Prolonged exposure therapy gives a person repeated exposure to their triggers in a safe setting. This may help the individual manage their response to previously traumatic stimuli and events.
Post-traumatic stress disorder (PTSD) is a mental health condition that may develop after a person experiences a traumatic event. This may result in long-term effects on their mental and physical health.
Prolonged exposure therapy aims to present a person with their trigger throughout sessions over time. A therapist works to help a person change their response and treat their PTSD.
In fact, this type of therapy is very effective in treating PTSD. It has very little risk, though some people may experience mild to moderate discomfort as a result of the trauma.
This article looks at what prolonged exposure therapy is for PTSD and what it involves, plus outlines the benefits and risks, success rates, and PTSD support available.
Prolonged exposure is a specific type of cognitive behavioral therapy (CBT) that helps individuals approach the triggers that cause their traumatic memories and feelings over time.
This therapy aims to decrease PTSD symptoms over time as someone begins to face these events or feelings.
Treatments usually consist of 8 to 16 weekly sessions that last for 1 hour each. Research has shown this treatment duration to be successful in clinical trials.
What is PTSD?
PTSD is a mental health condition that can occur after a person experiences or witnesses a traumatic event.
According to the Department of Veterans Affairs (VA), symptoms usually start soon after the traumatic event. However, some people may develop them only months or years later.
The VA provides four types of symptoms people may experience. For someone to receive a diagnosis of PTSD, they need to have each type.
The types of PTSD symptoms include:
- repeatedly experiencing symptoms, which may cause:
- nightmares
- flashbacks
- avoiding reminders of the event, such as:
- not entering crowds if a person feels they are dangerous
- not driving if they were in an accident
- experiencing more negative feelings than before the event, including:
- forgetting parts of the event
- feeling guilty or ashamed about the event
- feeling on edge, referred to as hyperarousal, which may cause:
- shock or reaction to loud noises
- habits such as misusing drugs or alcohol
Learn more about PTSD.
Prolonged exposure therapy usually starts with the therapist providing an overview of treatment and asking the person about their past experiences. They will also encourage the individual to use to manage any anxiety.
After the initial assessment, the exposure begins. This causes anxiety for most people, so therapists aim to reassure the person they are in a safe space for encountering potentially traumatic stimuli.
Different types of exposure include:
Imaginal exposure
The American Psychiatric Association (APA) suggests this type of exposure involves a person detailing the event in the present tense, with support and guidance from the therapist. They will discuss and process any emotion caused by the exposure.
The therapist records the session so the client can watch it back between sessions. This allows the client to process any emotions further and practice breathing techniques.
In vivo exposure
In vivo exposure is when a therapist and person work together to identify possible stimuli and situations associated with the traumatic fear, such as people or places. They will then confront their feared or traumatic stimuli (in vivo exposure) at home, outside of their therapy session.
Therapists encourage people to confront the exposure gradually to overcome the fear and manage the associated emotions.
Interoceptive exposure
Interoceptive exposure alters an individual’s interoceptive sensitivity. This refers to the response to stimuli produced within a person’s body.
Interoceptive exposure aims to increase a person’s tolerance for somatic sensations (including touch and temperature) by reducing the distress related to physical sensations.
According to the VA, trauma-focused psychotherapy, such as prolonged exposure, is one of the most effective treatments for PTSD.
The research suggests if a person confronts the details of the trauma, they will have fewer unwanted memories at other times. It concludes that most people who complete prolonged exposure therapy find that the benefits outweigh any initial discomfort caused by the therapy.
The results also indicated that prolonged exposure therapy was effective in reducing depression, even though depression was not a direct target of the treatment.
In addition,
- with multiple interpersonal trauma
- who had multiple previous treatment attempts
- chronic PTSD
The VA suggests that the risks of prolonged exposure therapy include mild to moderate discomfort when engaging in new activities and when talking about trauma-related memories.
Research from 2019 showed that, as prolonged exposure therapy exposes people to traumatic memories, individuals may experience pain and relapse of PTSD symptoms, especially in cases where a person’s life may still have stress factors relating to PTSD.
However, technological advances have made it easier to implement CBT, even in challenging circumstances.
According to 2022 research, prolonged exposure therapy response rates range from
The treatment response rates showed that 46% to 60% achieved recovery for PTSD symptoms and that 44% to 48% no longer met diagnostic criteria for PTSD.
People may benefit from additional support and accessible treatment options. Doctors or mental health professionals can advise on the best resources available. This could include support from helplines, groups, and peers.
In addition to treatment, many people with PTSD may find it helpful to share memories and feelings with others who have similar experiences, such as in a peer support group.
Helplines or hotlines offer immediate support for people with PTSD and other mental health conditions, such as:
- The Crisis Text Line: This helpline is for people experiencing a PTSD flashback and connects someone with a trained crisis counselor through the Crisis Text Line by texting CONNECT to 741741.
- The 988 Lifeline: The 988 hotline helps with mental health distress and difficulties related to PTSD.
- The National Suicide Prevention Lifeline: This group supports people experiencing suicidal thoughts at 800-273-TALK (8255).
In-person or online support groups are available through the following organizations and groups:
- The Anxiety & Depression Association of America
- The National Alliance on Mental Health
- The National Center for PTSD
- CPTSD Safe Group
- The Health Resources & Services Administration
- HealthCare.gov
- ClinicalTrials.gov
- The Gavin Farrell Foundation
- The Open Path Psychotherapy Directive
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
Read more about PTSD support.
Prolonged exposure is a type of CBT that helps individuals approach traumatic memories and feelings in a safe setting.
Different types of exposure include imaginal exposure, which details the event in the present tense with support from the therapist. In vivo exposure involves people confronting feared or traumatic stimuli at home outside of their therapy session. Interoceptive exposure aims to increase a person’s tolerance for somatic sensations.
Trauma-focused psychotherapy, such as prolonged exposure, is one of the most effective PTSD treatments. This has also been used for war veterans.
Although people may experience mild to moderate discomfort and there is a potential risk of relapse, the success rates of prolonged exposure therapy are up to 80%.
A person can speak with a mental health professional for advice on managing symptoms and the best treatment. Groups and organizations offer support helplines and guidance from trained clinicians. These include the 988 Lifeline and the National Center for PTSD.