Prolonged Exposure Therapy
After a traumatic event, many
individuals experience distress and symptoms of posttraumatic
stress disorder (PTSD). This distress may be highest when
dealing with memories, thoughts, feelings, and situations
that are related to the trauma. Exposure therapy is a type
of therapy that helps you decrease distress about your trauma.
This therapy works by helping you approach trauma-related
thoughts, feelings, and situations that you have been avoiding
due to the distress they cause. Repeated exposure to these
thoughts, feelings, and situations helps reduce the power
they have to cause distress.
Prolonged
Exposure (PE) is one exposure therapy that works for many
people who have experienced trauma. It has four main parts:
Education: PE starts with education about
the treatment. You will learn as well about common trauma
reactions and PTSD. Education allows you to learn more about
your symptoms. It also helps you understand the goals of the
treatment. This education provides the basis for the next
sessions.
Breathing: Breathing retraining is a skill
that helps you relax. When people become anxious or scared,
their breathing often changes. Learning how to control your
breathing can help in the short-term to manage immediate distress.
Real world practice: Exposure practice with
real-world situations is called in vivo exposure. You practice
approaching situations that are safe but which you may have
been avoiding because they are related to the trauma. An example
would be a Veteran who avoids driving since he experienced
a roadside bomb while deployed. In the same way, a sexual
trauma survivor may avoid getting close to others. This type
of exposure practice helps your trauma-related distress to
lessen over time. When distress goes down, you can gain more
control over your life.
Talking through the trauma: Talking about
your trauma memory over and over with your therapist is called
imaginal exposure. Talking through the trauma will help you
get more control of your thoughts and feelings about the trauma.
You will learn that you do not have to be afraid of your memories.
This may be hard at first and it might seem strange to think
about stressful things on purpose. Many people feel better
over time, though, as they do this. Talking through the trauma
helps you make sense of what happened and have fewer negative
thoughts about the trauma.
With the help of your therapist, you can change how you react
to stressful memories. In PE, you work with your therapist
to approach trauma-related situations and memories at a comfortable
pace. Usually, you start with things that are less distressing
and move towards things that are more distressing. A round
of PE therapy most often involves meeting alone with a therapist
for about 8 to 15 sessions. Most therapy sessions last 90
minutes.
With
time and practice, you will be able to see that you can master
stressful situations. The goal is that YOU, not your memories,
can control what you do in your life and how you feel. Therapy
helps you to get your life back after you have been through
a trauma.
PE therapy for Veterans
PE
has been shown to be one of the most effective treatments
for PTSD. For this reason, the VA's Office of Mental Health
Services has rolled out a national PE training program. VA
providers throughout the country will be trained in how to
use PE treatment. The providers will at first be supervised
as they use these treatments in actual cases. Then they will
be asked to use PE in their routine clinical care. Others
will be selected and trained as consultants.
See this video describing how In-Context
Exposure Therapy Helps Bring Closure to Veterans.
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