science

Prolonged exposure therapy

Prolonged exposure therapy is a science topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Prolonged exposure therapy rather than just read about it. In short: Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures.

Key takeaways

Prolonged exposure therapy belongs to science; place it in that map before memorising details.
Learn the definition first, then one example that makes the definition concrete.
Connect Prolonged exposure therapy to a quantity you can measure, compute or draw — that is where exam questions come from.
Reproduce the core statement of Prolonged exposure therapy from memory before moving on to harder problems.

Reference excerpt

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. 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 the Center for the Treatment and Study of Anxiety at the University of Pennsylvania. Prolonged exposure therapy (PE) is a theoretically based, and is posited to be, a 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. However, little social commentary is available on the effects of repeatedly exposing trauma victims to trauma instead of changing the circumstances which led to the victims' trauma in the first place. 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 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 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 eight 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 (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 (EMDR) treatment. 6 month follow ups revealed that PE had also lessened psychotic and schizophrenic issues. Furthermore, the symptoms of 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.

See also Post-traumatic stress disorder Exposure therapy Behavior therapy Cognitive behavioral therapy Edna B. Foa Barbara Rothbaum

References

Worked examples

Example 1 — a first encounter with Prolonged exposure therapy

Start with the simplest possible case. Write down what Prolonged exposure therapy claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In science, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Prolonged exposure therapy before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Prolonged exposure therapy ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Prolonged exposure therapy

In research: Prolonged exposure therapy appears in science research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Prolonged exposure therapy in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Prolonged exposure therapy is common in secondary-school and first-year university syllabi. It links to neighbouring topics Behavior therapy, Behaviorism, Cognitive behavioral therapy, so understanding it makes those chapters shorter.
In everyday life: Look for Prolonged exposure therapy outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Prolonged exposure therapy in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Prolonged exposure therapy means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
Explain Prolonged exposure therapy out loud to somebody else — or to Teacher Smith in the lgStudy chat.

Frequently asked questions

What is Prolonged exposure therapy in simple terms?

Why does Prolonged exposure therapy matter?

Because it connects several science ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Prolonged exposure therapy?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Prolonged exposure therapy.