Prolonged Exposure (PE) Therapy

What is PE (Prolonged Exposure)?

PE is a type of evidence based therapy used for people who have experienced trauma. In PE, the client will gradually approach trauma-related memories and situations that they have been avoiding. PE involves talking about the traumatic incident and approaching things in life that the client has been avoiding because they remind them of the trauma. By approaching these memories and situations, the client’s intense feelings related to the trauma will decrease as will their PTSD symptoms.

What happens during PE?

People who have experienced trauma often try to avoid thinking about the trauma and avoid anything that could trigger memories of the trauma. In the short term, this is not a bad strategy, but in the long term this could lead someone to lose a lot of parts of their life. For example, a client who experienced combat trauma in the military might avoid anything that reminds them of the military to prevent them from thinking about the trauma. This could lead them to cut out friends from that time period and to avoid memories of positive military experiences. It could also lead them to avoid crowded places, like malls, movie theaters, and shopping centers as they don’t feel safe. Over time, the small pieces of avoidance can build up until someone starts to only feel comfortable alone at home.
The central theme of PE is to reduce avoidance, both of the traumatic memory itself and of trauma reminders. At the beginning of PE, the client will learn a breathing technique that can be used to help manage anxiety. Then the client and therapist will work together to make a list of people, places, or activities that the client has been avoiding since the trauma. The client will then work to re-engage with these activities that they have been avoiding, slowly working through this list. With time, the client will start to feel comfortable in these situations again and start to regain important aspects of their life. For example, someone who was involved in a car accident by a shopping mall might avoid going to malls because being around a shopping mall brings up memories of this accident. A re-engagement activity for this person could be to go to sit in a parking lot at the mall. Another key component of PE is having the client talk about their trauma during the therapy sessions. The client will talk about the trauma during each PE session, after the introductory sessions, and these sessions will be recorded for the client to listen to as a part of homework. Talking about the trauma allows the intense emotions, like fear, anger and sadness, to decrease.

How long does treatment last?

PE typically consists of 9-15 sessions.

Is homework a part of PE?

Yes, homework is an essential component of PE. The client will practice doing some of the things that they have avoided since their trauma. The client will also listen to a recording of their therapy sessions. The homework assignments will typically take about 30-45 minutes per day.
PE (Prolonged Exposure) Online Resources

National Center for PTSD
Provides an explanation of PE and short videos about this treatment option.

American Psychological Association
Provides a more detailed explanation of PE and a case study of a patient’s experience with PE treatment.

About Face
Provides a more in-depth video of one patient’s experience with PTSD and his PE treatment.