Who Benefits from Prolonged Exposure Therapy?

Prolonged exposure therapy is an intervention technique often used in cognitive behavioral therapy (CBT) and to treat people with posttraumatic stress disorder (PTSD). It teaches people to gradually approach their fears or traumatic memories rather than avoiding them. Prolonged exposure therapy is based on the concept that avoiding trauma only reinforces the anxiety and distress surrounding it. Pioneers of this approach believe that by facing what they are fearful of, people will slowly learn that memories and emotions are not dangerous and do not need to be avoided.

What Is Prolonged Exposure Therapy?

Prolonged exposure therapy typically involves repeated exposure to trauma-related memories and situations. It is often used to treat war veterans, trauma survivors and other sufferers of PTSD. It has also been effective in treating some anxiety disorders.

Trauma and anxiety can severely impact a person's life. In most cases, it leads to avoidance of triggering situations and a reluctance to engage with life. This is what therapists call "learned avoidance," and it is a perfectly valid safety-seeking response to trauma. Instead of protecting the person against further trauma or preventing memories from resurfacing, this kind of avoidance can become extreme and have the opposite effect. Over time, avoidance can lead to social isolation, as well as difficulties in the home, at work and in relationships. Avoidance can also prolong or even intensify PTSD symptoms.

The goal of prolonged exposure therapy is to gradually allow the person to meet the traumatic thought, emotion or situation so that they have the opportunity to realize that it is not as threatening as it seems. Accepting the thought, memory or situation also helps the person to process the experience and begin to recover.

Prolonged Exposure Therapy Methods

In vivo exposure: this is what most people think of when we talk about prolonged exposure therapy. In vivo exposure is the direct confrontation of a feared situation, object or activity under the guidance of a therapist.

Imaginal exposure: refers to the process of imagining feared images, memories or situations. This is often used when it is not possible or considered unsafe for a person to directly confront a feared situation – for example, with veterans.

Interoceptive exposure: designed initially to treat panic disorder, this method can help people approach bodily symptoms associated with anxiety and PTSD with the assistance of a therapist.

Prolonged exposure: the term prolonged exposure therapy refers to a combination of all of the above methods. It consists of learning how to control physical symptoms, finding coping mechanisms to exist in the real world and talking about trauma.

What Are the Problems with Prolonged Exposure Therapy?

Dealing with trauma can be exceptionally difficult. And while prolonged exposure therapy has received empirical support as a treatment for PTSD, that doesn't mean it is right for everyone. If you're not ready to process or accept your trauma, then you may find this kind of therapy too challenging.

A 2012 study published by the U.S. National Library of Medicine also found that PTSD has high rates of comorbidity. Comorbidity is the existence of one or more conditions in the same person, such as major depressive disorder, schizophrenia or borderline personality disorder. While comorbidity doesn't necessarily pose a problem for prolonged exposure therapy, it is suggested that for those with severe comorbidity (such as dissociation, psychosis or suicidal behavior), prolonged exposure therapy should be treated with other therapeutic approaches to ensure all areas of ill mental health are monitored and addressed.

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