Prolonged exposure therapy

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous (despite being objectively safe). Additional procedures include processing of the trauma memory and breathing retraining.

Prolonged exposure therapy was developed by Edna B Foa, Director of the Center for the Treatment and Study of Anxiety at the University of Pennsylvania. Prolonged exposure therapy (PE) is a theoretically based, and is posited to be, a highly effective treatment for chronic post-traumatic stress disorder (PTSD) and related depression, anxiety, and anger. PE falls under the category of "exposure-based therapy" and is supported by scientific studies which reflect its positive impact on patient symptoms.

Exposure-based therapies focus on confronting the harmless cues/triggers of trauma/stress in order to unpair them from the feelings of anxiety and stress. Prolonged exposure is a flexible therapy that can be modified to fit the needs of individual clients. It is specifically designed to help clients psychologically process traumatic events and reduce trauma-induced psychological disturbances. Prolonged exposure produces clinically significant improvement in 40–75% of patients with chronic PTSD, with the only reliable predictor of treatment outcomes being pre-treatment chronic PTSD symptom severity.

Prolonged exposure is rooted in the theory of emotional processing, in which new, accurate information challenges previously learned fear structures and modifies them in such a way that the new, accurate information is more readily retrieved. With PTSD, it is thought that traumatic events cause inaccurate associations to develop, between stimuli and responses from the event. These inaccurate associations lead to avoidance of trauma-related stimuli, which acts as a barrier to emotional processing. However, little social commentary is available on the effects of repeatedly exposing trauma victims to trauma instead of changing the circumstances which led to the victims' trauma in the first place.

Over years of testing and development, prolonged exposure has evolved into an adaptable program of intervention to address the needs of varied trauma survivors.

In 2001, Prolonged Exposure for PTSD received an Exemplary Substance Abuse Prevention Program Award from the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA). Prolonged exposure was selected by SAMHSA and the Center for Substance Abuse Prevention as a Model Program for national dissemination.

PTSD is characterized by the re-experiencing of the traumatic event through intrusive and upsetting memories, nightmares, flashbacks, and strong emotional and physiological reactions triggered by reminders of the trauma. Most individuals with PTSD try to ward off the intrusive symptoms and avoid the trauma-reminders, even when those reminders are not inherently dangerous. To address the traumatic memories and triggers that are reminders of the trauma, the core components of exposure programs for the disorder are:

The goal of this treatment is to promote processing of the trauma memory and to reduce distress and avoidance evoked by the trauma reminders. Additionally, individuals with emotional numbing and depression are encouraged to engage in enjoyable activities, even if these activities do not cause fear or anxiety but have dropped out the person's life due to loss of interest.