Prolonged Exposure Therapy

What is Prolonged Exposure therapy?

Prolonged exposure therapy (PE) is a specific type of cognitive behavioral therapy for trauma that teaches clients to gradually approach their trauma-related feelings, memories, and situations. With exposure, a client eventually learns that trauma-related cues and memories are not dangerous and do not need to be avoided. It is natural to want to avoid anything that reminds you of a trauma, and avoiding something that causes anxiety helps you feel better in the moment. Yet over time, avoidance reinforces fear and anxiety and helps maintain symptoms of posttraumatic stress disorder (PTSD).

PE helps clients face their fears associated with a traumatic experience by exposing them to trauma-related thoughts, feelings, and situations in a controlled and gradual manner. By talking about the details of trauma in therapy sessions, and facing safe situations that have been avoided, clients learn that trauma memories and cues may be unpleasant, but, again, are not dangerous and PTSD symptoms decrease over time.

PE is a strongly recommended treatment for PTSD by the American Psychological Association (APA) Clinical Practice Guidelines. Similar to other types of trauma therapy, treatment begins with providing psychoeducation about the treatment and understanding the client’s past experiences. Next, anxiety coping skills, such as breathing techniques, are taught. Then, exposure begins which can take the form of imaginal exposure and in vivo exposure.

Types of Exposure

Imaginal Exposure

Imaginal exposure occurs in the therapy appointment with the client describing the traumatic event in detail. By talking about the event in therapy, over time, the client will have fewer unwanted memories of the trauma at other times. The client and therapist also process the emotions that arise for the client when discussing the traumatic event. The client’s recounting of the event is recorded in the therapy appointment so the client can listen to the recording outside of appointments which creates ongoing exposure and ability to process emotions while also practicing coping skills.

In vivo exposure

In vivo exposure is exposure to anxiety-provoking situations in real life outside of therapy appointments that are assigned as homework. Collaboratively, the client and therapist will identify anxiety-provoking situations such as specific places, people, or situations (for example, crowds) that the client can gradually expose themselves to and build confidence in their ability to confront feared situations and cope with associated emotions.

PE is an effective treatment for PTSD. In general, clients participating in PE have weekly therapy sessions and treatment generally lasts about 3 months. The main risk of doing PE is experiencing mild to moderate discomfort when discussing trauma-related memories or engaging in activities that have historically been avoided. Typically, discomfort decreases over time if you keep doing PE, and most people who complete PE report the benefits outweigh the discomfort they felt.

 This Psychology Today article provides an overview of PE. 

Prolonged Exposure Therapy vs EMDR

PE and EMDR are both evidence-based therapies for PTSD. One difference between PE and EMDR is PE involves talking about the details of a traumatic memory in therapy sessions and then listening to a recording of yourself talking about the memory between sessions. In EMDR, the client identifies beliefs, emotions, and physical sensations associated with a traumatic memory and brings those pieces to mind with bilateral stimulation. The client is accessing a memory or feeling yet is not discussing details of the traumatic memory with the therapist.

To learn more about EMDR, please check out this CBT Denver blog. And, please contact us at CBT Denver to learn more about prolonged exposure therapy and other evidence-based trauma therapies.