Prolonged Exposure Therapy

What is Prolonged Exposure Therapy ?

Prolonged exposure is a specific exposure therapy program that has been the subject of considerable research in the treatment of PTSD. PE is comprised of three main components: first, in vivo exposure to trauma reminders, typically as homework; second, imaginal exposure to the memory of the traumatic event, both in session and as homework; and third, processing of imaginal exposure, as well as two minor components: psychoeducation about the nature of trauma and trauma reactions, including a clear rationale for the use of exposure therapy, and training in controlled breathing.

McLean, C. P., & Foa, E. B. (2011). Prolonged exposure therapy for post-traumatic stress disorder: A review of evidence and dissemination. Expert Review of Neurotherapeutics, 11(8), 1151–1163. https://doi.org/10.1586/ern.11.94

When is Prolonged Exposure Therapy Not Recommended?

Prolonged Exposure (PE) Therapy may not be recommended in the following situations:

Active suicidal ideation or self-harm risk: Individuals in acute crisis may require stabilization before engaging in trauma-focused therapy.

Severe dissociation: Those with significant dissociative symptoms may struggle to engage in or benefit from the exposure process.

Untreated substance use disorders: Co-occurring substance abuse may interfere with therapy effectiveness.

Unstable medical or psychiatric conditions: Individuals with uncontrolled medical issues or severe mental health disorders (e.g., active psychosis) may not be suitable candidates.

Lack of readiness or consent: Clients who are unwilling or unable to engage in the structured, trauma-focused nature of PE therapy may benefit from alternative approaches.

What is the Difference Between Prolonged Exposure Therapy and EMDR?

The difference between Prolonged Exposure Therapy and EMDR lies in their methods and focus:

Prolonged Exposure Therapy (PE):

Focus: Helps clients process trauma by gradually exposing them to memories, feelings, or situations they have avoided due to fear.

Method: Involves imaginal exposure (revisiting the trauma memory in a safe setting) and in vivo exposure (gradual confrontation of real-life triggers).

Goal: Reduce fear and avoidance through desensitization, allowing the trauma memory to feel less distressing over time.

Eye Movement Desensitization and Reprocessing (EMDR):

Focus: Aims to reprocess traumatic memories and reduce their emotional impact by integrating them into the brain's adaptive memory networks.

Method: Uses bilateral stimulation (e.g., guided eye movements, tapping) while the client recalls distressing memories, facilitating cognitive and emotional shifts.

Goal: Resolve unprocessed memories and foster a sense of resolution and empowerment.

Both approaches are evidence-based treatments for trauma but differ in their structure, techniques, and theoretical underpinnings.