Prolonged Exposure Therapy
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Prolonged exposure therapy (PE) is a form of
behavior therapy Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or oth ...
and
cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
designed to treat
post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on ...
. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous (despite being objectively safe). Additional procedures include processing of the trauma memory and breathing retraining.


Overview

Prolonged exposure therapy was developed by Edna B Foa, Director of th
Center for the Treatment and Study of Anxiety
at the University of Pennsylvania. Prolonged exposure therapy (PE) is a theoretically based and highly effective treatment for chronic post-traumatic stress disorder (PTSD) and related depression, anxiety, and anger. PE falls under the category of "exposure-based therapy" and is supported by scientific studies which reflect its positive impact on patient symptoms. Exposure-based therapies focus on confronting the harmless cues/triggers of trauma/stress in order to unpair them from the feelings of anxiety and stress. Prolonged exposure is a flexible therapy that can be modified to fit the needs of individual clients. It is specifically designed to help clients psychologically process traumatic events and reduce trauma-induced psychological disturbances. Prolonged exposure produces clinically significant improvement in 40-75% of patients with chronic PTSD, with the only reliable predictor of treatment outcomes being pre-treatment chronic PTSD symptom severity. Prolonged exposure is rooted in the theory of emotional processing, in which new, accurate information challenges previously learned fear structures and modifies them in such a way that the new, accurate information is more readily retrieved. With PTSD, it is thought that traumatic events cause inaccurate associations to develop, between stimuli and responses from the event. These inaccurate associations lead to avoidance of trauma-related stimuli, which acts as a barrier to emotional processing. Over years of testing and development, prolonged exposure has evolved into an adaptable program of intervention to address the needs of varied trauma survivors. In addition to reducing symptoms of PTSD, prolonged exposure instills confidence and a sense of mastery, improves various aspects of daily functioning, increases the ability to cope with courage when facing stress, and improves the ability to discriminate safe and unsafe situations. In 2001, Prolonged Exposure for PTSD received an Exemplary Substance Abuse Prevention Program Award from the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA). Prolonged exposure was selected by SAMHSA and the Center for Substance Abuse Prevention as a Model Program for national dissemination.


Components

PTSD is characterized by the re-experiencing of the traumatic event through intrusive and upsetting memories, nightmares, flashbacks, and strong emotional and physiological reactions triggered by reminders of the trauma. Most individuals with PTSD try to ward off the intrusive symptoms and avoid the trauma-reminders, even when those reminders are not inherently dangerous. To address the traumatic memories and triggers that are reminders of the trauma, the core components of exposure programs for the disorder are: #Imaginal exposure, revisiting the traumatic memory, repeated recounting it aloud, and processing the revisiting experience #''In vivo'' exposure, the repeated confrontation with situations and objects that cause distress but are not inherently dangerous The goal of this treatment is to promote processing of the trauma memory and to reduce distress and avoidance evoked by the trauma reminders. Additionally, individuals with emotional numbing and depression are encouraged to engage in enjoyable activities, even if these activities do not cause fear or anxiety but have dropped out the person's life due to loss of interest. The imaginal exposure typically occurs during the therapy session and consists of retelling the trauma to the therapist. For the ''in vivo'' exposure, the clinician works with the client to establish a fear and avoidance hierarchy and typically assigns exposures to these list items as
homework Homework is a set of tasks assigned to students by their teachers to be completed outside the classroom. Common homework assignments may include required reading, a writing or typing project, Exercise (mathematics), mathematical exercises to b ...
progressively. The therapist may also record the session and ask the patient to continue to complete in vivo exercises on their own time with the help of the recording. Both components work by facilitating emotional processing so that the problematic traumatic memories and avoidances habituate (desensitize) and are better tolerated. Randomized control trials reflect that only 10–38% of PTSD patients who take part in PE therapy terminate treatment before their program is complete (generally after at least 8 sessions).


Studies

Practitioners throughout the United States and many other countries currently use prolonged exposure to successfully treat survivors of varied traumas including rape, assault, child abuse, combat, motor vehicle accidents, and disasters. Prolonged exposure has been beneficial for those with co-occurring PTSD and substance abuse when combined with substance abuse treatment. Studies have also reflected that prolonged exposure therapy aids patients who have both PTSD and borderline personality disorder when the treatment is coupled with dialectical behavior therapy. Some were concerned that PE would negatively affect the treatment of patients with
substance abuse disorder Substance use disorder (SUD) is the persistent use of drugs (including alcohol) despite substantial harm and adverse consequences as a result of their use. Substance use disorders are characterized by an array of mental/emotional, physical, and b ...
(SUD) as purposefully and intentionally exposing them to their reminders and triggers may worsen their state; however, randomized control trial studies exist which indicate that there are no negative effects of using PE for patients with SUD. Conducted studies have reflected positively on the effectiveness of PE. For example, in the Netherlands, patients responded better to PE than to
eye movement desensitization and reprocessing Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy developed by Francine Shapiro in the 1980s that was originally designed to alleviate the distress associated with traumatic memories such as post-traumatic stress d ...
(EMDR) treatment. 6 month follow ups revealed that PE had also lessened psychotic and schizophrenic issues. Furthermore, the symptoms of in a small group of female methadone users in Israel had decreased after PE treatment. PE therapy was also found to be superior to supportive therapy in female veterans with PTSD in a
randomized controlled trial A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment used to control factors not under direct experimental control. Examples of RCTs are clinical trials that compare the effects of drugs, surgical te ...
.


See also

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Post-traumatic stress disorder Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that can develop because of exposure to a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on ...
*
Exposure therapy Exposure therapy is a technique in behavior therapy to treat anxiety disorders. Exposure therapy involves exposing the target patient to the anxiety source or its context without the intention to cause any danger (desensitization). Doing so is thou ...
*
Behavior therapy Behaviour therapy or behavioural psychotherapy is a broad term referring to clinical psychotherapy that uses techniques derived from behaviourism and/or cognitive psychology. It looks at specific, learned behaviours and how the environment, or oth ...
*
Cognitive behavioral therapy Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
*
Edna B. Foa Edna Foa (born 1937, Haifa) is an Israeli professor of clinical psychology at the University of Pennsylvania, where she serves as the director of the Center for the Treatment and Study of Anxiety. Foa is an internationally renowned authority in t ...
*
Barbara Rothbaum Barbara Rothbaum is a psychologist at Emory University School of Medicine in Atlanta, Georgia. She is a professor in the Psychiatry department and a pioneer in the treatment of anxiety-related disorders. Rothbaum is head of the Trauma and Anxie ...


References


Further reading

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External links


Center for the Treatment and Study of Anxiety, University of Pennsylvania
Edna B. Foa, PhD, Director.
Private Prolonged Exposure Therapy in London
* ttp://cogbtherapy.com/los-angeles-ptsd-treatment-1 Information about PTSD and Prolonged Exposure Therapy {{Cognitive behavioral therapy Cognitive behavioral therapy Behavior therapy Behaviorism Psychotherapies