Prolonged Exposure Therapy
Prolonged Exposure Therapy for Posttraumatic Stress Disorder
Traumatic events occur quite frequently. It is estimated that up to 60% of the US population is exposed to at least one traumatic event in their lifetime. However, not everyone who experiences a traumatic event develops Posttraumatic Stress Disorder (PTSD). We know that there are several common reactions to trauma. One of the biggest contributors to the development of PTSD is avoidance of trauma-related reminders, including situations and people that bring up memories related to what happened.
It is natural to want to avoid the discomfort and anxiety caused by facing a trauma reminder. Many people who have been traumatized try to avoid thoughts, feelings, situations, and activities that remind them of the trauma because facing them is too distressing. However, while the act of avoiding can make you feel more comfortable in the short run, it actually can make the problem worse in the long run, because it prevents you from overcoming your fears.
Actually, the more you avoid, the more difficult it is to face those situations in the future and the narrower your life becomes. For example, a person who experienced a traumatic car accident might find themselves not wanting to get in a car ever again. This might cause them to miss work, social functions, or important appointments, which leads to more isolation and more avoidance, causing even more disruption in daily life. This is why in Prolonged Exposure therapy, avoidance is gradually diminished in order to process the traumatic memories and allow new learning.
How does Prolonged Exposure Therapy work?
In Prolonged Exposure (PE), traumatic memories are faced in a gradual, safe way. PE applies the same therapeutic tools to treating trauma as Exposure Therapy does for phobias and anxiety disorders and Obsessive Compulsive Disorder. Extensive research has shown that using exposure as a therapeutic tool leads to greater success in therapy and better quality of life.
The process of using exposure in PE is two-fold. The first is imaginal exposure, in which you relive the trauma repeatedly in your mind and recount what happened aloud. The second part is in vivo exposure, in which you confront safe situations that you have become afraid of following your trauma.
When you confront your fears in a systematic way under relatively safe circumstances, you learn that you can manage your anxiety. You learn that when you repeatedly confront things you have avoided, the fear and distress gradually decrease. Over time, you notice yourself getting increasingly comfortable in situations that used to be very distressing.
We call this habituation. Habituation is the process by which anxiety comes down on its own, when you stick it out and stay in a frightening situation for a long enough time and you go back to that same situation often enough. You simply become less frightened of this situation. In a way, it’s similar to getting into a cold pool of water. When you first jump in, you notice yourself tensing up as the cool water surrounds you. However, the longer you stay in the pool, the more comfortable you get and before too long, the pool water seems quite pleasant.
Habituation works with frightening memories too. Letting yourself engage in the traumatic memories rather than avoiding them will allow you to remember the trauma with less distress. Exposure to the trauma memories, i.e., reliving the trauma in imagery, also allows you to gain control over them and they will be less likely to pop up at times you don’t want them to. Thus the flashbacks, the nightmares and intrusive thoughts that many trauma victims often experience are less likely to occur after you repeatedly relive the trauma, and when they do occur, they are less upsetting.
Frequently Asked Questions about Prolonged Exposure Therapy
What are the risks and benefits of Prolonged Exposure Therapy?
Thirty years of research has proven that PE is an effective treatment for PTSD. Research has also shown that PE is effective for various types of traumas. Not only does PE seem to reduce PTSD symptoms, but research has also shown that other trauma-related problems, such as depression, anxiety, anger, guilt, and self-injurious behaviors are reduced through the course of PE. Thus, PE is a way for an individual to reclaim their lives from PTSD and move towards a value-driven and purposeful life.
The main risks involved in PE are temporary discomfort and emotional distress that occurs when confronting trauma-related memories and situations. It is natural to feel anxiety, sadness, anger, and guilt during the treatment process. In fact, many people report that they seem to get worse before they start to get better. Your therapist is there to help monitor your emotional distress, so it never gets to an unmanageable level.
Who is a good candidate for PE?
Not every trauma survivor needs a trauma-focused treatment like PE. In fact, the mechanisms of natural recovery after a traumatic event work quite well and most people notice that PTSD symptoms tend to subside on their own in the following 3 months after a traumatic event. It is normal to experience trauma-related symptoms immediately after a traumatic event and they would not even be labeled as PTSD until if they persist for longer than one month. During the first month after trauma, is it very important to ensure that survivors have a safe and supportive environment where they can talk about what happened.
For those trauma-survivors that have trauma-related symptoms that persist for more than a month, PE can be an excellent treatment option. There are some instances, however, when PE would not be a good choice. If you’re experiencing suicidal, homicidal, or self-injurious behaviors currently or if you are in an environment that is dangerous, getting you to a safe place physically and mentally takes precedence. Also, if you are experiencing any psychotic symptoms, it is recommended that medication is used prior to starting PE to stabilize these symptoms.
How long does the treatment take?
Traditionally PE consists of 9-15 weekly or twice-weekly sessions that are 90-minutes long. It is possible to change the session time to 45 minutes as well, depending on therapist and client availability. Each client is unique, and the therapist will conduct on-going assessment to ensure that treatment is working and tweak the treatment protocol as needed.
Eeva Edds, MA LPC is a trauma-informed therapist who specializes in helping trauma survivors recover from their past and move forward towards a value-driven life. Eeva is trained in Prolonged Exposure Therapy (PET) and Eye Movement Desensitization and Reprocessing (EMDR) and utilizes both modalities with success to help her clients.
Read More About the Treatment of Trauma on our Blog!
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