Prolonged Exposure Therapy for PTSD and Trauma

PTSD can hijack the lives of those who suffer from it. Fortunately, there are trauma treatments that work. Prolonged exposure (PE) therapy is one of the best such established treatments.

Post-traumatic stress disorder, or PTSD, is a serious mental health condition that can happen following a traumatic event. These events can involve combat experiences, motor vehicle accidents, terrorist attacks, assaults, sexual assaults, and other experiences that typically involve harm or the threat of harm.

PTSD can dominate the lives of people who have it, either in obvious or subtle ways. Fortunately, there are several effective treatments. Most of them are specific types of psychotherapy. (These types of psychotherapy are generally more effective for PTSD than is medication.)

Perhaps the best known of these therapies is prolonged exposure (PE) therapy. PE therapy should be administered by a mental health professional who has been trained in PE. The therapy typically involves weekly therapy sessions for a period of several months.

What Does Prolonged Exposure Involve?

The first stage of prolonged exposure therapy is learning a bit about PTSD and how it works. The more you understand, the more effective the subsequent treatment is likely to be.

In Vivo Exposure

You and your PE therapist will work together to make a list of things that remind you of the traumatic event. Often these are everyday things that most people encounter regularly. Just about anything can qualify — for example, let’s say the trauma you survived was a near-drowning. Reminders for you might include things like a postcard with a picture of the beach, a bathing suit, or walking along the water. Once you and your PE therapist have constructed such a list, you will work together to do an exposure exercise in which you spend time in the physical presence of something related to your trauma. In the example above of someone who nearly drowned, this could mean spending time holding a brochure for the beach town where the traumatic event happened. Exposure exercises like this are difficult but they are specifically designed to be not too difficult. You and your therapist will be in ongoing conversation about which exercises you feel comfortable enough to try, and which ones feel overwhelming. You will not be asked to do anything that feels overwhelming.

Imaginal Exposure

Another part of the treatment is called imaginal exposure; this refers to doing exposure exercises around memories or situations you imagine. Unlike in vivo exposures, there is no concrete reminder present. Imaginal exposure exercises, when repeated, are effective at reducing the impact of the traumatic experience. Research shows that the more people expose themselves to situations, memories, emotions, and thoughts they have avoided, the more PTSD improves.

Does It Work?

Prolonged exposure therapy is highly effective. This conclusion stems from many scientific research studies conducted over the past three to four decades. PE therapy is effective in helping people overcome PTSD generally. It also helps in reducing related suicidal thinking, excessive guilt, anxiety, and depression. Studies have generally found that PE therapy produces symptom improvement in 80% to 90% of people who do it. Some of those people see partial improvement from the therapy, and some see a more complete response.

Prolonged exposure therapy also tends to help people achieve lasting recovery from PTSD. Gains are typically maintained for the long term, and for some people, the recovery is lifelong, even though the memories remain. One study showed that only 6% of people who had completed PE therapy had PTSD symptoms return years later; this is a remarkably strong result for any therapy or medication in mental health.

Does PTSD Go Away?

Many people suffer from PTSD for years. This can happen because people:

Prolonged exposure therapy is just one of several different effective treatments for PTSD — help is out there! And it works!

Pros and Cons of Prolonged Exposure Therapy

As mentioned above, prolonged exposure therapy is just one option for treating PTSD. There are pros and cons to choosing it.

Here are some of the pros:

It works. Scientific research clearly shows PE therapy to be an effective treatment for PTSD and trauma.
The benefits are long-lasting — research suggests that those who benefit from PE therapy are likely to maintain the improvement they make.
It involves no medication or injections (some other PTSD treatments do).
It’s time-limited — PE therapy typically lasts a few months (not years).

Some of the cons include:

As mentioned above, prolonged exposure therapy is just one option for treating PTSD. There are pros and cons to choosing it.

Here are some of the pros:

Where to Find a Prolonged Exposure Therapist

The Center for the Treatment and Study of Anxiety at the University of Pennsylvania maintains a list of PE therapists nationwide. You can visit it here.

Generally speaking, psychologists and social workers are the most likely to have received specific training in prolonged exposure therapy for PTSD. Are you trying to find a PE provider near you? If so, ask any potential therapist whether they’ve been trained in prolonged exposure therapy. Ask them also how many others they have treated using prolonged exposure therapy.

The clinical directory listed here from the Association for Behavioral and Cognitive Therapies is a good resource for finding therapists with good training in cognitive-behavioral therapy — PE therapy is a form of cognitive-behavioral therapy, so many of the listed providers will be experienced in PE therapy.

Please contact us

if we can help you in your efforts to find prolonged exposure therapy for PTSD or trauma here in New York. Our trauma therapists are doctoral-level psychologists, and we also have student therapists who offer reduced-fee services. Our offices are in midtown Manhattan, but we offer teletherapy services to people elsewhere in New York State, New Jersey, and Florida. If you’re looking for prolonged exposure therapy in another part of the country or world, please contact us — we are happy to help!