Prolonged Exposure for PTSD

National Center for PTSD, U.S. Department of Veterans Affairs
Prolonged Exposure for PTSD

Prolonged Exposure (PE) teaches you to gradually approach trauma-related memories, feelings, and situations that you have been avoiding since your trauma. By confronting these challenges, you can decrease your PTSD symptoms.

What type of treatment is this?

Prolonged Exposure (PE) is a psychotherapy for PTSD. It is one specific type of Cognitive Behavioral Therapy. PE teaches you to gradually approach trauma-related memories, feelings, and situations that you have been avoiding since your trauma. By confronting these challenges, you can actually decrease your PTSD symptoms.

How does it work?

People with PTSD often try to avoid anything that reminds them of the trauma. This can help you feel better in the moment, but not in the long term. Avoiding these feelings and situations actually keeps you from recovering from PTSD. PE works by helping you face your fears. By talking about the details of the trauma and by confronting safe situations that you have been avoiding, you can decrease your PTSD symptoms and regain more control of your life.

What can I expect?

Your provider will start by giving you an overview of treatment and getting to know more about your past experiences. You will also learn a breathing technique to help you manage anxiety.

Around your second session, you will work with your provider to make a list of people, places, or activities that you have stayed away from since your trauma. Over the course of therapy, you will work through your list step-by-step, practicing in vivo exposure. This means that you will gradually confront these situations. With time, you will find that you can feel comfortable in these situations--and you will not need to avoid them anymore.

After a few sessions, you will begin to talk through the details of your trauma with your provider. This is called imaginal exposure. Talking about the trauma can help with emotions like fear, anger, and sadness. You will listen to recordings of your imaginal exposure between sessions. By confronting the details of the trauma in therapy, you will find that you have fewer unwanted memories at other times.

Is it effective?

Yes, trauma-focused psychotherapy (including Prolonged Exposure) is one of the most effective types of treatment for PTSD.

How long does it last?

PE usually takes 8-15 weekly sessions, so treatment lasts about 3 months. Sessions are 1.5 hours each. You may start to feel better after a few sessions. And the benefits of PE often last long after your final session with your provider.

What are the risks?

The risks of doing PE are mild to moderate discomfort when engaging in new activities and when talking about trauma related memories. These feelings are usually brief and people tend to feel better as they keep doing PE. There is also a slight risk that someone could listen to a therapy session without your permission if the recording was not secure. You and your provider can discuss ways to secure your personal information related to this program. Most people who complete PE find that the benefits outweigh any initial discomfort.

Group or individual?

PE is an individual therapy. You will meet one-to-one with your provider for each session.

Will I talk in detail about my trauma?

Yes, around your third session, you will start talking in detail about your trauma. Your provider will guide you through it, keep track of your anxiety level as you talk, and will make sure you take things at your own pace. You will listen to a recording of this part of your session at home between sessions.

Will I have homework?

Yes, you will practice doing some of the things you have avoided since your trauma. You will start with activities that are manageable for you, and you will work up to activities that are more challenging. You will also listen to a recording of your therapy sessions, including your imaginal exposure recording. Practicing these skills between sessions helps you get the most out of PE.

How available is this in VA?

Moderate. Almost all VA Medical Centers offer PE in their specialized PTSD programs and more than 2,000 VA providers are trained in PE. Smaller VA facilities that do not offer PE may be able to use video-conferencing to have you receive PE from a provider at another location.

Does VA have an app for that?

Yes, PE Coach Coach is a mobile app that you can use while you are doing PE with a provider. PE Coach can help you to learn more about PE and PTSD symptoms and helps you stay organized as you complete PE. It a free download on most mobile devices. After your initial download, you will not be required to use your personal minutes or data. This app does not share any information with the VA, so it is up to you if you want to show your provider your information.

Choosing the best treatment for you

Trying to figure out which PTSD treatment is best for you? For more videos about Prolonged Exposure and other treatments that work, get started with the National Center for PTSD's PTSD Treatment Decision Aid.

Posted on BrainLine September 19, 2017. Reviewed December 18, 2018.

From the National Center for Posttraumatic Stress Disorder, US Department of Veterans Affairs.

Comments (1)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

I expected "How Long Does It Last" would give evidence for how long the healing from PTSD lasts after PE. What do the longitudinal studies say, and where can I find that evidence?