Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder, characterized by re-experiencing the traumatic event through remembering it and engaging with, rather than avoiding, reminders of the trauma (triggers). Sometimes, this technique is referred to as flooding.
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Description
Prolonged exposure therapy (PE) is a theoretically-based and highly efficacious treatment for chronic post-traumatic stress disorder (PTSD) and related depression, anxiety, and anger. Based on basic behavioral principles, it is empirically validated, with more than 20 years of research supporting its use. 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 about 80% of patients with chronic PTSD. The PE therapy was found to be superior to supportive therapy in sexually abused women with PTSD in a randomized controlled trial.
Prolonged exposure therapy was developed by Edna B Foa, PhD, Director of the Center for the Treatment and Study of Anxiety. Practitioners throughout the United States and many other countries currently use prolonged exposure to successfully treat survivors of varied traumas including rape, assault, child abuse, combat, motor vehicle accidents and disasters. Prolonged exposure has been beneficial for those suffering from co-occurring PTSD and substance abuse when combined with substance abuse treatment.
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 addition to reducing symptoms of PTSD, prolonged exposure instills confidence and a sense of mastery, improves various aspects of daily functioning, increases client's ability to cope with courage rather than fearfulness when facing stress, and improves their ability to discriminate safe and unsafe situations.
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.
Components
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:
- Imaginal exposure, revisiting the traumatic memory, repeated recounting it aloud, and processing the revisiting experience, and
- In vivo exposure, the repeated confrontation with situations and objects that cause distress but are not inherently dangerous.
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.
The imaginal exposure typically occurs during the therapy session and consists of retelling the trauma to the therapist. For the in vivo exposure, the clinician works with the client to establish a fear and avoidance hierarchy and typically assigns exposures to these list items as homework progressively. Both components work by facilitating emotional processing so that the problematic traumatic memories and avoidances habituate (desensitize).