For many of those with a history of trauma or a PTSD diagnosis, more traditional talk therapies may not be the most ideal therapy treatment, and Prolonged Exposure (PE) Therapy has been developed as an evidence-based treatment to address PTSD and reactions to trauma.
Common Reactions to Trauma
Avoidance behaviors describe the behaviors which seek to avoid internal and external reminders of the trauma. For example, an individual who experienced a traumatic response to a car accident may avoid driving and take public transit to reduce their distress when traveling to work. While avoidance behaviors help in the short-term because they typically alleviate distress, they can create unintended long-term consequences by continuing to send the signal to a person’s nervous system that “uncomfortable” is the same as “bad” or “dangerous” and can erode distress tolerance.
Trauma-related beliefs are beliefs that an individual develops after trauma to assign emotional meaning to the trauma, which can negatively impact a person’s view of themselves, the trauma, and the world around them. For example, a person who experienced a trauma involving a physical assault by a stranger may develop a trauma-related belief after the event that “the world is not safe.” While this belief is not necessarily untrue, it can be considered an unhelpful belief, as it can significantly impact this person’s willingness to engage with the outside world.
What is Prolonged Exposure (PE) Therapy?
Prolonged Exposure (PE) therapy is a specialized, evidence-based therapy designed to treat trauma and Post-Traumatic Stress Disorder (PTSD). PE therapy operates by the belief that avoidance behaviors and trauma-related beliefs both perpetuate PTSD symptoms. The therapy encourages the individual to confront the previously avoided experiences in a safe environment so the individual can process the trauma and regain distress tolerance to everyday stimuli.
The treatment consists of the tools used in the therapy sessions, and the homework exercises which are completed between sessions. In the therapy sessions, the individual receives a lot of psychoeducation on PTSD and how avoidance perpetuates symptoms of PTSD. Additionally, the individual will complete imaginal exposures in the therapy sessions, which consist of repeatedly revising and retelling the traumatic memory in detail to process the emotions related to the trauma and reduce distress levels over time. Finally, the individual and the therapist will process the individual’s reaction to each imaginal exposure in each therapy session to develop insights into the trauma and challenge trauma-related beliefs.
Outside of the therapy sessions, the individual will be completing in vivo (“in life”) exposures which involve confronting real-life situations or activities which the individual has been avoiding since the trauma. Examples could include crowded spaces, driving, watching TV shows or movies involving themes like the individual’s trauma, or writing a letter to a perpetrator.
Why is PE Therapy Effective?
PE therapy was developed to address specific areas of trauma response and PTSD which can cause the most distress for an individual:
- Direct confrontation of the trauma through structured exposure allows the individual to emotionally process the trauma for deeper insight and challenges the individual’s desire to suppress or avoid their feelings about the trauma, which can perpetuate trauma response symptoms.
- Breaking the cycle of avoidance is central to PE therapy as avoidance is one of the main mechanisms that maintains PTSD symptoms. By repeatedly confronting and addressing the avoided thoughts, feelings, and situations (a process called habituation), PE works to desensitize the response to trauma triggers.
- Reducing fear and anxiety by rebuilding an individual’s confidence and self-trust after the trauma. The repeated exposure to the trauma memory and the avoided thoughts and situations teaches the brain that the traumatic memory and these everyday situations are not inherently dangerous (this process is referred to as extinction learning).
Who Could Benefit from Prolonged Exposure (PE) Therapy?
- People with unresolved trauma
If you have tried other forms of talk therapy, and you continue to feel distressed by a previous trauma, a more intensive and targeted form of treatment such as PE may be the right fit.
- People with specific trauma memories/acute trauma
PE therapy is used on one specific trauma memory for each course of treatment (anywhere from 8-15 sessions), so those with acute trauma or those who continue to experience intrusive thoughts or memories about a specific trauma may benefit from PE therapy. PE therapy may not be as effective for those with a long history of trauma, developmental/complex trauma from early life, or those who do would want more flexibility in the structure of their treatment.
- Individuals looking for quicker results
Traditional talk therapy may span over months or years of weekly therapy, and PE therapy was designed to address this common frustration for many individuals. A course of PE therapy can be completed within 8-15 sessions, with many individuals noticing relief within 2-3 months of treatment.
Conclusion
After reading this article, you may have some questions about PE therapy. For my clients who are curious about PE therapy, I typically discuss the difference between readiness and willingness – rarely (if ever) can a person say that they are “ready” to talk about the horrific details of their trauma history. For many people, the memory of trauma has been haunting them daily, and they are ready to move forward and feel hope for their future. I like to refer to the evidence supporting PE therapy as a treatment for trauma and PTSD, and ask my clients if they can give themselves permission to say “I may not be ready to talk about this, but I am willing to explore this process because I want to reconnect with myself, my body, and my life.” Remember that no matter how distressing the emotional and physical symptoms of trauma response may be, they are stemming from an event you have already survived, which only highlights how strong and resilient you truly are.
For additional questions or information please reach out to us at hello@thebtrc.com or give our office a call at 425-616-1261.