PTSD and Prolonged Exposure Therapy

Understanding PTSD and Prolonged Exposure Therapy

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that can develop after experiencing or witnessing a traumatic event, learning that a close or important person was involved in a traumatic event, or after repeated exposure to details about traumatic events.  Traumatic events can include natural disasters, serious accidents, and personal assaults, including sexual assault. Individuals with PTSD experience a range of symptoms that have effects on their physical body, their cognitions, their emotions, their mood, their behavior, their ability to feel connected to others, their feelings about themselves and their ability to focus.

Symptoms of PTSD

PTSD symptoms are generally categorized into four types:

  1. Re-experiencing symptoms include intrusive memories, flashbacks, or nightmares. 

  2. Avoidance symptoms involve avoiding places, activities, or people that serve as reminders of the traumatic event and avoiding thinking, talking about, or experiencing emotions related to the traumatic event. 

  3. Negative changes in thinking and mood can manifest as negative thoughts about oneself or others, hopelessness about the future, memory problems, and difficulty maintaining close relationships.

  4. Changes in physical and emotional reactions may include being easily startled, always being on guard for danger, self-destructive behavior, risk-taking behavior, trouble sleeping, trouble concentrating, irritability, or angry outbursts.

Prolonged Exposure (PE) Therapy

Prolonged Exposure (PE) is a specific type of trauma-focused Cognitive Behavioral Therapy (CBT) that has proven highly effective in treating PTSD. This therapy helps individuals gradually approach trauma-related memories, feelings, and situations that they have been avoiding since the traumatic event. By confronting the memories, emotions, and situations a person has been avoiding, PTSD symptoms may begin to decrease, and new understandings may begin to take shape as a person processes their experience in a complete way.  Often this results in individuals feeling more in control of their lives, having more space for pleasant emotions, and feeling more connected to others.

How Prolonged Exposure Therapy Works

PE therapy involves several key components: 

  • Psychoeducation is the first step, where individuals learn about PTSD, how PE can help, and breathing techniques to assist with managing anxiety.  PE involves two types of exposure: In vivo and Imaginal.  

  • In vivo exposure (meaning in life exposure) allows a person to gradually confront safe situations related to the trauma that they have been avoiding in addition to gradually resuming activities they enjoyed prior to the trauma but have stopped engaging in. 

  • Imaginal exposure involves repeatedly recounting the traumatic event in a safe environment to process the associated emotions. 

  • PE includes homework assignments each week that encourage practice with exposures between sessions, helping to solidify the work that a person engages in during the session.  

Steps in Prolonged Exposure Therapy

The initial sessions involve the therapist providing an overview of the treatment and gathering information about the individual’s experiences. The therapist also teaches breathing techniques to help manage anxiety. Together, the therapist and the individual create a hierarchy of avoided situations, ranked by the level of discomfort they cause. The individual then gradually confronts these situations, starting with the least uncomfortable and working up to the most uncomfortable. During imaginal exposure, the individual recounts the traumatic event in detail during therapy sessions.  The therapist and individual take time to process the individual’s experience following the imaginal exposure.  The sessions are recorded for the individual to listen to between sessions.

Effectiveness of Prolonged Exposure Therapy

Research has shown that PE is one of the most effective treatments for PTSD. Most individuals who complete 8-15 weekly sessions of PE show a significant reduction in PTSD symptoms. This therapy helps individuals learn that trauma-related memories and cues are not dangerous and do not need to be avoided.  PE also helps individuals to form more helpful thoughts, ideas, and understandings about their traumatic experience, all of which lead to a decrease in PTSD symptoms and an improvement in overall quality of life.  


Conclusion

Understanding PTSD and the available treatments, such as Prolonged Exposure Therapy, is crucial for those affected by this condition. PE offers a structured and effective approach to help individuals confront and process their trauma, leading to significant improvements in their symptoms and overall well-being. If someone is struggling with PTSD, seeking professional help and exploring treatments like PE can be a vital step towards recovery.