• Kelly Skovron, LCSW

We Need To Talk: Prolonged Exposure Therapy for PTSD

Updated: Feb 4


What Is Prolonged Exposure?

Prolonged exposure (PE) therapy is another form of psychotherapy that was developed specifically to treat post-traumatic stress disorder (PTSD). In fact, it's one of the most highly regarded evidence-based therapies for PTSD. PE is strongly recommended by the APA and the VA too. The way that PTSD symptoms are typically maintained is by 1. avoiding thoughts, memories, and situations associated with trauma, and 2. problematic beliefs about oneself and the world. Avoidance allows us to maintain beliefs that the world is dangerous, people are bad, and we need to consistently seek safety in relatively ordinary situations. Thus, this leads to the continuation of PTSD symptoms due to a past trauma. PE is based on the emotional processing theory which indicates that exposure to something fearful can alter the relationship between the self and the thing that's feared.


Prolonged exposure therapy involves bringing yourself to the trauma memories and the people, places, and things you've been avoiding because of your past. Prolonged exposure therapy is highly structured and involves homework in between sessions. It works for anyone who has experienced or witnessed a traumatic event. PTSD symptoms are necessary for PE as it requires a person to speak about the trauma and encounter trauma-related thoughts and feelings. Those with past trauma without current distress would not benefit from PE.


It might seem difficult to imagine talking about the worst days of your life or confronting your real-life fears. You may experience discomfort during this therapy and, in fact, it's recommended to feel the pain during these exposure exercises. The felt distress is brief and afterward, people typically feel significantly better because of treatment. PE shows people that they can survive, have survived, and have the strength to confront their fears. It indicates that while the memory, thoughts, and emotions of your trauma may have at one time felt debilitating, you are now safe and the memories are only that - memories.


What Does PE Therapy Look Like?

The protocol for Prolonged Exposure involves the following components:

  1. psychoeducation regarding treatment rationale and common reactions to trauma;

  2. breathing retraining, a form of relaxation;

  3. in vivo exposure, or approaching avoided trauma-related but objectively safe activities, situations, or places; and

  4. imaginal exposure, or repeated recounting of the traumatic memory

Standard PE therapy involves 10-15 treatment sessions that can be 60-90 minutes long. The first couple of sessions includes gathering an extended history of your life and past traumas. It also includes a lot of education about trauma symptoms, avoidance, prolonged exposure therapy, breathing retraining, and an overview of the program. Imaginal exposure begins in the second or third session. In vivo exposure typically occurs between sessions as homework. The combination of these two approaches allows you to overcome trauma-related fears as well as to habituate to the trauma memory. By repeatedly recounting the trauma and exposing yourself to real-life fears, you can successfully process the memory, differentiate past from present, and gain an improved sense of control over the memory.


Is PE Therapy For You?

As I said above, PE therapy is usually most appropriate for people who are struggling with PTSD symptoms and are able to recall memories of a past trauma. When considering any type of therapy, it's helpful to think of the pros and cons of any treatment. Here are some of the pros and cons of PE:


Pros:

  • It works. Many scientific studies and scholars have researched PE therapy to deem it effective, evidence-based, and efficient for reducing PTSD symptoms. Even the APA and the VA highly recommend this therapy.

  • Timely. PE therapy typically takes a few months for complete improvement, not years.

  • Results last. Most clients feel a need to talk about their trauma memory even though they may never have. After follow up many studies indicate the reduction of symptoms long-term.

  • It's accessible. PE therapy can be done via any format and is indicated as effective for all types of trauma and symptoms experienced.

Cons:

  • It can be hard. The reason why you may be avoiding trauma to begin with is because it can be unpleasant to experience. It's no secret this therapy can be difficult during the treatment itself.

  • It requires commitment. Not going to lie, this type of therapy is a lot of work. It requires you to record and listen to your sessions, to work on in vivo exposure everyday, and to complete homework every week.

Whatever you decide about whether to engage in prolonged exposure therapy or not, it's always good to educate yourself on the different types of therapy available for trauma.

 
  • Eftekhari, A., Stines, L. R., & Zoellner, L. A. (2006). Do You Need To Talk About It? Prolonged Exposure for the Treatment of Chronic PTSD. The behavior analyst today, 7(1), 70–83. https://doi.org/10.1037/h0100141