What is prolonged exposure therapy? Prolonged exposure therapy is a research based time-limited treatment that successfully decreases posttraumatic stress disorder symptoms in 85% of the people that under- go the treatment by more than 70%. Prolonged exposure is a cognitive-behavioral technique used to reduce the symptoms of post- traumatic stress disorder through a process of desensitizing the client to specific traumatic events.

How can prolonged exposure therapy help posttraumatic stress dis- order? Prolonged exposure therapy decreases the client’s sensitivity to internal and external triggers of historical trauma through a process called imaginal exposure that allows the client’s physiological responses to be modified over time. By decreasing avoidance and experiencing safety during the exposure process the client’s internal processes adjust to the present safe context in which the exposure is being done. This difference allows the client to have fewer and less intense triggers in the environment after a series of  imaginal exposures.

What is a typical session using prolonged exposure therapy like for a client? A typical session for a client in prolonged exposure therapy is tough, especially in the beginning. In each session the therapist will work to increase the intensity of the exposure, which often results in increased physiological symptoms during the exposure session. A session is 90 minutes long. It begins with a 15-20 minutes review of the client’s experience during the past week, especially the daily homework the client is to complete. The following 30-40 minutes are spent with the client doing the actual exposure process while the therapist monitors the client’s subjective units of distress, and physical signs of anxiety. The final 20-30 minutes are spent grounding the client in the present, discussing the client’s experience of this exposure and defining the homework for the week.

What last advice would you like to leave for someone who is coping with post traumatic stress disorder and is considering prolonged exposure therapy? Work with an experienced therapist that is trained specifically in prolonged exposure therapy.  Have an evaluation by a psychiatrist to see if medication may assist in modulating your trauma symptoms. Medication may make doing the prolonged exposure work manageable and less frightening. Timing is important in the treatment of symptoms for trauma especially if you suffer with co-morbid mental health illnesses. Realize that your symptoms will get worse before they get better, therefore some behavioral issues must be contained in order for the exposure work to be effective. If you use drugs, alcohol, or have an eating disorders or other behaviors that you use to numb or block intense emotions they will decrease the effectiveness of treatment. Therefore, consider treatment for these specific behaviors before and during pro- longed exposure therapy. If you are currently living in abusive or traumatizing environments do not undergo prolonged exposure therapy until you are living in a safe environment.

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