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   Prolonged Exposure Therapy for Chronic PTSD (PE)

Prolonged Exposure Therapy

Prolonged Exposure Therapy (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 that prolonged exposure Therapy can treat

Not every trauma survivor needs PE, as studies have shown that many people spontaneously recover from traumatic experiences. Therefore 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 PE:

  • PTSD
  • Depression
  • Chronic anxiety
  • Mood disorders
  • High levels of shame and/or anger
  • Alcohol/drug use
  • Persistent, invasive and unwanted memories of the event

PE will not be initiated if the following are present as these symptoms will have 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 CBT for trauma 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.

PE 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. Sessions range from 10-12, 90 minute sessions to a total of 15 sessions. Ideally you will meet with a therapist once a week. Therapy will be completed in 2-3 months. Each client is case by case as trauma experiences tend to differ, severity of symptoms and presence of other concurrent symptoms.


Scarlett Eyben – PE trained since September 2016 and continues to use this therapy.