Prolonged exposure therapy

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat posttraumatic stress disorder.

About Prolonged Exposure Therapy
Prolonged Exposure Therapy (PE) is a theoretically-based and highly efficacious treatment for chronic Post Traumatic Stress Disorder (PTSD) and related depression, anxiety, and anger. Based on basic behavioral principles, it is empirically validated, with more than 20 years of research supporting its use. 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 about 80% of patients with chronic PTSD. .

Prolonged exposure therapy was developed by Edna B Foa, Ph.D., Director of the Center for the Treatment and Study of Anxiety. Practitioners throughout the United States and many foreign 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 suffering from co-occurring PTSD and substance abuse when combined with substance abuse treatment.

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 client's ability to cope with courage rather than fearfulness when facing stress, and improves their 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.

Source: Center for the Treatment and Study of Anxiety: About Prolonged Exposure Therapy

Components
PE treatment commonly has two components. The first is imaginal exposure which typically occurs during the therapy session and consists of reliving the trauma. The second is in vivo exposure in which the clinician works with the client to establish a fear and avoidance hierarchy and typically assigns exposures to these list items as homework progressively. Both components are designed to elicit emotional processing so that the problematic traumatic memories and avoidances habituate (desensitize).

Research Information
Prolonged exposure is an effective treatment for PTSD in female veterans and active-duty military personnel. It is feasible to implement prolonged exposure across a range of clinical settings. The committee reviewed 53 studies of pharmaceuticals and 37 studies of psychotherapies used in PTSD treatment and concluded that because of shortcomings in many of the studies, there is not enough reliable evidence to draw conclusions about the effectiveness of most treatments. There are sufficient data to conclude that exposure therapies -- such as exposing individuals to a real or surrogate threat in a safe environment to help them overcome their fears -- are effective in treating people with PTSD. But the committee emphasized that its findings should not be misread to suggest that any PTSD treatment ought to be discontinued or that only exposure therapies should be used to treat PTSD.
 * Prolonged Exposure Therapy for PTSD: Emotional Processing of Traumatic Experiences, Therapist Guide by Edna B. Foa, Elizabeth A. Hembree, Barbara Olasov Rothbaum, March 2007, Oxford University Press, "Treatments that work".
 * Reclaiming Your Life From a Traumatic Experience, Workbook, Barbara Olasov Rothbaum, Edna B. Foa, Elizabeth A. Hembree, March 2007, Oxford University Press, "Treatments that work".
 * Prolonged Exposure Therapy for Posttraumatic Stress Disorders SAMHSA Model Programs.
 * Center for the Treatment and Study of Anxiety, University of Pennsylvania Edna B. Foa, Ph.D., Director.
 * Beyond the manual: The insider's guide to Prolonged Exposure therapy for PTSD EA Hembree, SAM Rauch and EB Foa. Cognitive and Behavioral Practice (2003) 10:22-30.
 * Cognitive Behavioral Therapy for Posttraumatic Stress Disorder in Women: A Randomized Controlled Trial, Paula P. Schnurr, Matthew J. Friedman, Charles C. Engel, Edna B. Foa, et al., Journal of the American Medical Association, February 28, 2007; 297: 820 - 830.
 * Treatment of PTSD: An Assessment of The Evidence, Institute of Medicine, October 17, 2007.