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WHAT IS PROLONGED EXPOSURE THERAPY?

Prolonged exposure therapy (PE) is one type of cognitive-behavioral therapy (CBT).

1. CBT is a family of therapies that includes exposure therapy, cognitive restructuring, and anxiety management techniques.
2. PE is a specific program of exposure therapy.
3. The premise of CBT is that thoughts and feelings influence behavior; as such, changes in one's beliefs can influence one's behavior, and vice versa.

PE is an effective treatment for PTSD because its components emulate and jump-start the natural recovery process.

1. There are three core components of PE treatment:
   1. Imaginal exposure, in which the patient retells the trauma memory many times, in gradually-increasing detail.
   2. In vivo exposure, in which the patient approaches objectively safe trauma reminders in real life.
   3. Processing, in which the therapist and patient explore the thoughts and feelings that the trauma memory evokes, with the goal of correcting unhelpful thoughts and bringing the patient to new awareness about the trauma and about him- or herself.
2. These components help break the cycle of avoidance.
   1. They encourage patients to gradually approach things they have been avoiding.
   2. Repeated activation of patients' fear structures in a safe environment allows patients to incorporate new information into their fear structures, so they can challenge inaccurate beliefs and uproot maladaptive fear responses.
   3. Approaching trauma reminders will make patients' overall anxiety worse at first; however, through continued exposure, patients' anxiety will gradually decrease until they no longer feel the need to avoid. This is called habituation.
3. These techniques promote new learning, which can have a powerful effect on PTSD symptoms. Specifically, these techniques teach patients that:
   1. There is a difference between remembering the trauma and experiencing it.
   2. Their memories cannot hurt them.
   3. Trauma reminders are not, themselves, dangerous.
   4. They can tolerate and manage the anxiety caused by the trauma memory.
4. PE also helps patients challenge and correct negative beliefs resulting from the trauma, such as "I am completely incompetent" or "the world is extremely dangerous."

Efficacy: does PE work?

1. Several decades of research show that the answer is "yes, definitely."
2. In a 2010 meta-analytic journal article that analyzed over 675 cases of PE treatment, it was found that PE was an improvement over waitlist conditions in 86% of patients. Improvement in symptoms was substantial and sustained over time.
3. In a 2008 IOM report on treatments for PTSD, PE was the only psychotherapy conclusively supported by data.
4. The International Society for Traumatic Stress Studies and the Veterans Affairs / Department of Defense recommend PE as a first-line treatment for PTSD.
5. At this point, the efficacy of PE for treating PTSD is no longer in question.