Prolonged Exposure Therapy for PTSD

Today is National PTSD Screening Day

Prolonged Exposure (PE) therapy is one of the gold-standard psychotherapies for PTSD. I provided PE for countless patients as part of my involvement in various NIMH/DOD clinical trials. I treated a variety of patients with different trauma histories: sexual assault, combat, adult survivors of child abuse, suicide survivors, domestic violence, injuries, medical trauma, motor vehicle accidents, etc. Although patients’ treatment responses varied, my takeaway from this rich training experience was the belief that PE is one of the many “tools” that clinicians should be well-versed in when treating clients with significant PTSD symptoms. Under the right conditions, PE can make a significant impact on PTSD symptoms, regardless of trauma type. Given that PTSD is such a chronic and debilitating condition, clinicians need to have as many tools available to them to provide trauma-informed treatment plans and recommendations.

Deeply learning PE during my formative training years provided me with invaluable clinical skills that I still access today in my work with a range of clients. Some of those skills:

✅Clinical resilience to hear painful traumatic material

✅Clinical courage to motivate and support clients to make contact with uncomfortable emotions and memories so they can be processed and filed away, rather than responded to with avoidance, denial, and repression.

✅ Clinical discipline to stay focused and targeted in delivering a protocol so that ingrained avoidance behaviors are not reinforced

✅ Deep understanding of the difference between "actual" traumatic events and trauma-related thoughts, feelings, memories, and sensations that are often (inconveniently) activated when survivors go about their daily lives.

📢 I recommend all aspiring psychotherapists pursue training exposure therapy (PE, ERP for OCD, interoceptive exposure for Panic Disorder). The skills will translate/generalize to your work as a psychotherapist even if you decide not to specialize in exposure therapy.

Although I deliver PE less often in private practice, the fundamentals of exposure therapy broadly informs much of my clinical work. Effective psychotherapy, at its core, creates new, adaptive beliefs and behaviors that have the power to overshadow maladaptive ones. Effective psychotherapy helps people to create lives worth living by increasing their willingness to engage in behaviors that align with their chosen values EVEN IN THE PRESENCE of distressing thoughts, feelings, sensations and memories. Clinicians who have experience providing exposure therapy have phenomenal abilities to motivate clients to do hard things and Stop Avoiding Stuff: 25 Microskills to Face Your Fears and Do It Anyway.

Knowing how to conduct exposure therapy, and understanding the rationale for it, has been one of my superpowers as a clinician!

Watch this Dateline Video which shows Prolonged Exposure Therapy in action. PE creator, Edna Foa, is also interviewed.

***Be forewarned that this video shows a sexual assault survivor recounting details of her trauma***

PE is an emotionally evocative therapy for both the client and the therapist. PE does NOT involve talking passively about traumatic experiences. PE involves engaging with traumatic memory material in a prolonged and specific way. PE follows a specific, 4-12 session (120 minutes/session) protocol that involves regular imaginal exposure and in-vivo exposure practice (both in-session and between-session homework).

Because of its intense nature, many clinicians and clients are hesitant to receive and provide PE. They express concern that PE re-traumatizes survivors. What I’ve seen in my clinical practice, is that PE can work wonders on PTSD symptoms for patients who are motivated, adherent, and have good enough systemic and social support. On the whole, the short-term discomfort of the treatment is worth the deep, long-lasting change it often provides trauma survivors.

In response to concerns over the PE potentially retraumatizing patients, Blanche Freund gives a poignant response in the Dateline video.

💜 "I wouldn't call it cruel. We're encouraging them to experience what's in their memory that they've effectively pushed down. We're not creating any monsters. They already have those monsters there." - Blache Freund, PhD

If you are curious about PE or other treatments for PTSD check out resources at the NATIONAL CENTER FOR PTSD.

Trauma treatments are most effective for patients who meet the criteria for PTSD. The National Center for PTSD provides a quick, 5-question screening tool.

A screening tool is a great way to determine if further assessment is warranted. If you screen positive, seek out a healthcare provider who specializes in trauma to receive a more comprehensive assessment.

It is important to note that experiencing a traumatic event does NOT equal PTSD. Most people experience traumatic events throughout their lifetimes. Fortunately, natural recovery is the norm at about 3-months post-trauma exposure. The ones who are at risk for developing PTSD, are those who develop ingrained habits of "pushing the memory away," isolating, and disengaging from activities that could provide corrective learning.

PE is an excellent treatment for people with PTSD who struggle with ingrained behavioral and emotional avoidance as their primary BUT ultimately ineffective coping strategy for dealing with trauma-related memories and reminders.

For more reading on PTSD and Trauma check out the Library Page on my company’s website, PsychInsideOut.Com