Prolonged Exposure Therapy: Could This Treatment Help You Cope With Trauma?
Key takeaways:
Prolonged exposure therapy (PE) may be a good treatment option for people with PTSD (post-traumatic stress disorder).
PE helps people decrease their anxiety by slowly helping them confront their trauma memories in a safe and therapeutic environment.
PE can take 12 weeks (or longer) to help you feel better, depending on your symptoms and how often you see your therapist.
There are many different therapy options to help you cope with mental health conditions or heal past hurts. The key is finding one that fits you and your needs.
If you are struggling with PTSD (post-traumatic stress disorder), one option you may want to look into is prolonged exposure therapy (PE). This therapy was developed by psychologist Edna Foa and is research-backed to treat PTSD.
What conditions can prolonged exposure therapy be used for?
Prolonged exposure therapy (PE) is used to treat PTSD. PE has been proven helpful for people who have experienced specific trauma events or events that occurred within a limited time frame. For example, PE is often used to treat veterans who have experienced combat trauma.
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Other types of trauma PE has been shown to treat effectively include:
Rape or sexual assault
Car accidents
Natural disasters
There is not as much research to support that PE is as helpful for people with complex trauma (trauma that has happened repeatedly over a long time period).
PE can also limit symptoms of depression and anxiety related to PTSD. What’s more, it can help those in treatment for both PTSD and a substance use disorder when used with substance use treatment.
How does prolonged exposure therapy work?
PE works by addressing one important trauma-related response: avoidance.
When people experience fear, it is natural to want to run from the thing causing it. Often when people struggle with PTSD, they avoid certain people, places, or things. In the moment, this helps lower anxiety. But avoiding fears or reminders of painful past experiences can actually make anxiety worse over time.
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The main goal of PE is to address this avoidance. One of the first tasks of PE is to make a list with your therapist. This list will contain all the things you are avoiding out of fear. Then, you and your therapist will start working on addressing each item on the list using PE.
Typically, you and your therapist will start with the item on the list that scares you the least. Then slowly, you will work up to more and more challenging items. The list will help you practice exposure to trauma reminders that you avoid in your life.
Reminders are different for everyone, but they are usually:
Sounds
Sights
Smells
Sensations in your body
During PE, you will practice exposure using real-life, visualization, or virtual reality to go over memories of the traumatic experience or reminders you fear with your therapist. Your therapist is there to help track your anxiety levels and make sure therapy moves at an appropriate pace.
Going over your traumatic experience is helpful because it allows you to “confront these reminders and stay in them long enough to help you and your brain realize that the situation is not as threatening as your body is responding,” explains Barbara Olasov Rothbaum, a psychologist and director of the Emory University’s Trauma and Anxiety Recovery Program.
Typically, PE involves homework. This can be practicing breathing techniques to help you stay calm if you are struggling with anxiety in between sessions. Or it could be listening to recordings of yourself in therapy talking through your traumatic experience. It could also involve practicing exposures on your own at home.
Over time, repeated exposure helps to lower your PTSD symptoms. And by facing your fears in a safe environment, you may eventually be able to lessen them. PE can also help you:
Process the emotions from a traumatic experience
Weaken the connection between fears and bad outcomes
Realize that you can face your fears
Learn how to manage the anxiety around your fears
What should you expect from your first experience with exposure therapy?
When you start PE, you won’t jump right into exposures for your first session. The main goal of the first session is to set you up for success for the rest of the PE process. This includes helping your therapist understand your specific needs and giving you coping tools for in between sessions.
During your first PE session, your therapist will:
Go over what you should expect throughout the rest of the PE process: Your therapist will likely explain how the treatment process works, outline what will be expected of you, set goals for treatment, and answer any questions you may have.
Gather detailed background information on your mental health and trauma history: To design an effective treatment plan, your therapist needs to know more about your symptoms. Based on this information, you and your therapist will figure out what traumatic memories to target using PE.
Teach you breathing retraining: During breathing retraining, you will learn breathing techniques to help you learn to slow down and space out your breaths. Breathing fast sends an alert to your brain that you might be in danger. Learning to properly slow down your breathing helps send signals to your brain that you are safe.
How long does it take for prolonged exposure therapy to work?
