program Evaluation at the VA Atlanta Healthcare System. “Having flashbacks, thinking about the trauma a lot, pushing it away, are part of a normal response to trauma in the acute aftermath. But for some people, those memories get stuck. And that’s what we call PTSD.”

Initially developed for use on victims of sexual assault, PET soon became one of the major therapies that the Veterans Administration (VA) began to use for war veterans. It has shown to dramatically reduce symptoms of PTSD and even put those suffering from the disorder well into remission.

While women suffer PTSD at higher rates than men, some of this discrepancy can be chalked up to the fact that men are half as likely as women to seek mental health treatment. And PTSD, unlike mental health disorders that might land you in a hospital (many panic and anxiety disorder patients think they are having a heart attack and go to the emergency room when they’re actually having a panic attack), creeps up on victims slowly, shrinking their life into acceptable and unacceptable situations, until what was once a full and vibrant existence is compressed, into rules, rationalizations, and closed doors. It is often not until someone is given an intervention or forced to seek treatment that they realize that something might be wrong with them, and that what might be wrong with them is, in fact, treatable.

PET therapy lasts, on average, anywhere from eight to 15 weeks of sessions. One of the main elements of therapy is imaginary exposure. This requires the person going through the treatment to record themselves in the therapist’s office telling the story of their trauma over and over again while rating themselves on a Subjective Units of Distress Scale (basically, how anxious are you, 0 to 100.) They then must listen to it every single day in between sessions. LaBeouf wrote many of Honeyboy’s scenes, which dive into and out of his childhood as a young actor while dealing with his father, a rodeo clown, through recordings he made when working through the trauma he experienced as child. They are, quite literally, his memories.

The other part of the therapy occurs outside of the therapist’s office. That’s called in vivo exposure. Patients work with their therapist to come up with a list of situations that remind them of their trauma or that they’ve started to avoid due to their trauma that give them anxiety on a scale called SUDS (Subjective United of Distress Scale) of 0 to 100. They then go and do those things during their therapy.

“In vivo essentially [means] in life — going into situations that are safe, but that remind a person of their trauma, to help them learn that the world is safe, and learn to not be afraid when they are triggered by reminders,” says Dr. Paula P. Schnurr, the Executive Director at the National Center for PTSD, a Veterans Affairs Center, and a Professor of Psychiatry at Dartmouth.

For example, a war veteran who is anxious about being in open crowds might start their in vivo treatment by going to the grocery store with a friend at peak hours. Or to the town parade they haven’t gone to in years. Whatever that was for LaBeouf is unclear, of course. But dealing with his trauma helped him gain control over what he became publicly known for: public freakouts; rage issues; being “difficult,” and so on.

Dr. Rauch, whose work has largely been focused on understanding the mechanisms that make PET so effective in order to make it more accessible for trauma victims, suspects that the effectiveness of the treatment lies in, in layman’s terms, the way that it builds emotional resilience in people who go through it.

“PET works through extinction learning processes,” says Rauch. In other words, when someone goes through a traumatic experience, their brain pairs that experience with, understandably, feeling fear. What PET does is helps reassociate the brain with less fear-based responses, and helps trauma victims place what happened to them in a context. It might even help them re-orient some of their beliefs about what happened — like if they still believe they could have prevented it somehow. “When we go through the trauma five times, and only good things, no bad things happen, that trauma pairing with the fear extinguishes, goes away, and disappears,” Rauch says.

In other words, no matter how hard it may be, those going through the treatment start to gain some positive beliefs about themselves. When trips to the grocery store gets easier — and self-talk about the traumatic event gets cleared up when the memory comes into the forefront — trauma victims can start to realize that even if that traumatic event happened to them again, they’d survive it. But the most important thing is that those who think they might be suffering from PTSD seek treatment as soon as possible. It’s as important as regaining the full breadth of their lives.

“PTSD is a disorder of avoidance,” says Rauch. “As soon as a patient raises their hand, and says, ‘I want treatment,’” the more quickly we can get something to them that will show them that they can get better, the more likely it is that they’ll stick through an episode of care, and actually get what they can out of it.”