Prolonged Exposure Therapy for Chronic PTSD
What is Prolonged Exposure therapy?
Prolonged Exposure (PE) is one of three primary evidence-based practices used specifically for Post Traumatic Stress Disorder (PTSD). It is similar to EMDR and Cognitive Processing Therapy (CPT) in terms of emotional processing the trauma, but differs in the approach to address the situation, memories, thoughts and feelings related to traumatic experiences. This therapy includes 2 types of exposures: imaginal (revisiting the experience) and in vivo (exposure in “real life”). Trauma events can include but not limited to; sudden death of loved one, chronic child sexual/physical abuse, war, refugee, suicide, homicide, natural disaster, etc.
Common issues Prolonged Exposure therapy can treat
Not every trauma survivor needs PE, as studies have shown that many people spontaneously recover from traumatic experiences. This treatment is targeted to those who are 3 months post the trauma event to allow for normal symptom attenuation, and will be assessed to see if this treatment is appropriate.
If appropriate the following PTSD symptoms can be treated by Prolonged Exposure:
Mood disorders
High levels of shame and anger
Alcohol and drug use
Persistent, invasive and unwanted memories of the event
Prolonged Exposure will not be initiated if the following are present, as these symptoms need to be addressed first:
Suicidal/homicidal ideation
Serious self injurious behaviour
Psychosis
High risk of being assaulted
Dissociative symptoms
Lack of clear memory or insufficient memory of trauma event
Acute stress disorder or trauma related stressors/symptoms that are not PTSD. In this case, other therapies such as Trauma-Focused Cognitive Behavioural Therapy may be used.
How can Prolonged Exposure therapy help me?
PE focuses on the fears that you are experiencing and on the problems coping of which are directly related to trauma experiences. People cope in two ways: avoidance of people, places and situations that cause distress and are a reminder of the event and second, pushing away images and feelings surrounding the event. Avoidance helps in the short term, but actually maintains post-trauma problems.
Prolonged Exposure encourages you to face these thoughts and situations as a way to help you deal with them. There are two types of exposure:
Imaginal: You will revisit the the trauma experience and recount it aloud (only one event is processed at a time). The goal is to help you process that memory by asking you to revisit it several times (up to 45 minutes) in your mind and told out loud to the therapist. Studies have shown that prolonged exposure to memory is effective in reducing trauma-related symptoms and helps you think differently. Many people think that revisiting the memory will be re-traumatizing, this is incorrect. The event already happened. The therapist will not create an unsafe place for the same event to happen in real time. This would be harmful and unethical. We are only addressing the memory you have of it. There is no harm addressing memories, anxiety provoking, yes, but studies show anxiety decreases as a result of repeated exposure to the memories.
In vivo: The therapist will ask you to approach situations that you have been avoiding in real life directly or indirectly as they are reminders of the trauma (example: walking alone at night, males with long hair, driving a car). This exposure reduces excessive fears and avoidance after trauma events. If you avoid objectively safe situations, you don't give yourself time to get over your fear of those situations.
How quickly does Prolonged Exposure therapy work?
PE is a direct and stand alone approach for chronic PTSD and accompanying symptoms. Treatment can range from 10 to 12 90-minute sessions to 15 90-minute sessions. Ideally you will meet with a therapist once a week, with therapy completed in 2-3 months.
Each client is case by case as trauma experiences, severity of symptoms, and presence of other concurrent symptoms differs in individuals.
Psychologists who offer Prolonged Exposure therapy
Many of our therapists in Edmonton have received training in PE and can offer therapy based in this modality. If you’d like to book an appointment or learn more about Prolonged Exposure Therapy, please contact us today.