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  1. Prolonged Exposure Therapy

Prolonged Exposure Therapy

Program Goals

Prolonged Exposure (PE) Therapy is a cognitive–behavioral treatment program to reduce the symptoms of posttraumatic stress disorder (PTSD), depression, anger, guilt, and general anxiety. PE Therapy reduces PTSD symptoms such as intrusive thoughts, intense emotional distress, nightmares and flashbacks, avoidance, emotional numbing and loss of interest, sleep disturbance, concentration impairment, irritability and anger, hypervigilance, and excessive startle response.



Target Population

PE Therapy is targeted at individuals suffering from PTSD or sub-diagnosis of PTSD, such as victims of crime or traffic accidents, adults exposed to violence as children, and veterans.



Program Components

The program consists of a course of individual therapy designed to help clients process traumatic events and thus reduce trauma-induced psychological disturbances. PE Therapy has four components:

  • Imaginal exposure—repeated recounting of the traumatic memory (revisiting of the traumatic memories)
  • In-vivo exposure—gradually approaching trauma reminders (e.g., situations, objects) that, despite posing no harm, cause distress and are avoided
  • Psychoeducation about common reactions to trauma and the cause of chronic posttrauma difficulties
  • Breathing retraining for the management of anxiety

It can be used in a variety of clinical settings, including community mental health outpatient clinics, veterans’ centers, military clinics, rape counseling centers, private practice offices, and inpatient units. Treatment is individual. Standard treatment consists of 8 to 15 once- or twice-weekly sessions, each lasting 70 to 90 minutes:

  • Sessions 1 and 2 are aimed at psychoeducation and information gathering, presentation of the treatment rationale, discussion of common reaction to trauma, construction of a list of avoided situations for in-vivo exposure, and initiation of in-vivo homework. Clients are taught to reduce anxiety by slow, paced breathing.
  • Sessions 3 to 8 (or 11) include homework review, imaginal exposure (i.e., 30 to 45 minutes of repeated recounting of traumatic memories), processing of imaginal exposure experience, reviewing in-vivo exposure, and homework assignments.
  • The final session consists of imaginal exposure, review of progress and skills learned, and discussion of the client’s plans for maintaining gains.
  • The treatment course can be shortened or lengthened depending on the client’s needs and the rate of progress.

Key Personnel

Treatment is conducted by therapists trained to use the PE Manual, which specifies the agenda and treatment procedures for each session.

Intervention ID
152
Ages

15 to 70

Rating
Effective
Outcomes

Study 1

Posttraumatic Stress Disorder (PTSD) Severity and Depression

The results of the Foa and colleagues (1999) study showed that the Prolonged Exposure (PE) Therapy treatment was effective in significantly reducing the severity of PTSD and depression, when compared with the wait list (WL) group. Similar results were also found for the other two treatment conditions, and the results were maintained throughout the follow-up.


 

Anxiety

The intent-to-treat analysis revealed that PE Therapy provided significantly improved results in posttreatment anxiety and follow-up global social adjustment, more so than the other treatment conditions (with larger effect sizes). Overall, the PE Therapy-only treatment condition provided the best results for participants, with effects lasting throughout the follow-up period.


 

Study 2

PTSD Symptoms

The results of the Foa and colleagues (2005) study showed that the PE Therapy treatment significantly reduced the symptoms of PTSD compared to the WL group in both the intent-to-treat and the completer samples, and these results carried over to the follow-up periods.


 

Depression

PE Therapy also reduced depression compared with the WL group in the intent-to-treat and completer samples, with effects carried on through the follow-up.


 

Social Adjustment and Functioning

PE therapy also significantly improved social functioning in the completer sample, compared with the WL group, with effects lasting through the 12-month follow-up. The addition of Cognitive Restructuring to PE Therapy did not create any significantly different outcomes between the treatment groups.


 

Study 3

PTSD Severity

Resick and colleagues (2002) found that the PE Therapy treatment group and the Cognitive–Processing Therapy (CPT) group showed significant differences in the severity of PTSD, compared with the Minimal Attention (MA) control condition, and those gains were maintained throughout the follow-up periods.


 

Depression

There were also significant differences between the treatment groups and the MA control group on the severity of depression, which were also maintained through the follow-up.


 

Trauma-Related Guilt

Both treatment conditions showed significant improvement of trauma-related guilt measurements, when compared with the control group (although the CPT condition provided better results for two of the four indicators in the Trauma-Related Guilt Inventory).

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