Prolonged Exposure (PE)

What is Prolonged Exposure Therapy?

Prolonged Exposure or PE is a form of Cognitive Behavioral Therapy developed specifically to treat PTSD.

PE is based on Emotional Processing Theory, which says that the symptoms of PTSD are a result of psychological fear structures that are created by a traumatic event.

What is a Fear Structure?

A fear structure is similar to a computer program that runs when a trauma survivor encounters certain reminders of the trauma (a sight, sound, smell, feeling, situation, type of person, etc.). This program includes emotional, physical, cognitive, and behavioral responses that are very uncomfortable and disrupt the person’s life. These responses may include:

• Fear or anxiety
• Increased heart rate and breathing
• Hyper-alertness for danger
• Heightened startle response
• Beliefs about losing control of emotions
• Anger or aggression
• Cued trauma memories or flashbacks

These responses become so problematic that people with PTSD often turn to avoidance strategies to cope. They may avoid certain places or things, withdraw from relationships and social settings, use alcohol or drugs to manage feelings and memories, or make other substantial life changes to prevent trauma-related distress. Unfortunately, this avoidance only perpetuates their symptoms, because it prevents habituation (decreased emotional response to the memory or reminder) and does not allow exaggerated beliefs about danger to be corrected experientially.

Types of Prolonged Exposure Therapy

Imaginal Exposure Therapy

PE counteracts avoidance using two types of exposure exercises. Imaginal exposure involves repeatedly revisiting the trauma memory, replaying it moment by moment in the imagination, to evoke and reduce the overwhelming emotions stored with the memory.

In Vivo Exposure Therapy

In vivo exposure involves intentionally approaching anxiety-producing (but safe) situations or reminders, to decrease the fear response to them over time. Through these intense but effective exercises, survivors decrease the anxiety and avoidance that have controlled their lives, while gaining a healthier perspective on the trauma, more control over the memory, and greater self-confidence.

Prolonged Exposure Therapy for PTSD

PE is a structured therapy that varies in length, typically between 8-15 sessions. Patients complete imaginal exposure in session with the guidance and support of the therapist, then listen to an audio recording between sessions. In vivo exposure activities are also planned and reviewed during the session, then completed by the patient between sessions.

PE has been demonstrated effective by many high-quality research studies, and it is recognized by the Departments of Defense and Veteran Affairs, as well as other authoritative professional organizations, as a first-line intervention and best practice for treating PTSD.

National Center for PTSD's video for PE