PE can last anywhere from 2 to 12 weeks, depending on your symptoms and how you get treatment. Some people may need treatment for longer than 12 weeks. The total length of treatment depends on your treatment program and your specific needs.
In an intensive program where you participate in therapy every day for several hours, you may only need 2 weeks of therapy. If you’re seeing an individual therapist for just 1 hour each week, it can take longer to complete PE. Most people attending weekly PE therapy need 8 to 15 sessions.
Dr. Rothbaum recommends that people try to schedule at least two PE sessions per week if possible. This helps you get enough support while you’re in treatment, since it can be scary and uncomfortable at times. And those feelings may increase the farther apart sessions are.
When is prolonged exposure therapy not recommended?
Though it can be very effective for PTSD, prolonged exposure therapy may not be for everybody.
Research suggests PE may not be the best treatment option if you have PTSD along with another mental health condition or complication such as:
Borderline personality disorder (BPD)
Severe depression
Complex PTSD or severe PTSD
Dissociation
PE is also an intense type of therapy. You’ll be asked to confront painful memories and major fears. Because of this, about 30% of people who try the therapy don’t finish. If you’re concerned about trying PE, ask to talk with your therapist in-depth about the pros and cons before starting treatment.
How do you get started with prolonged exposure therapy?
To get started with prolonged exposure therapy (PE), you will need to find a therapist who offers this treatment. You can start your search online.
The following organizations offer a directory to search for therapists trained in PE:
Emory University School of Medicine provides a list of licensed PE therapists across the U.S.
Penn Psychiatry also has a list of trained PE providers you can search for providers near you.
Some other sites that can help you find a therapist near you are:
Open Path Psychotherapy Collective (lower cost therapists)
If you have health insurance, you may be able to find a PE therapist using your health insurance provider directory. If you are unsure how to do this, call the customer support number on the back of your insurance card. They should be able to direct you.
Due to changes and advancements in the last few years, you may be able to take part in PE online via teletherapy. So if you cannot find a PE therapist near you, you may still be able to see one online if they’re licensed in your state.
The bottom line
Prolonged exposure therapy (PE) is an evidence-based treatment for people with PTSD who experienced a time-limited traumatic event or series of events. It can be scary to think about facing your fears head-on. But avoiding fears can actually make life more difficult. Your PE therapist will be there to support you while you tackle your fears in a safe space. If you are tired of avoiding parts of life to manage fears or cope with past traumas, PE may be an option worth looking into.
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References
American Psychological Association. (2017). Prolonged exposure.
Eftekhari, A., et al. (2013). Effectiveness of national implementation of prolonged exposure therapy in veterans affairs care. JAMA Psychiatry.
Emory Healthcare. (n.d.). Transform your life at Emory Healthcare veterans program.
Emory University. (n.d.). Barbara Olasov Rothbaum, PhD.
Emory University. (n.d.). Nationwide directory of PE providers trained by Emory University PE consultant training program.
Foa, E. B. (2011). Prolonged exposure therapy: Past, present and future. Depression & Anxiety.
GoodTherapy. (n.d.). Find the right telehealth therapist.
Najavits, L. M. (2015). The problem of dropout from “gold standard” PTSD therapies. F1000Prime Reports.
OpenPath. (n.d.). Find your therapist.
Perelman School of Medicine. (n.d.). Center for the treatment and study of anxiety.
Psychology Today. (n.d.). Find a therapist.
Rothbaum, B. (2020). Breathing retraining in PTSD: A practical exercise. Psychotherapy Academy.
Rothbaum, B. (2020). PE therapy sessions: Structure and main components. Psychotherapy Academy.
Society of Clinical Psychology. (n.d.). Diagnosis: Posttraumatic stress disorder.
Therapy Den. (n.d.). Find the right therapist for you.
U.S. Department of Veterans Affairs. (n.d.). Prolonged exposure (PE) for PTSD.
van Minnen, A., et al. (2012). Examining potential contraindications for prolonged exposure therapy for PTSD. European Journal of Psychotraumatology.
Varker, T., et al. (2021). Dropout from guideline-recommended psychological treatments for posttraumatic stress disorder: A systematic review and meta-analysis. Journal of Affective Disorders Reports.
Wenrui, D., et al. (2019). The efficacy of virtual reality exposure therapy for PTSD symptoms: A systematic review and meta-analysis. Journal of Affective Disorders.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
