What is Prolonged Exposure (PE) Therapy?
Prolonged Exposure (PE) therapy is an evidence-based treatment for Post-Traumatic Stress Disorder (PTSD). It is a form of cognitive-behavioral therapy (CBT) that focuses on helping individuals confront and process traumatic memories and reduce the distressing symptoms associated with PTSD, such as flashbacks, nightmares, and hyperarousal. PE therapy helps individuals gradually face their traumatic memories in a safe and controlled way, with the goal of reducing fear and avoidance.
Key Components of Prolonged Exposure Therapy
1. Education about PTSD & Trauma Responses
At the start of treatment, the therapist helps the individual understand the nature of PTSD and how trauma can affect the brain and body. This education helps normalize the experience and empowers the person to engage in treatment.
2. Imaginal Exposure
In imaginal exposure, the individual is encouraged to recall and vividly describe the traumatic event in as much detail as possible. This helps them confront the memory and the associated emotions, which are often avoided. The therapist may ask the person to repeatedly talk about the traumatic memory during each session.
This process helps reduce the emotional intensity of the memory over time and allows the individual to experience that the fear and distress associated with the memory can diminish through repeated exposure.
3. In Vivo Exposure
In vivo exposure involves gradually confronting real-life situations, places, or activities that may be associated with the trauma but are now avoided. These might include reminders of the trauma (e.g., driving if the trauma occurred in a car) or activities the person has been avoiding out of fear.
This gradual exposure helps reduce the avoidance behavior that maintains PTSD symptoms, enabling the person to regain a sense of control over their environment and daily activities.
4. Processing the Trauma
During both imaginal and in vivo exposures, the therapist helps the person process their feelings and reactions related to the trauma. This may involve identifying and challenging unhelpful thoughts, beliefs, and fears related to the trauma, as well as learning to cope with distressing emotions.
5. Habituation
The goal of PE therapy is to allow the individual to experience habituation—a decrease in the emotional response to the trauma memory or feared situation over time. As the individual repeatedly confronts the trauma in a safe space, their anxiety and fear gradually diminish.
6. Developing New Coping Skills
PE therapy also helps individuals develop healthier coping strategies to deal with distressing emotions, triggers, and anxiety. These new skills help individuals manage their symptoms in the long term and reduce reliance on avoidance.
How Prolonged Exposure Therapy Works
Confronting Avoidance
PTSD often leads to avoidance of people, places, or situations that remind the individual of the trauma. Avoidance can maintain symptoms of PTSD because it prevents the person from processing the trauma and learning that they can handle distressing memories and triggers. In PE, avoidance is gradually reduced through exposure to the feared memories and situations.
Reducing Emotional Distress
By repeatedly confronting trauma-related memories or cues in a safe, structured way, individuals learn that their emotional distress can decrease over time. The repeated exposure leads to habituation, where the individual’s emotional response to the trauma becomes less intense.
Processing Trauma-related Thoughts
PE also involves identifying and addressing unhelpful thoughts and beliefs related to the trauma. For example, a person might believe that they are powerless or that they can never feel safe again. Through the process of exposure and discussion, these maladaptive beliefs are challenged and reframed, which helps reduce PTSD symptoms.
The Structure of PE Therapy
Duration
PE therapy typically lasts 8-15 sessions, depending on the individual’s needs and progress.
Frequency
Sessions are usually scheduled on a weekly basis.
Home Practice
Between sessions, individuals are encouraged to practice the exposure exercises at home. This may involve revisiting trauma memories or engaging in real-life exposures to feared situations.
Is PE Therapy Effective?
Yes, Prolonged Exposure therapy is one of the most researched and effective treatments for PTSD. It has been shown to significantly reduce PTSD symptoms in individuals with trauma histories, including those with military trauma, sexual assault, and accidents. The therapy is often considered a first-line treatment for PTSD and has been supported by decades of clinical research. It requires active participation and commitment, but the benefits, such as reduced symptoms of PTSD and improved overall well-being, make it a powerful tool for those struggling with trauma-related difficulties.