Prolonged Exposure Therapy

Prolonged Exposure Therapy is a mental health treatment designed to treat  Post Traumatic Stress Disorder (PTSD).

Trauma refers to a distressing event or experience that is so painful that it challenges and exceeds an individual’s coping abilities, such as experiencing or witnessing a natural disaster, violence, sexual assault, or combat.

Post-traumatic stress disorder (PTSD) is a mental health disorder that can develop after experiencing or witnessing a traumatic event.  Generally speaking PTSD is defined as distressing symptoms lasting over a month past an incident. And in fact the distressing event can have occurred many months or years prior.

PTSD symptoms can include intrusive memories or flashbacks of the traumatic event, avoidance of situations or triggers that remind the person of the trauma, negative changes in mood or thoughts, and hyperarousal or increased anxiety.

Treatment for trauma and PTSD typically involves psychotherapy, medication, or a combination of both.

Following an acute trauma and for weeks after that clients may not be ready for therapy beyond discussion designed to meet the client’s readiness to explore the event.  And for some trauma survivors this may remain the treatment of choice.

Others who have clear remaining memories  may benefit from a more particular and structured psychotherapy approach.

Prolonged Exposure Therapy (PE) is an example of this sort of therapy.  It was developed by Dr. Edna Foa, from the University of Pennsylvania , following years of work and research.  Dr. Foa is the Director of the Center for the Treatment and Study of Anxiety.

PE is a highly structured program which  focuses on helping individuals confront and process traumatic memories and reduce symptoms associated with PTSD.

Over the years it has been researched and lauded for its success in this effort.  It is a treatment used widely by the Department of Veteran’s Services.

The organization and process of PE is highly structured, with about eight sessions, 60 to 90 minutes long.  However the program can be structured to match the needs of the client. Each session is recorded by the client, and listening at home to the session becomes  a very important of the process.

The process of various homework activities is an important commitment by the client.

The first sessions involve overview as to how the program is organized and how it works.  The therapist will also seek to learn about the clients history of trauma and how the person has coped thus far.

The process of exposure therapy generally begins in the second or third session, but can vary according to need.

There are two exposure therapies used for the sessions. These are in vivo exposure therapy and imaginal exposure therapy.

In vivo therapy refers to specific stimuli that a trauma survivor is uncomfortable with due to direct or indirect memory of the trauma. The therapist and client will work together to develop one or more steps for the client to accomplish toward overcoming these fears. This activity is part of the client’s homework.

Imaginal exposure refers to the clients recounting of the trauma in sequential sessions, with help and feedback from the therapist. The therapist takes great care to attend to a client’s comfort.

Sessions are recorded for the client to work with as homework.

Several important and empowering changes occur through this process.

1. Reliving the memory in this safe space helps to process the traumatic experience.
2. The client learns that thinking and talking about the trauma is not dangerous,  no matter if they feel anxious or frightened during the session, or at other times.
3. The client will  become less fearful of other situations outside of the session that remind them of the trauma. ( This also is a benefit of invo therapy).
4. The client learns that they can handle fear and anxiety, which is greatly empowering. (also a benefit of in vivo therapy).
5. The client learns that repeatedly confronting memories or situations previously avoided allows fear and distress to diminish on their own.

Staying with a frightening, but structured situation ( both in imaginal and in vivo sessions) for a set length of time allows anxiety and fear to subside on its own.

Throughout the process of the prolonged exposure sessions the client and therapist will discuss the work and issues that arise.  The understanding of the events and insights made are extremely important and empowering.

The above events and insights can continue in therapy sessions as needed after the prolonged exposure is completed.